Young people are underrepresented in England’s PrEP rollout

Data from England’s first large implementation trial of HIV Pre-Exposure Prophylaxis (PrEP) study, IMPACT, was presented at the British HIV Association (BHIVA) and British Association of Sexual Health and HIV (BASHH) join conference last week – data which revealed that young people were unrepresented in the trial when compared to their older counterparts.

The trial’s Principal Investigator, Dr Ann Sullivan of Chelsea & Westminster Hospital, identified clear inequalities in access to prevention healthcare for young people, even when accounting for different risk groups and ethnicities.

The results suggested that young people aged 16-25 were underrepresented in terms of their risk of contracting HIV compared to older people.

"Only 8% of those enrolled were in the two youngest age groups, compared with 16% in the older two," - from the study.

This is still preliminary data, however, in forthcoming analyses the team will explore each infection amongst trial participants and the cause/reason for them to have occurred. More data will allow researchers to create risk calculators to assess HIV risk on individual and population levels.

The IMPACT trial took place from October 2017 to July 2020. Initially 10,000 trial seats were allocated, but the demand for places led to two expansions with a total of 26,000 places eventually offered across 157 sexual health clinics in England.

The total number of participants enrolled during the trial period was 24,255 with the vast majority (99.57%) being cisgender gay and bisexual men.

The remaining 1,038 (0.43%) participants were:

• 359 transgender women
• 333 cisgender women
• 152 transgender men
• 150 cisgender men
• 35 non-binary participants

Although the participants ranged from 16 to 86 years in age the median age was 33 years old, with cisgender women skewing older and transgender women younger.

Most participants were white, with a lower proportion of black African participants despite the increased number of HIV diagnosis in that group.

When asked about the reasons for the underrepresentation of young people, Dr Sullivan said that young people may be less aware of PrEP and sexual health in general. They may be more reticent in disclosing sexual behaviour, especially if healthcare professionals do not ask them directly.

Discussions about how injectable therapy and PrEP will be delivered in the real world continues. According to UNAIDS, the number of people who received PrEP at least once in the previous year, sharply increased in recent years. However, global coverage is still far from the target of 3 million people receiving PrEP in 2020.