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Yeah, I really Hello. Hi. Sorry, I have how you I'm all right. Thank you. How are you? Good. I'm fine. Thank you very much. Right. So it's already started recording on by hand over control to you Host controls. Is that okay? Yeah. And then how do I have the Maybe somebody else. So if you hover over so off May or the bash picture, you can see the three dots in the top, right hand of the corner. Oh, yeah. If you click on or just hover over that, a drop tumble up here and in the second sort of box, you can see make host grown, or you could make somebody co host. Okay, Perfect. So I'll make you host. But you can also make somebody else host or make them po host. Pretty. Yeah, that's great. Okay. And have they got waiting room on there? You have Indeed. So now that your host you'll be able to admit people I've just admitted Tasmania I can in Looks like he's joining. So, Luke, Luke, uh, co presenting. That's great. Wonderful. So you can make Luke co host. Is that okay? Yeah, that Really. Thank you so much. You're welcome. Good luck, guys. I hope the meeting goes well. Thank you. Thank you. Thank you. How did I flicked? Can I flipped my thing? I don't know. And I need to read a myself because I was on here. Something else. All right. Let me just shut there. Can you see it? Yeah. Okay. Brilliant. Oh, I didn't know so weird. So that's what I was thinking. Nearly out. Could remember. What the next session Waas on day was wondering about contraception. That's very weird. Oh, yeah, yeah. No, it should be really good. Um, so that we just will admit that everybody in the way to remove that one contract the speakers. Sorry just yet. Yeah, if you're back and we ask you just to leave the memory joy in a minute. Okay. Um yeah. Okay. And did you ask, um, Greg on D um, chapter shampoo. Government early. So did you mention to Greg about coming? Problem is early. Yeah. And then they, um Yeah. No, they sat there, which they said that they would they would. They were fine with it. Some hoping perfect on. You've got all of the you've got the flight is I'll have any. Yeah. I mean, I'm hoping grand houses. Well, I've got that. And so I don't know if, um, because he sent them over. Didn't say so. He should have a copy, but I've I've got them loaded, ready to go, in case there's a problem. And I could always shut my screen or something. Can I? Yep. So just keep an eye out the to keep an eye out for and Comey pick people to enter. Yeah. Could you hold on the waiting room? You can pick people. That of that. I would make it yet, and I mean, yeah, I am. It was a bit of a my day to day because they swapped the war's around. There was, um, issues. Yeah, well, maybe I don't know. I know. I'm grateful that, um, you're getting a lot. No. Great, actually. Ah, that might actually I was negative. Okay. I think we're being recorded, just, you know. Oh, that's right. Okay. You're gonna admit him. Yeah. Hi, Greg. I Hello. Can you hear us? Oh, hold on, I think. Hold on. Yeah, yeah, yeah, yeah, yeah. I just grabbed with just made your co hope. Go. You have to share in everything. It. So yes, it's only us in the room at the moment. We haven't admitted anybody else yet. Okay, Okay. Just write. How you I just got a little wheeze. There are tests. Look okay, today show a little bit rough, and but I don't feel like I'm about out, so Okay, a positive table. You think that I got a positive? I had only nasty cold for about 10 days, and then it it started clearing up with the end of last week. And then on Friday last week, I was like, Oh, God, this has come back. But like, but nasty, I'm gonna I did a test on Monday and taking back positive today. Oh, no, no pool. You all right? There's not as bad as I thought. I I thought it would be so I'm I'm I'm I guess relatively. Okay, so thank you, Biaxin. A shins and stuff. So how are you guys? Yeah, we're good. We're going to be evil. Dizzy days is well and just racing to get home the left. Sorry. I mean, I know my message really well, with a light going your your colleague is it champ? Yes. So? So her full name. It's been Shamu on, but when it's when it's shortened to show my called a child with the C But either of those sheets for some. Okay, My my stomach slowly. It really Yeah, I am Way. Thank you so much for doing this, Greg, By the way, we really appreciate it. That's okay. I didn't I'm Ellie. Sorry. I'm one of the education stashed. I know. Well, and I think what we're gonna do is you're going to speak for it when you on Dench's, um Yep. And then we're going to understand question to the ends. If that's okay as well. I'll let I'll try and get people to stay on mute, um, on then, you know, come, You know, whatever. They can come up on you today. Congest questions instead. Text. You know, it's a chapter. Anybody have you Have you got this slide or do you want me to share my screen or have you got them on your All right. So I have Okay, I'm happy for you to keep if you want to keep control of that, I'm not. No, no, no, no. It's