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5: Why are so many people still locked out of PrEP access?
In the fifth episode of this six-part limited series documentary, about the battle for PrEP access in the UK - Why PrEP, despite being now free on the NHS, is still so difficult for many communities to get hold of, and what it tells us about wider LGBTQIA+ health inequalities.

The Other Blue Pill has so far talked a lot about gay and bi men's sexual health, which is for a good reason with how much the HIV pandemic has affected us.

But this community isn't the only one who needs access to PrEP; it’s a drug that can protect everyone from HIV. This week, we focus on the nuances and needs of other marginalised groups of people who are also disproportionately affected by HIV and need better access to PrEP. We also explore the wider health inequalities these communities face - and what lessons those fights can learn from PrEP with guests:

  • Deborah Gold - Chief Executive of National Aids Trust
  • Marc Thompson - Co-founder of PrEPster and The Love Tank
  • Dani Singer - Act Up London activist
  • Vanessa Apea - Doctor with expertise in sexual health
  • Tarun Shah - Denied access to PrEP before being diagnosed with HIV
  • Lauren Duffey - Head of Services, LGBT Foundation

Credits: Hosted and written by Phil Samba. Produced by Jamie Wareham. A QueerAF Production for the Love Tank, with support from National Aids Trust.


Bridging prescriptions — QueerHealth

Full show notes, with sources

Deborah Gold

We knew that the NHS was going to appeal. So there was just a bit of a sense of kind of exhaustion and like, how are we going to do this again? And they also released a really damaging press release in response to losing, which was problematic on two fronts. It was essentially homophobic, you know, kind of, it was like dog whistle politics essentially saying all these promiscuous gay men want to have sex.

Phil Samba (Host)

Weeks after the first court case in 2016, National Aids Trust won it’s second court case against the NHS

The case meant the legal barrier the NHS felt it had to prescribe PrEP was lifted. But it was just the first of many more hurdles to getting this revolutionary drug to the people who needed it most. 

And let’s be clear, the legal fight wasn’t about whether the NHS WOULD prescribe PrEP. It was about whether it COULD. Getting it to do that was a whole other thing. 

So while Deborah and many of us were overjoyed by this moment, we knew there was a long road in front of us to get the drug to those who needed it most.

We’ve talked a lot about gay and bi men so far, which is for a good reason with how much the HIV pandemic has affected us. But we’re not the only people who need PrEP, it’s a drug that can protect *everyone* from HIV. Yet not everyone is taking it.

When PrEP first became widely known the HIV and sexual health sector focused heavily on gay and bi men because of our history with the virus. This was doubled by the stigma we face around men having sex with other men and our perceived notions of promiscuity.

Though we did incredible work that did raise awareness, I think many of us in the sector may have made a mistake by not focusing on other marginalised groups of people who are also disproportionately affected by HIV.

Marc Thompson

Okay, well HIV does affect predominantly gay men. In the UK, the gay men make up the largest number of people with diagnosed HIV. 

Phil Samba (Host)

That’s Marc Thompson, the co-founder of The Love Tank.

Marc Thompson

That's not the same globally. Globally, women make up a larger percentage of that. So I think it's really important that we look at that. But I think in the global north, that gay, bi and other men who have sex with men still make up the largest proportion of people who are impacted and make up the numbers.

But as we have seen over the years that the impact that there are more men from racially minoritized communities and migrant men and men who don't speak English as their first language are disproportionately impacted by HIV. So we can look at white gay men and yes there may be more of them who have HIV but we look at the numbers of black gay men who are smaller in population groups but have more HIV in that community, then that is a real issue. 

But we also know, we've learned over the years that that isn't because of anything that racially minoritized men, black gay men, and men from other communities are doing. So it's not about us having more sex, more sexual partners, more risky sex. It has a lot to do with social factors, access to care, access to testing, understanding that HIV impacts our communities, access to PrEP, understanding that PrEP is something that we should and could be taking to protect the sexual health of ourselves and our partners. 

So it's about health inequity. This is the reason why black queer men, racially minoritized men, make up disproportionate numbers of people who live with HIV or who are impacted by HIV. And until we fix that, until we fix those health inequalities, we are always going to see that disparity.

Phil Samba (Host)

Marc explains that institutional racism has an effect on healthcare for people of colour.

