PrEP and Women in Scotland Roundtable: A Community Report

The newly released report on the first year of the implementation of HIV Pre-exposure prophylaxis (PrEP) in Scotland marks a significant public health achievement. NHS Scotland was amongst the first wave of publicly-funded health systems to offer PrEP, a radical new HIV prevention tool, through NHS sexual health clinics from July 2017. At a time when debates continue to be held in other countries (including England) about if and how PrEP should be offered, Scotland has provided PrEP to nearly 1900 people in the first year of its availability with no additional funds. What is also noteworthy is that 99% of those prescribed PrEP in Scotland were gay, bisexual and or men who have sex with men (MSM). A significant and welcome prevention tool for a community that has long been affected by HIV, access to PrEP for others affected by HIV - women, trans communities, people from migrant African communities, and people who use drugs – is limited. Thus, although PrEP has been shown to work in all bodies – men, women, cis, and trans – it continues to only be available to some.

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Work from my CSO-funded postdoctoral fellowship Developing HIV Literacy has sought to understand not only how PrEP – a radically new HIV prevention pharmaceutical technology – could be supported outside of a clinical context, but if and how PrEP might be translated within and across diverse communities. This means paying attention to communities for whom PrEP might be beneficial, but where awareness, understanding, access and use are constrained; shaped by social, cultural, clinical and socio-economic barriers. In other words, we need to pay attention to the specificities of different bodies, genders, identities, communities, and their social and sexual practices, as they navigate public health systems and negotiate these new biotechnologies.

In collaboration with Josina Calliste, PrEPster’s Strategic Lead for Women, and HIV Scotland, as part of the ongoing Developing HIV Literacy project, we ran a PrEP and Women in Scotland Roundtable  in September 2018. This roundtable sought to understand better how women might be able to access PrEP, to recognize the diversity of women and to engage with the specific needs of different groups of women, in order to begin to imagine PrEP pathways that are accessible and acceptable to these women. Roundtable participants came from across the sector including those who work with: Black, Asian and Minority Ethnic (BAME) women, women who sell sex, women who use drugs and trans communities. Organisations included Waverley Care, Hwupenyu Project, Umbrella Lane, Scottish Trans Alliance, Terrence Higgins Trust Scotland, Scottish Drugs Forum, and NHS Greater Glasgow and Clyde, as well as researchers from the University of Edinburgh, Glasgow Caledonian University and the University of Chicago.

This community report documents roundtable discussions. It describes existing research, shared knowledge and experience, and outlines both existing problems and potential solutions which emerged from our discussions. The report reflects the first of hopefully many collaborative endeavours across research, community and clinical stakeholders to ensure that PrEP – and HIV prevention more widely – can be made available to all who need it, in Scotland and beyond.

Dr Ingrid Young is a Chancellor's Fellow at the Centre for Biomedicine, Self and Society