fine. It's fine. It'll be a bit like next. Next slide, please. Nonsense is next. Yeah. You don't really want that. We're trying to keep an eye on the room to see if Sandton Sham is Luke. Wiping everybody is automatically meted. Marvelous job. Let you know on. Then you can ask people to run mute. Yeah, when they're asking questions is nearly and mm to say she's known by anything else. Yeah, it's probably cold. Today is one in it. You know, I've been in the house, and I've sort of been in my job. I I don't know what it's been like outside. So what, We're going to have you go? Oh, I see Now for 10 days. Well, so the the guy the guidance is Teo, if you're symptomatic, is to isolate for 10 days from the start of your symptoms. If you're asymptomatic, I'm gonna cause a result of the guidance is from the day of your test. So I my symptoms started on Friday, so I'll be out of commission on Monday. So that's I mean, it's not gonna massively impact my life to be on this because we're not really going in the office of them in it anyway, So Okay. How so you didn't have any massively can plan? Uh oh. Actually did. How about Well, I'm always sexual, so I have brunch plans for something, but I mean games very high. I'll do it next day. Yeah. So I've been about It's a hair spray next Friday. Uh, some are you doing? Yeah, the Manchester mumble. See, it's a good now I have it. It's, um and I'm just keeping an eye on this. Yeah. Look, I don't think she's that yet, So good, cause I was gonna introduce both of you at the start so that it's kind of a bit more. Yeah. Okay. Rather than stop starting and and things and I'm I've been a few things down are probably wrong. Did it Did you go to the I'm intrigued by this. The life goal in 2017? Yes, I did. I was in a ward there. I may Campbell and Actonel City, or more ECG and continue on Just own who was, like, 4 m away doing little turn on it. So what have you ever been? No, no, no, no. Is Indiana is know something being Yeah. It's why it stopped. Now Got Gary. The guy organized. It has stopped it, but it's so it's wise is absolutely wise. It's a slight next level, extravagant on. It's just money, money and I society everywhere. Once a time with seven on me, we'll give you 50 Is normal with keppra today in the waiting room. I don't really thought like that. Um, but I messaged everybody in the waiting room. Hope so. They can all see it just to say, Well, let the morning after seven. Okay. Yeah. Uh right. Oh, here we go. Okay. Ignoble. That now. Yeah, yeah, yeah. You know I jam e there. I'm there. Hurry. Less nice to see I'm Luke. Nice to see you too. Uh, you need to use your cell phone on Saturday. I I'm Ellie on one of the medication, right. Thanks so much for joining us. They really, really appreciate it. Yeah. No, My pleasure. Thank you so much. And then just just double check. And we already have this jacket just to see how What would you like to be called? And how does pronounce it and I don't get it wrong. Um Ah. Traumatised buying gold. It's a It's a u c h a mut. And you can just change, you know? Yeah, I can change that. Hold on. So sorry. Um, let me just update airing for a second, and I will. No one else is new with you, except for us to really get on jammers. Yeah. So much. Yeah. Um, it Okay, I know. What is that? This's a big dark I can get a little lamb. Know what I do is I just fine. Has old did compete with you? I have a friend bring out. I mean, I'm not going to disrupt my positioning. I have a whole ring light set up a lot more areas. Wife, One of my falls low lights out, and so it's all really informal, isn't it? So these these guys are either medical students or doctors who have interested potentially in doing exceptional health. So we assume no knowledge of any sort of very chills on, but we always say when they're asking questions at the end, it does No, no, no such thing as a city question. So I was gonna introduce you both, and then I think last given first and then, um, some of your afterwards, and every contraction question to the end is okay. Yeah, What's the Intal? You were right to that. People in? Yeah, I'll turn my camera and I'll just leave it to you and I'll just lack of it again on Give me one second. Great. Okay, that's just a few more people coming in, guys, So we'll give and we'll give it another minutes or so and then we'll get started. Cool is 5.7, so I wonder whether we should get started in the interest of time. And so good evening, everybody. I'm welcome to a third stash workshop of the A. B. C's of crap on If you have not been to one of our workshops before, Welcome on do If you have a nice to see you again on Do. These workshops have bean designed to shine a light on areas of sexual health. It's were the we see day today that maybe you don't get to know about in your undergraduate or indeed post graduate training. So I said, My name's Luke. I'm one of the, um, registrars in northwest of England. Onda. We've dipped are toes into the world of cancer acts. Last month on then August. We had a bit