Thank you, Deputy Llywydd. The Llywydd has shown great wisdom in selecting questions, as usual.

Will the Cabinet Secretary make a statement about his decision to approve the use of pre-exposure prophylaxis in Wales as part of a study? TAQ(5)0155(HWS)

Thank you for the question. I have discussed the framework for the study with both Public Health Wales and the Terrence Higgins Trust, as well as officials within the Welsh Government. I issued a Welsh Government statement following a meeting that took place yesterday with both Public Health Wales and the Terrence Higgins Trust. I do welcome the support from the Terrence Higgins Trust to help promote access to Truvada, the branded PrEP medicine that is available, and the wider care package that will be available throughout the course of the study.

Can I thank the Cabinet Secretary for his reply and thank him also for the decision that he has taken in the last few days, and thank him for the time that he and his officials have made available to myself and others to discuss this important matter?

The health, emotional relationship and social consequences of an HIV diagnosis can be very, very serious, and although many, many people are living into later life with HIV medication, it’s incumbent on us to make available to people in Wales the tools that they need to manage their health prudently and to reduce HIV transmission. The clinical effectiveness of Truvada is well established—between 86 and 100 per cent effective at reducing HIV transmission as part of a range of safe sex measures. So, I welcome the decision that he has taken.

He has mentioned that this will be rolled out across Wales. Can he confirm that it will be available across Wales from the outset, mindful of the fact that there is an uneven distribution, if you like, of genitourinary medicine clinics across Wales? Secondly, from the perspective of the patient, will participating in the study alter that experience for the patient? Will there be additional expectations from the patient, above and beyond the clinical expectations? Thirdly, what measures does he envisage being taken to raise awareness amongst communities that are particularly at risk of HIV transmission of the availability of PrEP on the NHS in Wales?

Thank you for that series of questions. I think you’re right in terms of awareness raising, to start off with, that there is a real challenge in continuing the message about the reality of HIV and reducing the number of people with HIV in Wales. We still have people every year who contract HIV in Wales, so there’s a real need to improve our ability to reduce the numbers of people who have HIV and then the treatment and care for them as well.

There is something here about both the decision and the awareness around this, because we recognise there are groups of people who are likely to be at risk of HIV, or indeed who may have it and are reticent about coming forward. So, actually having a study, and the way that’s undertaken should help us to understand the levels of people who are at risk and actually the economic benefits of PrEP itself as well. That’s part of the reason behind the study, but I also see it within that wider context of care provided, too. I expect the study to start by the end of July this summer, so it will start in a matter of months. I can assure you that it will be available across all of Wales; it won’t be in particular parts first or afterwards, so it is a genuine all-Wales approach. Every single person where this is clinically appropriate will have PrEP made available to them—no extra hurdles or barriers to get over.

I think it’s also important to make clear that this will be primarily undertaken through GUM clinics. I know there’s a challenge through mid Wales in particular about the availability and access to them, and that’s part of the challenge in designing this, and in getting people access to an appropriate place to have that care and follow-up support undertaken. But it’s where most people access their support and advice on these areas. People are less likely to go to their general practitioner for this particular form of support and advice. So, that’s why we’re making sure, in the design of the study, that GUM clinics will be the primary place both for the prescribing, but also the follow-up treatment, care and testing and understanding about adherence to as well.

I’m looking forward to receiving back from Public Health Wales clear parameters about the study, how it will be undertaken, and the assessment of the value and the impact of the study, and the learning on the behaviour of individuals who are at most risk as well. Obviously, there’s a lot of learning we can get from this, and I look forward to being able to update Members, hopefully before recess, about where we are on the start of this particular study—that will be another part of awareness raising—but, in particular, what we will do with third sector organisations like the Terrence Higgins Trust and others to raise awareness from those most at risk as well. So, very pertinent questions, which are absolutely in my mind as we take this work forward.

The results of the UK-based 2015 PROUD study, evaluating the effectiveness of HIV pre-exposure prophylaxis, or PrEP, amongst a high-risk group of gay and bisexual men, showed that daily use reduced the number of HIV infections by 86 per cent in this group, and that, when taken properly, the effectiveness was nearly 100 per cent. Noting that, how do you respond, given your comment about your engagement with the Terrence Higgins Trust, to their call for this to be provided alongside other prevention interventions, such as condom use, behaviour change, and regular HIV testing?

Well, I’m happy to confirm my response. That’s exactly what Jeremy Miles has called for, it’s exactly what the Terrence Higgins Trust has called for, and it’s part of what the study will be looking at. It won’t just be PrEP in an isolated way—it’s seeing it in its context, as part of the work that we want to do to try and ensure that as many people as possible do not acquire HIV. So, it’s an important part of where we are. And it’s also about understanding the real level of incidence rates that exist in Wales, because we do think we probably undercount and underestimate what they are. So, there are real challenges that we understand from the advice we’ve had from the All Wales Medicines Strategy Group. But we are looking to resolve those by having this study and making sure that PrEP is genuinely available across the whole country for everyone where it’s clinically appropriate. And that’s a really important step forward for us here in Wales.

Thank you very much. And the second topical question this afternoon, again to be answered by the Cabinet Secretary for Health, Well-being and Sport, is from Darren Millar.