Marc Thompson

I think that institutional racism impacts the health and wellbeing and drives health inequalities because it's baked into the system. The system isn't made for us. It doesn't respond to the needs of black and brown and other racially minoritised people. It's an unequal footing from which we enter into the system. It's baked in that they are not looking to address our needs, but also how they treat us how they expect us to be within a particular space.

So that drives health inequalities, racism as we know drives health inequalities, drives poor outcomes around employment, around the criminal justice system. So all of those are tied together. So we can't undo one without undoing the other.

So it's not just a case of going, right, if we fix institutional racism in the healthcare system, then hey, job done we need to look at the criminal justice system, we need to look at employment, we need to look at education, because all of them tie together.

And until we start looking at it as a whole, like we look at the whole person, holistically, then that won't be fixed. So we are on an unequal footing from the minute, from birth, as people of colour, right through to death. So until that is fixed, then that's always gonna be the issue.

Phil Samba (Host)

So how can we start to dismantle systemic racism? Here’s a recommended read for you

Marc Thompson

The reason I ran off and I'm not sure if you want to use it, but I'll give it anyway. So I'm just reading Divided by Annabel Sowemimo. I think that's how you pronounce her name. And there's a quote in there, which I thought was just really helpful. Yeah, that's the book. Racist policy says exactly what the problem is and where the problem is. Institutional racism and structural racism and systemic racism are redundant.

Racism itself is institutional, structural and systemic and that comes from Ibram X. Kendi's book, How to Be an Anti-Racist. And so until we recognise that racism isn't just part of the institution, it's baked into life in this country, we're not gonna fix any of these issues. And that is the brave conversation, the radical conversation that people need to have to fix any of our issues.

Phil Samba (Host)

It’s not just gay and bi men who have had issues accessing the drug, this also affects trans and non-binary people too.

Dani Singer

So the barriers that trans people face in accessing PrEP, it kind of is quite polarised, I think, in people's experiences. 

Phil Samba (Host)

Trans people are less likely to take PrEP in the UK. Dani Singer, formerly of ACT UP London spoke about what it’s like being trans and trying to access PrEP in England, currently. 

Dani Singer

I think it depends what services they are engaged with. So for people like me who have been engaged with places like 56 Dean Street and so on, from pretty much from the beginning, I wouldn't really say there are any barriers to accessing PrEP.

I mean, that they will throw like boxes and boxes of it at you, even if you're just running out going, no, I've got some, I've got some. I was like, no, just take more, just take more. So that's one end of the experience spectrum. And I think, yeah, for people who are engaged in services, it's quite readily available. There are nuances within that as well, though, I think, in terms of information that people have access to.

Phil Samba (Host)

Dani mentions HRT in clinical services, HRT stands for Hormone Replacement Therapy, it’s sometimes known as gender-affirming hormone therapy.

For those of you who may not know what this is, it’s treatment with estrogen or testosterone that can bring a trans person’s physical characteristics in line with their gender identity.

And whilst like it's, it's fairly like everyone, like at the clinics will say to you like, Oh, this won't affect your HRT. If that's, if you're on HRT, this won't affect your hormones or anything because of the lack of research that's been done into how to take prep safely as a trans person who is accessing HRT.

Um, I feel like there's, there's still a lot of gray areas around like how, how people, how different trans people take their prep and what is considered safe and effective because of there's a total lack of research.

So that's more of the barrier for people who are accessing services. The main barrier broadly for the trans community is just a lack of access to services full stop. So I'm lucky, I live in central London, I can access Dean Street easily, I can access any sexual health clinic really easily. But that's because of the, you know, that, you know, I'm out in like my whole life, like I don't have any fears about accessing those services, there's no repercussions of me doing so in terms of my job or my community or my family or anything like that.

Around the country, there will be still a huge number of trans people who just can't access any services full stop for those reasons, for stigma reasons or for fear of being outed or for fear of, yeah, like, yeah, being put in difficult situations that would compromise their existing lives, so their families, jobs, communities and so on.

And then the broader question for like rural people, and like generally is like, you know, if you live in the middle of nowhere and you don't drive and there's like one bus a day, then how do you access any sexual health clinic? And obviously for trans people that's compounded because then they can't access any of the healthcare services that they might need.

Phil Samba (Host)

Postcode lottery’s are a term often used over here in the UK - it reflects that despite having one NHS - really, because of commissioning groups who make decisions at local levels, PrEP access changes depending on where you live.

