SX Health Improvement Worker, Alastair Rose, gives his personal reflections on the decision to bring PrEP to Scotland.

Yesterday, I was privileged with colleagues to meet the Minister for Public Health and Sport, Aileen Campbell, to talk about the much welcomed decision to make PrEP available on the NHS in Scotland.

It’s a demonstration of how far we’ve come in Scotland, that I’m able to sit down with a Scottish Government Minister to talk openly about the sex that gay and bisexual men have, the health inequalities we face, and our right, like all members of society, to pleasurable sexual experiences with the least harm.

I was proud to be joined at the meeting by one of our volunteers whose voice, like that of so many others in the community, played a vital role in this great development in HIV prevention.

We are now on the cusp of achieving something remarkable – something that, until recently, would have been a distant dream for many gay and bisexual men. PrEP, alongside the great strides that have been made in treatment as prevention and the continuing promotion of condom use, opens the possibility not only to stem the flow of HIV transmission, but to significantly reduce the number of infections at a rate which would not otherwise have been possible.

However, in writing this piece, there is a realisation that our work has only just begun. So, yes, while we should rightly celebrate as a community the realisation of PrEP, we now need to turn the possibility of reduced HIV infections into reality. For that to happen will require an effort from us all, community members and organisations alike, to embrace this opportunity. Now is the time to resource ourselves with the biggest prevention tool possible – information. Speak to your local gay and bisexual men’s services or contact the agencies that have worked to make this happen; encourage your friends and sexual partners to do the same; tell us the information you need to help inform the resources we will produce; get involved and volunteer to make our sex lives safer and healthier.

The decision on PrEP goes further than just reducing HIV, it creates an environment where once and for all we can eradicate stigma from the sex that gay and bisexual men have. Many of us have faced discrimination in a society that too often views the sex lives of gay men through the eyes of disease. That has inevitably had a damaging effect on the self-confidence and esteem of many men, leaving them fearful of the consequences of the sex they have and under the impression that HIV is an inevitable consequence of gay sex. For the first time since the HIV epidemic began, we can now say that our prevention tool kit can remove the fear of HIV and allow us to enjoy the sex we have.

This development does not mean the end of condoms, in fact, their role will be just as important as it ever has been. PrEP will only prevent HIV, not other STIs like syphilis and gonorrhoea, which still disproportionately affect gay and bisexual men. In addition, given that PrEP will only be available to those at most risk of HIV, condoms will remain the best option for many of us. As a community though we have, for the first time, a real and effective range of prevention options available, allowing us to discuss openly with healthcare practitioners the best way to keep our sex lives healthy.

The decision does not immediately change PrEP access in Scotland - a lot of work needs to happen before sexual health services will be in a position to provide PrEP to individuals. SX and Waverley Care, along with HIV Scotland and Terrence Higgins Trust Scotland, are working with health boards to ensure access. That said there are steps that sexually active gay and bisexual men can take to be prepared for PrEP. Firstly, know your HIV status - get tested every three months, either at your local community based service or sexual health clinic. Secondly, speak to your local organisations and sexual health services about PrEP, especially if you are already accessing it online. If you do access PrEP online, make sure you are aware of the services available to ensure you remain healthy and, if you don’t know where these are, get in touch with us at SX. Thirdly, don’t forget about using condoms - they are still an important and effective prevention tool in their own right.

It is important to remember that the decision on PrEP would not have been possible without the determination and activism of many individuals over a number of years. For me this is a deeply personal issue. I have worked with, known and loved so many people affected by HIV. I have lost people along the way, seen many fight for equality and access to care and treatment, and seen many others overcome challenges both socially and politically. It is important we never forget the huge effort and commitment that many people living with HIV have given to the movement for effective prevention. Today, we stand on the shoulders of these individuals who have made both treatment and prevention of HIV their lifetime commitment.

I am proud of the role that SX, Waverley Care, HIV Scotland and Terrence Higgins Trust Scotland have played in supporting this work under the banner of PrEP4Scotland. Together we will be continuing to work to ensure that PrEP is now delivered effectively. I’d also like to take this opportunity to pay thanks to the hundreds of gay and bisexual men across Scotland who supported the PrEP4Scotland community events and gave their personal accounts to help inform decision makers.