Written Statement: PrEP and Sexual Health in Wales

It has been two years since the Welsh Government took the decision to make Pre-Exposure Prophylaxis (PrEP) routinely available for people at risk of HIV through a three-year monitoring study. In the two years following that decision we have been closely monitoring the availability and use of PrEP. I am delighted it is now fully embedded within and routinely available from sexual health services across Wales.  Over 1,000 people have accessed PrEP since July 2017 and I’m pleased to say that no one in this cohort has contracted HIV whilst receiving PrEP.

I am proud that all those for whom PrEP is clinically indicated are able to access it in Wales.  That said, around 24% of those attending sexual health services who are eligible for PrEP decline it; the reasons for this are complex.  Public Health Wales and Cardiff University are now conducting research to better understand why some people decline the offer of PrEP.  I look forward to seeing the findings of this work when they are available and considering what further action we can take to protect people at risk from HIV.

The latest data shows that 17% of people attending sexual health services who are eligible for PrEP were not previously known to the service. This means we have had the opportunity to test people for HIV and sexually transmitted infections (STIs) who may otherwise have gone untested and undiagnosed. At least eight people have been diagnosed with HIV by the baseline tests conducted before any patient is able to receive PrEP. Finding these cases allows us to offer affected individuals effective treatment which improves their lives and reduces the risk of transmission to others. As our study continues, sexual health services will work with Public Heath Wales to get a clear understanding of the acceptability and pattern of use of PrEP and to adapt service provision to ensure it meets the needs of the client group.

Tests have also identified 380 episodes of STIs amongst those taking PrEP. This includes 176 cases of gonorrhoea and 34 cases of syphilis. In the last decade, there has been an increase in gonorrhoea and syphilis diagnoses in Wales reflecting the general increase in these STIs across the UK. This increase has been more pronounced since 2016. Infections are most common amongst young people and men who have sex with men (MSM). Between 2016 and 2018 there was a 79% increase in cases of syphilis (from 138 to 247) and a 47% increase in gonorrhoea diagnoses (from 956 to 1,402).  

Any change in the pattern of STIs is of concern particularly given the emergence of antibiotic resistant gonococcal infections, but we have not as yet seen this in Wales. The Chief Medical Officer has asked Public Health Wales to consider what more needs to be done to minimise the risks posed by these infections. A number of recommendations have been put forward and they will be considered at the next meeting of the Sexual Health Programme Board in the autumn.

To take forward one of the recommendations from Public Health Wales’ recent sexual health review, I announced in September 2018 that the Welsh Government would fund a six-month pilot for online STI testing in the Hywel Dda health board area. I am pleased to say that the pilot has been successful and positively received by service users. The percentage of people testing positive for chlamydia in those who used the online testing service is comparable to that found amongst sexual health clinic attenders. This demonstrates that online testing provides a valuable service for patients who may not otherwise attend sexual health services. I have therefore approved funding for the pilot to be extended for a further six months in order that a robust evaluation can be undertaken. I have also agreed to fund a pilot for self-testing for chlamydia, gonorrhoea and syphilis in Welsh prisons. The pilot will be conducted by Public Health Wales, working with prison health care. It is anticipated that this will increase capacity of sexual health services in prisons; improving access to services for the prison population; and helping to raise the standard of prison services to that available to the general population. Both of these pilots will provide valuable insight into the acceptability and practicalities of online and self-testing and will help inform future developments in sexual health service provision in Wales.