Dani Singer

So I think, yeah, the experience is massively polarized depending on where you live and what community you have access to and how safe it is for you to access the services that you actually would like to. Because I think, yeah, the government say, oh, you can now get PrEP from any sexual health clinic. That's all well and good, but there's just like, there's a huge assumption there that it's possible for you to access that clinic, which for many people it isn't.

Oh God, I mean, like, I think it would be easy to say what are the barriers, like it would be quicker to say what are not the barriers, like where there's like, it's still so hard for trans people to access HRT. It's insane. I mean, it's, I'm not gonna go, like, I mean, people know about this, I'm sure, like the insane waiting lists. I was put on the, I mean, I'm a classic example, I was put on the waiting list to access a gender identity clinic in February of 2017. 

And I had my first appointment in August 2022. So that was five and a half years from being put on the waiting list to accessing the clinic. Now that was just my first appointment to actually get a prescription and to get anything happen with is like three plus appointments. Now, because I have access to the services I have access to, because I…

I'm a person who is quite confident and quite able to carry myself where I've been able to advocate for myself and for my healthcare needs with my GP long before I got that that GIC appointment. So I was already on hormones by that time for like four years. Yeah, so I was I was discharged pretty much from the GIC in that first appointment because I'd had my top surgery then. And I'd also been on hormones for ages and I was being prescribed and I'm still I'm now going to be prescribed my hormones forever by my GP.

However, there's like a lot of people's GPS aren't willing to do that. And there's no that they can do it, they absolutely can do it. But there's there's no, they don't have to do it if they if they decide they don't want to. And there are all sorts of cards they can pull to get around prescribing hormones if that's something they don't want to do for whatever reason, even if it's because they're transphobic, they can still you know, they can, they can find a way not to do it very easily. Um, so yeah, that's, that's the main barrier.

Then there's the cost of going private, which is obviously a massive barrier. And like, I mean, every single trans person has crowdfunded their, their gender, like reassignment interventions at some point. I don't like the phrase gender reassignment. I don't know why I said that. Um, but yeah, every single trans person I know who's like crowdfunded their surgery or hormones or just like the general living costs of being a trans person are absolutely astronomical, not only because if you do access hormones and surgery and things, then you need to think about things like buying new clothes and things like that. 

But generally trans people on the whole need to buy new clothes and things as well as their sort of expression of their gender develops and becomes more confident and changes, which we all do throughout life. I mean, that's not just a trans person thing.

Phil Samba (Host)

Listening to this, a much clearer context comes to light about why things are the way they are.

Dani Singer

But then there's the fact that trans people are statistically less likely to be in work or less likely to be in stable, well paid work. So that compounds their capacity to buy hormones privately. And the fact that we're crowdfunding from a community that statistically has less money anyway. So essentially there's just like, it's just wall after wall after wall up against trans people being able to access hormones.

A lot of people I know are just like buy hormones online and just sort of self-inject. And that's great. A lot of people doing that really, really safely and with huge amounts of community support. There's some really wonderful community initiatives that support people to do that and online resources as well that people access. 

And we've, I mean, we've just started a needle exchange now aimed at trans people who self -inject hormones or anything else. So, you know, like there are things happening that are just leaning into the fact that we as a community have always created our own resources for healthcare.

And I don't see, yeah, that doesn't seem to be changing anytime soon. So in answer to your very short question, Phil, what barriers are there to trans people accessing hormones? Every barrier imaginable is the answer.

Phil Samba (Host)

Given the current climate in the UK, with the press and politics’ focus on trans+ healthcare: Dani had a lot to say about how accessing hormone therapy works in England.

Dani Singer

So when I decided that I wanted to access hormones, I didn't really have much insight in how to do that. Apart from the standard, yeah, go on the gender, the waiting list for the gender identity clinic and sort of like shrivel up on that list or privately, like source it privately.

Neither of those things was an option for me. I was very, very poor at that point in my life and I didn't necessarily feel comfortable crowdfunding just because everyone around me was so poor as well.

So I did some digging online and I don't remember how I found out about it originally, but I worked out somehow and if someone out there sort of really led me to this and I've forgotten about that, I'm very sorry.

Phil Samba (Host)

Dani went into bridging prescriptions, which is incredible!

Dani Singer

But I found out about this thing called a bridging prescription, which is not something that's specific to trans related healthcare. It's a concept that's used for any specialist healthcare, which basically just means that whilst a person is on a waiting list to access that specialist clinician, there are aspects of healthcare that can be managed by a GP in the meantime.

