PEP contributing to a reduction in HIV incidence

1
PEP contributing to a reduction in HIV incidence

• Will Nutland Terrence Higgins Trust, London,
  England
• www.chapsonline.org.uk/pep
• www.tht.org.uk
• August 2006

2
The challenges for this discussion

• For many countries, PEP is old hat
• For very many others, PEP is a luxury way down
  on priority list
• The issue of HEALTH PROMOTION vs HIV PREVENTION
  what can we learn about mobilising for change?

3
Conflict and opinion pre 2003

• PEP is available in SOME places to SOME men and
  knowledge of PEP is not equally disseminated
  amongst gay men
• There is conflicting advice and information on
  PEP, its availability and its prescription
• We know there are examples of
• men being treated badly when asking for PEP
• men being passed from place to place when trying
  to access PEP
• increasing activism around the non-availability
  of PEP
• Continued

4
Conflict and opinion

• men who didnt know about PEP can feel cheated
  when they find out its available
• It sounds like something I might be quite
  skeptical (sic) about..it strikes me as a
  gimmick.I mean if there really was something out
  there that could stop you getting HIV I would
  know about it by now (CHAPS PEP Formative
  Evaluation Report, March 2004)
• UK is viewed as out of synch with several
  countries already publicising PEP to gay men,
  inc. Australia, France and the USA

5
Making it count - III

• Sufficient numbers of uninfected men are aware of
  their potential exposure to warrant making PEP
  more widely available
• DoH guidance updated in 2000 acknowledges
  potential value for Post Exposure Prophylaxis
  following sexual exposure (PEPSE)
• Development of UK guidelines for the use of PEP
  for HIV following sexual exposure (BASHH
  guidelines)

6
Making it count - III

• Strategic HAM aim 4
• Increase the proportion of HIV uninfected men who
  are sexually exposed to HIV who take
  post-exposure prophylaxis within 72 hours of
  exposure
• Strategic service aim 7
• An increase at NHS services in the availability
  of post-exposure prophylaxis (PEP) to men
  sexually exposed to HIV

7
Gay Mens Sex Survey 2003

• 12,525 men in England
• 21.2 know about PEP
• Of these
• 3.1 had tried to get it
• 2.1 report taking it
• 22.9 know someone who has taken it

8
Gay Mens Sex Survey 2003

• When asked if they would consider trying to get
  PEP if they thought they had been exposed to HIV,
  men replied
• Yes 70.8
• Maybe 27.2
• No 2.0
• Men with high levels of education were almost 3
  times more likely to know about PEP than men with
  low levels

9
What did we do?

• Created consensus expert think tank seminar
• Extensive lobbying and campaigning
• Undertook a direct contact programme for gay men
• Built the capacity of our sectors
• Evaluated the interventions
• Created an evidence base

10
Expert Think Tank Seminars

• Provide opportunities for discussion and debate
  within and outside of the gay mens health sector
• Seminars are highly focused, with emphasis placed
  on developing current thinking and practice, and
  influencing policy and research
• PEP ETTS (December 2003) - outcomes inc
• Important that CBOs both sell and advocate for
  the BASHH guidelines
• PEPSE sector summary report (published March
  2004)
• Mass and small media interventions for CHAPS
  programme on PEP (July 2004)
• Telephone and online based information provision

11
Extensive period of lobbying

• Commissioners of HIV services
• Providers of HIV services
• Government lobbying
• Convincing the medical establishment

12
CHAPS PEP Programme - key development areas

• Mass and small media
• www.chapsonline.org.uk
• Sector Development tools
• PEP training seminar
• PEP Programme Implementation Pack
• Issue and Issue Online
• PEP following sexual exposure sector summary
  report

13
PEP poster
14
Online materials for gay men

• The online self-assessment
• Basic information about PEP
• A download of the small resource
• Support information for men on PEP and how to
  stay safe from HIV after taking PEP
• A PEP diary outlining mens first-hand
  experiences of taking PEP
• Information on making PEP available in your area

15
Online materials for health professionals

• PDF downloads of the PEP programme implementation
  pack and the PEP sector summary report
• Training seminar

16
Sector Development tools

• PEP Programme Implementation Pack
• Establishing PEP availability locally
• Summary of BASHH guidelines
• CHAPS PEP Programme - FAQs
• PEP sector summary report
• PEP programme training seminar

17
Hickson et al., 2006 Change
18
Dodds Hammond, 2006 Method

• 30 men recruited from the GMSS 2005 online sample
  (broadly representative of 253 who said they had
  tried to access PEP)
• 45 minute telephone interview
• risk incident - clinical experience
• finding out about PEP - assessment of
• accessing PEP experience
• Implications for future risk

19
What changed?

• Mens knowledge increased
• Number of men seeking PEP increased
• Our sectors increased their knowledge and
  capacity
• CMO stipulated PEP should be part of local HIV
  prevention strategies

20
Learning to share

• Health promotion vs HIV prevention
  re-invigorating our role as activists
• The long, slow ride of bringing people along with
  us
• Behind the scenes lobbying and solution finding
  paid off bullying didnt
• Learning the lessons from our colleagues across
  the world
• The key role of early innovators