of a journey true HIV, right from its inception in the early eighties, a pin to the vast arsenal of medication that we have available today and that said ways really nicely into our talk tonight, which centers around prep, which is one of the cornerstones of HIV prevention on. We've got to wonderful speakers tonight, too, and we're really grateful that they've given at that time to talk to us on. So the format of tonight is that the the speakers will do their presentations one after each other on. Then we will take questions at the end. If that's okay s o. If you submit your questions into the chapped box on remember, this is a non threatening environment. There is no such thing as a silly question. So I'm going to introduce, um, our second speaker, fairest of that Make sense on who is Onda. She's the communities. Diversity and healthy quality lead. Terrance Diggins Trust, which is the UK, is leading sexual health and HIV charity. She has an NSC in health, economics and health policy. On is an experience and qualified program manager with a special focus and HIV prevention and healthy quality with a goal of empowering vulnerable on marginalized communities. Our first speaker, who's going to start is Greg, who is the co founder of I Want Now of the website, which facilitates to safe purchase of generic prepped on Greg is also the lead for a crap. It happens again is trust. He's a global pioneer. In fact, advocacy on Day was awarded the Life Just Award in 2017 at the Life Ball, organized by age Life for an outstanding contribution at eight Every Prevention. And he was also start starting and the critically acclaimed BBC documentary The People versus the HS. Who gets the drugs? So these as speakers and are shining lights in our specialty for patient advocacy and activism on bit forward to hearing what they have talked to us about. So our hand over too great to begin with, you're right to share your screen on. We'll get we'll get going out too much. Yes, thank you very much. Look, that we just screen on flight. So, um, there with me. Um Okay. Good evening, everyone and you Very much for the introduction and thank you for inviting me to speak this evening, and my name is grade going. I am cool funder off. I won't print now and look it over the explain what that is. I'll talk a little bit more about it and a bit on. I also read on that for 10 seconds. Trust and a shampoo You speaking appearance on, the better it is for my colleagues on this evening. I'm going to talking for about 20 minutes and we'll have a joint questions and answers session at the end on what I'm going to be talking about is the A B. C's of prep, really an overview of prep and and then a little bit about the collaborative activism between community and finish ins that have to sell tickets access in the early days. Most early days be 2015 16 17. It's a full disclosure I just deposited for covert today, so I'm a little bit under the weather and I hope my voice is clear enough. I hope I'm still making sense, so I want that now is website, which not only a sign posts were to buy genuine generic crept online, but it's a one stop shop for prep information. It gives you everything you need to know before starting pack while you're taking prep. I went stopping it, and if you like, it's a civilian friendly version. Off the bat, be the guidelines. So bashed. British Association and sexual health um, HIV Onda be the British Toby association. So those guidelines are presented and a digestive away. This website and but usually what we did back in 2015, long before prep was available on the Energen was we included. A click to by Seinfeld's week by Genuine Jerry Prep when we launched it costs about 150 lbs for three months worth off prep, and that's since come down to about 60 lbs for 33 months. So about 20 lbs not so relevant now because we have a pretty commission on the ogestral all four doubles nations, but was the catalyst for a lot of change back in 2015 and not just change in regards to the communities who would benefit, but almost a culture change within HIV prevention on self smoking drugs online. Okay, I think most people in the room will be anxious about that, and they're generally is on opinion a lot. We don't buy drugs online, this kind of change that culture a little bit. So before we start talking about Prep, and I know I said that, we're probably about 100 times already. But before we start talking about prep itself, let's talk about HIV and so the current situation in the UK I'm aware some of you who have Bean to previous sessions might know this information, But let's see this tingle snapshot at last year's they. So this is official data from Public Health England. It's estimated that currently in the United condemned, there are 105 people living with HIV, about 6% off. Those people are undiagnosed, so about 6.5 1000 people on that, uh, that presented just remains. Store in the eye past five years, 5 to 10 years, but is a good news story. In 2019 and 4139 people were you diagnosed with HIV, which