So people might access this for all kinds of health conditions, including like cancer treatments and I don't know, like various other like hormonal sort of situations and things. There's lots of reasons why people might have a bridging prescription. So I read all sorts of, I read like government guidelines and all sorts of different things about how a bridging prescription was was managed and how it was like how you could get one in the first place and then I literally went to my GP. It was a very sweet lady in Limehouse, armed with all of these printouts which I'd like highlighted and cross-referenced. Essentially I had like a guide for her, like here's how you're going to prescribe me hormones, here's the blood tests I need, here's what we need to do, blah blah blah. Now she was fantastic. I can't remember her name now, fuck.

She was such a nice lady and she really wanted to help. So the first major barrier there I didn't have to deal with because I had a GP who wanted to help me and who trusted my expertise in what I needed.

So it was a slow process probably from having that first appointment with her to actually getting the hormones was like maybe six months, but actually that felt about right. And that felt like a good amount of time for me to do the processing that I needed to do at that time. And there was also a sense that things were moving and progressing. And then she did send me for literally every single blood test under the sun, bless her.

But yeah, in the end I was able to get the hormones on bridging prescription and then I was on that bridging prescription for like five years and now it's just a prescription. So that was a real process that as I sort of made more connections in the community, I understood that not many people had insight into.

Phil Samba (Host)

Dani spoke about how they used what they learned to teach others about bridging prescriptions and it reminded me of how historically queer people have had to take their health into their own hands and help themselves and those in their communities.

Dani Singer

And if they did, they didn't know where to begin or didn't feel confident going through that process sort of by themselves. So a couple of years ago, maybe three years ago, I don't remember, but I say my chronology is very bad. Some years ago, not many, The Love Tank was doing The Love Hub at Fringe Film Festival.

And Will always says to me, Dani, what do you want to do a workshop for The Love Hub? And I said, actually, yeah, I'd like to run a workshop about how to get a bridging prescription because I think people would really benefit from it. And I was writing notes for the workshop. And then as I was writing the notes, I was like, oh, I'm writing so many notes. I'm essentially writing a zine here.

And then I just made the zine. And the original copy is so DIY. Like, I'm very bad at drawing and graphic design. And like, I just, it's so bad. But, you know, we made like 50 copies of it and gave it out to loads of people.

And I'd be just out and about and people would come up to me and say, oh, my friend showed me your zine. Like, oh, I was at your workshop and actually this is really helpful. I'm really thinking about doing this now, blah, blah, blah. I did that workshop two years in a row. And then, yeah, after that, we turned it into the slightly more polished, slightly more polished version that is available now on the website.

But yeah, I still think that that's a really valuable resource and unfortunately not much has actually changed in this process that people need to go through to access hormones. So it remains pretty, pretty useful. And even the government guidelines and things that I think were due to be updated since I first accessed them. I think they just haven't bothered to update them because they didn't give a shit about trans people. So yeah.

That's how I created it.

Phil Samba (Host)

PrEP has most commonly been used by gay and bi men - but it’s not only for us. Research shows that PrEP works and can be used by everyone, including cis and trans women yet access to PrEP for women is still low worldwide.

Vanessa Apea

So I think all women, I think that's one of the first things that whenever we think about risk and who could be potentially a risk of acquiring HIV, that term risk is a really difficult term for people to understand.

Phil Samba (Host)

Vanessa Apea, an HIV and sexual health doctor talked to me about how HIV affects women.

Vanessa Apea 

So a lot of people don't even think they're a candidate for HIV. So I feel anyone that is having unprotected sex and identifies as female is a woman that is at risk of HIV. But when I think more specifically, when we're looking at who do we see HIV play out more in certain communities, then I do think of particularly black women.

I think of women of black African heritage and women of Black Caribbean heritage as well. And when we look globally, we can see that there are definite certain groups of women that are disproportionately affected. So in the United States, I mean, we've got over 50 % of the epidemic that is Black women that are affected. So within the UK, we see significant numbers of women being affected in all their diversity, but we do see a greater proportion amongst black women.

Phil Samba (Host)

For Vanessa, its important we talk about healthcare issues of both cis and trans women.

Vanessa Apea 

Again, one of the limiting things is the data that we have and not all trans people feel safe enough to record and say that they are trans. And also, they may not have the opportunity to even say that they are trans because the only way that you will be recorded is if there is a form or request for you to say your how you identify and then you have to have the opportunity to say that you are trans.

