Item 6 on the agenda this afternoon is a statement by the Cabinet Secretary for Health and Social Services: an update on pre-exposure prophylaxis—our approach in Wales. And I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething.

Thank you, Deputy Presiding Officer. I welcome the opportunity to update Members on the introduction of pre-exposure prophylaxis, which we'll now refer to as 'PrEP', one year after it’s introduction here in Wales. PrEP, as you know, is an antiretroviral medication, which, if taken correctly, can prevent HIV for those at risk.

Public Health Wales undertook work with an independent HIV expert group in November 2016 to assess the public health effectiveness of PrEP. A health technology assessment of this treatment was also undertaken by the All Wales Medicines Strategy Group in April 2017. On 28 April 2017, I announced my decision to provide the drug Truvada as PrEP to all those who would benefit from this preventative treatment as apart of an all-Wales study. That study will last up to three years. It started in July 2017 and it will provide evidence for the acceptability and the effectiveness of PrEP in HIV prevention. Public Health Wales and the independent HIV expert group are overseeing this study, and health boards in Wales began providing PrEP in July last year through integrated sexual health clinics. Sexual health services have worked hard to introduce this intervention and I am pleased to say that all integrated sexual health clinics in Wales have been providing PrEP from the outset.

Any patient for whom PrEP is deemed suitable is required to have a negative HIV test and a baseline blood test to ensure they have no underlying health conditions. They are also required to receive counselling before PrEP is provided. Between 1 July 2017 and 30 June 2018, 989 patients in Wales were deemed eligible for PrEP. Almost half of these individuals were new or relatively new to sexual health services. It is important that individuals who participate in high-risk sexual behaviour engage with our sexual health services both to protect themselves and others. And making PrEP available has encouraged this. 

I can confirm that at least five individuals have been diagnosed with HIV as a result of their engagement with sexual health services for PrEP. These individuals can now receive the care that they need to stay well. A total of 559 people started on PrEP during the first year of this study and I am very pleased to say that no new cases of HIV have been diagnosed within this group of people. However, services did diagnose a number of significant sexually transmitted infections within this group. There were 70 cases of gonorrhoea and 15 cases of syphilis. That is to be expected in a high-risk group. What is important now is that they are attending sexual health services regularly, being diagnosed early and being treated for both their own health gain as well as preventing the spread of those infections to others. 

Members may have seen coverage of a story over the summer recess about the Terrence Higgins Trust having to fundraise to make PrEP treatment available. I want to reassure Members and the wider public that this problem relates to England and not to Wales. I have decided to take a national approach to PrEP and HIV prevention here in Wales in direct contrast to England, where a national approach is not being taken and a charity is looking to raise funds for PrEP treatment.

Our latest figures show a 32 per cent decrease in new HIV cases in Wales, returning to 2011 levels. As important as PrEP is—and there is no doubt that PrEP reduces HIV infection—it is one part of the wider strategy to reduce new infections of HIV. PrEP needs to be taken correctly and supported by wider, preventative sexual health services.

I look forward to updating you on further progress regarding our targeted efforts to reduce the transmission of HIV here in Wales. I will of course keep Members updated on the PrEP study and the planned wider improvements to our sexual health services.

Thank you for your statement today, Minister. It's welcome news. There is a steady increase in the number of people living with HIV in Wales, which reflects, actually, an increase in survival and new diagnoses—both of which are to be welcomed—and we believe that PrEP plays an important role in reducing these new diagnoses. 

I have two areas of questioning. Not all people have had equal access to the drug. Previously, you have highlighted that there were challenges in Powys, due to the lack of services, and that meant that there wasn't a consistent all-Wales approach. Back in May 2018, you gave assurances that this would be rectified, so I wonder if you could outline what progress has been made in these areas. And, with this newly available drug, really, it's important that clinicians and the prescribing medical professionals are aware of the new drug and prescribe it as required, so perhaps you can just give us a bit of an update about the consistency and universality of access to PrEP throughout Wales, but particularly looking at Powys. 

The second area I just wanted to ask you about was the outcomes of the Welsh trial so far. I was pleased to see that you are monitoring the prevalence of STIs that are detected, and I assume that, as part of that, you are talking about, or they are being given information on, the education and use of condoms et cetera, et cetera. But I was slightly concerned to see that, of the 559 at-risk people who took the drug, 153 are unknown or have been lost to follow-up, and I wonder if, perhaps, you could give us a bit of an overview as to why that has happened, how we've managed—. You know, those 153 have disappeared off our radar. What do we need to do to ensure that the people who come onto this PrEP drug actually stay with it and stick with the whole process, because, of course, as you have already identified, they are the most at-risk people?