represented a 10% for from the previous year 2000 and 18. But if we look at the figures from the pink in 2014, we see a 34% fall in new diagnoses on that's largely driven by gay bisexual men would saw an 18% fall in the last year, and again from that peak in 2014, it's been a 47% drop in diagnosis is amongst that group in some panic mode and 50 16 street, for example, they had a whopping 80% production within certain certainly keep populations. It's a really good news story for certain people, but not for everyone. I shall we talk about in a bit. So we're staying small reductions across all groups, a little bit more regulated data. So if we look at height chart there and about half your diagnosis, this is ethnicity were in people off white, 22% of black African heritage mixed other, and that includes black Caribbean on black mix. Black other is coming in. It's 15% and there is genetically at 7%. Now. That doesn't look particularly alarming until we establish that black African people make up 1.8% off the general population. So hugely just proportionate representation off back Africans. And but if we lived a little bit more on the on the bullet points there when we start looking at getting my sexual man, even though we've seen big reductions 20% off gave my sexual mental diagnosed were off ethnic minority backgrounds on droppingly 47% off. All diagnosis in women at those women were a black African, African descent. Onda, similarly worrying figure and 20 except sexual man diagnose were off black African to send. So those are our key populations. So what is prepped? I really don't want to make this two simple, but I do want to make a two complex or, I hope I find the balance for you. So prep for HIV. If it stands for pre exposure prophylaxis on that, it's pretty self explanatory. Pretty. So when you do before exposure in this case, the HIV oh, fax it to be on another treatment or action, you could take that Betsy's. So, in a nutshell, it's a pill that people take that will protect them from HIV. It's almost 100% effective when taken as directed, and it doesn't matter what a person's gender identity is because of sexuality is it doesn't matter what type of sex having if you take prep correctly, you have almost 100% protection from HIV, and it is worth one thing out. Prep Onley protects you against HIV, so if you wanted to really just a risk contracting other ST I see other tools are necessary. Example. Connell's on Our vaccinations were appropriate on DOT contraception in the case of pregnancy, and they're currently to approved formulations off prep prep. But we've just picked up the recording again. The regarding aids of formulations off breath their license to use on the first one you might be more familiar with it's Truvada are now is Jared Equivalent. And so the TFT seeing jewel pill on Does tenofovir on D Interested have been. There is a more recent a newer drug come to market for use again as HIV treatment in persons living with HIV on. Also, as expulsion perplexes on, that is slightly different molecule off the task important. So it's I'm sorry it's not for your component, which we call task. So then you were version task that you see it's currently on patients on under the name a desk a bit, and that formulation and has slightly less impact on renal function on book today. So what those were concerns, and there may be a benefit to the patient. But again, it's the way off off a generic drug, costing as the almost 5 to 10 lbs per part to 400 lbs of what happened above as though you delivery methods. Other delivery methods for prep are in line, including long acting injectables implants, vaginal rings call. Besides, so just on the long acting injectable last week we had some great news from Scotland. Long acting cap Take a Veer has Bean approved for use in treatment off people living with HIV. Sharon's outside. And so we would hope that the rest of the devolved nations will come on board with electing injectable treatment for living HIV on Cabotegravir has also bean a study going Trials produces pre expose flax is on. The results are very encouraging, and it should, at some point become available for use of prep. Prep is free on the air, Jess at all for nations on, some people still do by life, so on to the most important questions who was prepped for and who would benefit from it. So I'm going to talk about eligibility criteria on do that kind of leads on quite nicely from work. Keep populations. But I'm also I'm gonna put my mom my sample nous and say that initially, first of all, anyone who has self identified is needing Prep should be getting cramps. So that's my first caveat. Is that anyone who, uh, who wants it give it to the and it is completely appropriate. So the prep impact trial, which was the trial, ran in England for three years in 2017 too late 2000 and 20 and provided prepped for up to 26,000 people. 