So one of the limiting factors is that we don't always have enough data but what we do know from the data that we have is that trans people are disproportionately affected as well and also that the support that they may need isn't always there. And they often feel quite marginalised and quite stigmatised in terms of accessing services that they need.

Phil Samba (Host)

This is important because there are different benefits women can have from PrEP.

Vanessa Apea

Women can benefit from PrEP in so many ways. I think that one of the most powerful things about PrEP is that it exists and it exists as an option and as part of anyone's prevention toolkit. But particularly for women, one of the important things to recognise is that when we think about women being disproportionately affected, from certain communities.

We also have to think of some of the added life experiences that may make them more at risk. And part of that is being in relationships in which they may not be able to negotiate condom use and may feel and not only may feel, they definitely are being oppressed and not being allowed to even choose that option. Also, the fact that there is something that an individual, and this is for everyone actually, that they can take and no one else needs to know that they are taking it. 

And it's something, it's a choice for them. And it allows in any relationship, in any dynamic for one person to acknowledge the realities of relationships, you know, that we can be here, we may feel that we're in a monogamous relationship, we may recognize that we may not be, but there is a possibility or a reality that there is another person within your relationship.

And when I mean that is just, you know, your sexual network, whether you've chosen that or not. And so, and sometimes it's difficult to approach your partner and say, I think there's another person in this dynamic, what do we do? And PrEP enables people to say, I acknowledge this, I recognize that I may not always be able to use condoms, or it may not be part of my life in this way, but I have something that can protect me from HIV.

And that is really empowering. And it also just acknowledges the realities of life. We can tell someone that you need to do X, Y, Z, but we all know that life is not like that.

And rather than labeling people, judging people, there is an opportunity for people to have an option to protect themselves. But also, you know, the importance of that is that we don't give PrEP in isolation. We give it with support and information so that you can enable people to negotiate and support them to have other decisions in the future as well.

Phil Samba (Host)

Pleasure is something that is often missing when it comes to women and sexual health. Vanessa had lots to say about this.

Vanessa Apea

Yes, so I do feel that PrEP will allow women to have greater pleasure doing sex. And the reason that I say that is the concern about being exposed and acquiring HIV can be really limiting.

And it can be limiting for the person living with HIV and it can be limiting for the person that's having sex with someone living with HIV and also whether they know it or not. And so the concern about, you know, letting yourself go and thinking, okay, I'm in this situation, I want to move on, I want to do more, and I want to feel confident to do more, but I'm worried about acquiring HIV, PrEP brings a different dynamic into the situation there are many scenarios in which people will find themselves in but if you are someone that is having sex with someone that is living with HIV and no matter having the confidence to say I want to explore you in all ways, you know as human beings even though we will know certain facts it may not give us the full reassurance that we need. 

So having PrEP in that dynamic as well gives an added level, I believe, of reassurance and it enables people to feel more confident. And, you know, pleasure is really aligned to confidence and self-esteem and also how your partner explores you as well. So it's not just you feeling confident.

If you're in a relationship that your partner knows that you're on PrEP, and that gives an added layer of confidence, then it allows your partner to explore you in ways that they may not feel confident to without PrEP. So I think PrEP, there's a really important conversation to be had about sexual pleasure anyway. 

I don't think we talk about that enough, but with PrEP, I think there are real opportunities. And I think more of our conversations need to focus on confidence during sex, sex positivity, self-esteem and how PrEP could play a part in that.

Phil Samba (Host)

The impact of people not getting hold of PrEP because of any of the barriers we’ve discussed so far today has a vast impact on people’s lives. As we’ll hear after the break. 

Outside of all the issues certain groups have with PrEP, there’s also the postcode lottery that I mentioned earlier in this episode that affects almost everything the NHS does, not only in England but right across the UK

We saw this as soon as the PrEP IMPACT trial launched in 2017. 

It showed that young gay and bi men were less likely than other men to take PrEP and this is an observation that has been flagged by researchers and clinicians as “of particular concern.”

Tarun Shah, was one of those people who had difficulty getting onto the trial.

Tarun Shah

I think it was the Terrence Higgins campaign years ago. I think it was being touted as a miracle drug and I think it sort of was almost some sort of myth for a while. And then the kind of way I really heard about it properly and what it did was when the NHS was kind of refusing to launch it as a drug straight away that they'd fund.