Thank you for the two questions. In the early part of my statement, I did try to outline that every integrated sexual health clinic in Wales has been providing PrEP from the outset of the trial, which is good news, because, when we initially spoke in May, that was before the trial had begun. So, actually, within the period of time, the lead-in time, every integrated sexual health clinic has been providing PrEP. So, the postcode challenge that we were concerned about, as far as PrEP is concerned, hasn't taken place, so it has been available to every citizen who it's been appropriate for, and so they've had access. I'll happily make sure that we continue to monitor that it is genuinely available in every part of the country and every citizen who could and should access PrEP is able to do so. 

On your final point, though, about those people that have fallen out, it is an important point. It's part of the challenge about wanting to make sure that we talk about this as a normal part of health services, because there's still a stigma. There's still a challenge about people engaging in services and recognising it's actually in their interests—not just in the Government's interests or the health service's interests, but in their interests—and there isn't a cap on numbers in the way that there is across the border, and to make sure that all those people who could benefit do. And, actually, it's part of the study that's being undertaken by both Cardiff University and Public Health Wales, the research on attitudes to PrEP, because there is, if you like, the technical pathway about how to try and treat people, but it's actually the support around that to make sure that people actually are taking advantage of and fully complying with the treatment regime to actually have the full benefit of it. And, as we've seen, we are getting to the highest risk group of people, because of the levels of other sexually transmitted infections that are within this group of people. So, it does show it's making the right health gain, dealing with the right people, and that is actually providing a benefit to the wider public.

Thank you very much. I, too, welcome the success that appears to have come out of the trials to date. What we need now, of course, is to ensure that as many people as possible can access the PrEP trial, as it is extended. It's very encouraging to see a significant decrease in the number of new cases of HIV in Wales, but, of course, there is always more that can be done.

We also know about the whole host of barriers that there are to people being able to access PrEP. There are still a significant number of people who are eligible for PrEP who refuse to receive treatment. Also, of course, the demand for sexual health services has doubled in the period between 2011 and 2016, without a corresponding increase in the resources available for sexual health services. So, it isn't hard to see where the problem comes from. We also have holes in the information available in Wales in terms of demographic data and so on. 

So, three questions: what steps are you taking, or do you intend to take, Cabinet Secretary, to engage with individuals and groups of people who are eligible for PrEP to raise awareness of the treatment and to ensure that PrEP is accepted by those groups—and I think that sex workers are an important group to be targeted in this instance? Can we have a commitment from you that sexual health services will be funded adequately in order to support the PrEP study, to ensure that everyone who can benefit from it can get access to it? And, on this question of data, what steps can you take to look at the gaps that we have in the demographic data to ensure that PrEP services are targeted as effectively as possible?   

Thank you for the questions. I think one of the encouraging things we shouldn't lose sight of is that we are getting an engagement with people who previously weren't engaged with sexual health services because of the availability of PrEP. So, it's not just of benefit for HIV. As I said earlier, those other sexually transmitted infections that people are now being treated for would not have been discovered if they were not engaging with sexual health services to try and receive PrEP. That's a good thing. Not only that, though, but the five people that I mentioned earlier who have been diagnosed with HIV were previously undiagnosed, and they only engaged with sexual health services because of the nationwide availability of PrEP.

But, of course, that doesn't mean that everything is perfect. The sexual health review that I gave a statement to Members on in April of this year in Plenary highlighted a range of areas of both the review and the nine points of action being taken forward. And I will happily come back and make sure that Members are further updated, whether it's an oral statement or a written one, on the progress, and the board undertaking the progress of that is being overseen by the chief medical officer. So, it is at the senior end of the Government, the top of the Government, with the chief medical officer having oversight of it, because we recognise there is still more for us to do, and we need to make funding decisions that actually reach the need that we identify.

But, in terms of understanding how and why people do or don't engage with those services, there's not just the work that the review has done, but actually the study that I mentioned in answer to Angela Burns. Undertaken by Public Health Wales and Cardiff University, it is looking at how individuals living in Wales use PrEP and how PrEP relates to their behaviour and about their access to other health services. So, we're looking at that broader piece of work, and so we'll have some really useful information to come to us in the research being undertaken.

We also have an international perspective too. In the summer, last year, I met with Dr Owain Williams who, coincidentally, I knew when I was a student at Aberystwyth. He is now working in Queensland university—he's a senior research fellow in global health at the University of Queensland—and he's overseeing some of the work they're doing on a PrEP trial in Queensland too. So, we're looking at international evidence as well as evidence here in Wales as well. Because I would always want to be—and I say this regularly—guided by the evidence on what works best and understand that we can't force people to make decisions that we think are the right ones for them, but it's how we work with and understand the choices they make and try to help them to make genuinely informed choices, and that should inform our choices about the quality and the nature of healthcare that we provide to the wider public.

Thank you very much, Cabinet Secretary.

There are no more speakers, and therefore that brings today's proceedings to a close. Thank you.

The meeting ended at 17:09.