24,000 people actually enrolled on trial. Predominantly Medrol six men channels will look a little bit more at who was involved in that trial and who access prep through that filed in her presentation. And so, as part of the eligibility criteria for pep in parts Eligible counted, it's needed to have reported condoms penetrative sex in the previous three months. Unintended two, again in the future on prep in that trial broke down eligibility into three main groups. The first one was gay bisexual men, because they account for almost half, almost 50% off new diagnoses. It's year, people have black African descent, which is what we mentioned in the opening slides on. Then there was a third catch all if you like group, which was heterosexuals, a parody off risk to those first two groups. Now that's when we start to look a sexual networks sexual behaviors, and I start to have to expand beyond chemical chemical indicators are population level indicators, so those people might improve to some sex workers. I list some here all the time because it's no. All sex workers are all people who reject drugs are old transplant, even though we know transform in our 40 not started, the statistic was 49%. It's now been richest to 47 40 Sorry, 47 times, not percent, 47 times more likely to acquire HIV in their lifetime to the general public. So but not all transferred mint will need our benefit for pets or may not be need. They're on some people who trouble, too, or from high prevalence countries on a Z. I just mentioned people who are active, so now we have preparation on the energy. Yes, it's pretty much following. That's the image ability, criteria, and that is murdered in the back people guidelines. So I'm sure, look, are eligible providers links should you need them or want to do a little bit more research? One thing it's like one thing I should have said in this slide. Waas at the head of sexual, a parody off risk that includes partners off people living with HIV who are not just barely suppressed, so not yet undetectable for those not attend the other sessions. I haven't had an overview of where we are with the HIV today. I'm not going to reflect all the information on the slide. I'm sure they will. You can watch it back and more find this informational line. But crucially, the key piece of information here is people living with HIV. You were on effective treatment and two are undetectable. Cannot pass on HIV to their sexual partners. So there was two landmark studies partner, one partner to on they find into hundreds of sizes off initiative sex acts following these hero discordance, the one positive, um, one negative at partner they found no, he chubby transitions within the primary primary partner. So maybe on I've tried not reliever this presentation too much with the technicalities of prep from a clinical perspective, because those are things that you can find very easy from looking at the website videos all have. Our pounds will talk you through that and as I mentioned the guidelines but a little overview. So you know the general process. So before starting our baseline tests and recommendations are as follows. We would like a potential prep user to have a full STD I screen so everything, depending on which population that come from on. That would include hepatitis C screening for gay bisexual men with the option to treat to shoot a diagnosis to be turned on and hit the antibody adage in test. That's 1/4 generation test. Hepatitis B test, particularly because they're prevalent amongst gave My Sexual Man is higher than the general population, but also because prep can be used to treat hepatitis B. That's an awful be a component on so that word impact on to the door thing options which will not talk about too much. We'll talk about very briefly that will impact on with their dosing regimens that a person might choose from. We wouldn't want to be starting and stopping and because it will lead to viral flare ups also helps. See, I have b sorry on do a blood test for kidney function and on the HIV test needs to be repeated in six weeks. Should have seen our recent risk of exposure is that if a patient presents with the result risk of exposure and that recent risk has been very recent, we would potentially recommend using post exposure prophylaxis for a period of one month on, then transition eight straight over on to a prep during to the guidelines for HIV testing. With that, if initiation is deemed appropriate. But the person is displaying acute HIV infection symptoms, we would probably recommend doing a barrel A little test at that point as well. We wouldn't necessarily opt to the fair initiation of it. So although what we have found, actually what the data from Scotland has shown on what the data from Wells has shown on, hopefully when we get some sort of substantial data from the impact trial, what it will show for today is the prep is a great hope for for better general have sexual health. I'm general on tells in general. And so we're seeing a lot of people step up for who have not been to the sexual health clinic at all, or in 12 months. Previous to Teo Enquiring about starting prep, it gives you a great opportunity than two. Extend vaccination offers for hepatitis A, Having times be on T H P B again, where the patient it meets eligibility criteria. This, um, regular monitoring required prep, and that's slightly being mashed up for one of the better phrase, and you took a little bit. But the previous standard regular monitoring was for nasty I screen every three months, including that fourth generation HIV antibodies Aptitude test on the blood test for kidney function is repeated every 12 months unless the user is over 40 or has other indicators for a risk off renal disease and since covered on day for practical reasons and cost effective reasons to keep commissioner happy. And what we have seen is hybrid system where individuals will be able to visit clinic maybe once every other quarter. On do that, that alternate fill scream with a home, a sample kit, and I'm not being actively encouraged. Maybe because it's cheaper and also it's easier for a lot of users on. Is there any covert times? It was our only option. And again at the relationship which buildup between prep user on their clinic there Service provider would allow opportunity to discuss the difference for support services that may be needed. That relationship. But I have 2.5 minutes asks know as long as I thought I was gonna have when I got to this section. So I wanna give you a little bit of information just to take it away from the ABC on the technical stuff and just let you know how that really have a thing here in the UK So in 2015, there was no access to prep, but I personally I had tried to access prep myself on fails to do so. I'm failed to do so in the time you enter on subsequent me was diagnosed. Teacher, be positive on that. Spurred me on Teo. Find a way to make prep available outside of the energy s. So we went myself. Are my co founder Alex Credit. We went to see a friend. I was like, There's a friend who worked in the energy is on, but what that friend told us. Waas, that at their clinic they had a smoke. A wart off game by sexual man. Many gay man, actually who had been self sourcing this generic Truvada online and some of them for up to 18 months. That's our women in Proctor three years. But they had be monitored at that clinic for 18 months at the clinic with severe enough to record the names of the suppliers and to carry out therapeutic drug monitoring test where they could just verify drug levels. And the users blood on been confirmed that in fact, the drug course general. So our friend in the chest provided us with this information on back in 2015 that seem to cause I legal. It's not really scary and illegal on, so you're responsible if I'm perfectly over the spot. We did it. Three website was developed in four or five weeks on, but launched on a course of less than 150 lbs. So my diagnosis was the 12 of August and we started talking about a website that sort of September and it launched. Actually, it was the middle of September. I mean, on the 19th tourist. So it's just like six birthday just long, almost total set up costs less 150 lbs. So this little montage off images just to finish off just to kind of get your idea off high far and I speak when I say us I mean myself from I Will pet Wow, Alex critic are called Finder will not turned thrown prep stood on info and more Thompson from practice or not. And for relieve those community really grass roots or positions. We went a forest. We could go home. We did what we could in disseminating some sort of an equitable access. And but really, people like my legs up there with the red wall and the white tee shirt. Mike's approach. The GMC um, an afternoon. If they could initiate this conversation about prep on if they could sign post our website. So you know, that was a really crucial step in yeah, becoming acceptable. So my talents, the GNC mites also suggest that regular TV and monitoring for worse fires and then we worked with neck uh, you can see there are in the black T shirt and negative study on on therapy, drug wondering tests and from 50 16 straight, like this morning, my market center. Sheena a professorship. McCormick isn't actually actually funded. Some of the work up I will prep now is one that she was the lead lead on the proud study here in the UK on what they have found was the piece of their puzzle. That they were missing was community and gold. That's when we came along. There was a stone stone supporter and advocate. I mean, I think that's it, really. I just want to kind of border the flag up then. A lot of the collaboration between a medical sector and community activism in the early days is very gung ho, very underground. A lot of very, very gots a very brave conditions, correct with the neck and the reputations on the line and took a chance on some some wild troublemakers on. Do we where it only in situation we're in today because off off that relationship in the collaboration, So all that I would like to stop hand back to look, I think is going to hand over to my cold egg show. Thank you for listening, and I hope I didn't talk too fast.