They're going through the trials with it and that's when I really properly researched it for the first time. Around that time, I think, I knew that there were lots of clinics around the country. I knew there were a couple in London who were doing the PrEP trial.

So I kind of applied for it or looked into it as soon as I could because yeah, researching it, why wouldn't you? I was a sexually active gay man, I was one of the people who was higher risk of contracting HIV, so I kind of thought it was a no-brainer really to look into it.

Tarun Shah

It was quite anticlimactic to be honest. I was just, the trial was full. They had enough gay men in their quota. You know, they were still searching for, I think, other kinds of people, people from different communities. But in terms of gay men, it was so popular.

There wasn't any room left.

Tarun Shah

I mean, it was very frustrating. I think it was frustrating, but also I don't think I thought about it too much at the time. I think I was like, okay, they're doing the trials. It's annoying that they have to do these trials and it's all just red tape and bureaucracy, but when the trial's done, I'll get on PrEP and that's fine. That's the way it is.

Phil Samba (Host)

PrEP could have been essential for Tarun in completely removing his risk of HIV.

Tarun Shah

I mean, I think I didn't take, I think, you know what, if I had taken it more seriously and if I had fully understood what PrEP could offer, I would have probably been able to budget for it. But at the time, I just didn't think I could afford it. There were, you know, I just come straight out of uni, I wasn't on a very good salary. I was you know, like an intern, I wasn't really, you know, any kind of expense that I didn't have to spare, I wasn't going to. And so I didn't think PrEP was that kind of essential for me at the time.

It was quite, I mean, it was a bit unusual in that I had quite a bad seroconversion. And I was in hospital for a few days after kind of contracting HIV, well, a few weeks after contracting HIV. And I found out by going to the GP, I sort of had come out of hospital, they'd done all the checks, they couldn't find anything.

They hadn't really told me any of the details of my blood results. And it wasn't until I came out of hospital maybe three or four weeks later that I went to the GP expecting a sort of glandular fever diagnosis. And it turned out to be HIV. And yeah, the GP was not very equipped, I think, to deal with it. Didn't really know what to say.

Like he just seemed very awkward and the only advice I got was that I'd receive a letter, a written letter through the post in three weeks time which at the time having just been given this like bombshell information which you know is life-changing for anyone, I was like wait what three weeks time in the post like can I get a phone call, can I like chat to someone and he sort of said no that's sort of the best we can do.

But after that, I kind of did my own research and I called Terence Higgins almost straight away and they talked me through it. They were incredible. I booked an appointment at a London clinic. I wasn't living in London at the time, but it was sort of the nearest big city that I was like, I'm going to be able to find some services and managed to see someone within a few days. So I mean, that's the regional disparity there, but I was quite lucky.

Phil Samba (Host)

Since 2020, PrEP should be available at ALL sexual health clinics in England but many people who want PrEP but are unable to access it despite the change in provision. And each area of the UK and England has its own challenges. 

Lauren Duffy 

So in Manchester there were a number of clinics on the impact trial and the spaces really weren't enough for the population. 

Phil Samba (Host)

Lauren Duffy, the head of sexual health at LGBT Foundation in Manchester talking about the PrEP Impact trial.

Lauren Duffy

What that resulted in was lots and lots of demand so the spaces on the trial filled up quite quickly and lots of people particularly towards the end of the trial still wanted access to prep through the trial and just weren't able to get on.

So I think in general, there have been over the last few years and particularly through the trial period, funding cuts around sexual health and health in general. So, you know, people weren't always able to access clinic appointments, there weren't enough appointments, there weren't enough clinicians available to see the number of people who wanted to get in.

Not all of the clinics across Greater Manchester at the time were offering sessions in ways which worked for people. So, you know, walking sessions weren't available in the way that they had been previously.

People were finding that in order to get an appointment, they had to go into queue outside clinics quite early in the morning, which obviously is really tricky for people who aren't out, don't want to be seen, don't want to be visible outside a sexual health service or for people who have ongoing health issues, don't have the physical ability to go and weigh in queues, or for people who are working or just don't have time. 

A lot of people do need to be able to go and walk in without weighing in in the morning. And similarly, some people really need appointment systems, which weren't working for people either.

Phil Samba (Host)

One thing that I think is misunderstood about Manchester is its rising population in recent years.

Lauren Duffy

I think Manchester's population has changed significantly. We have lots of people moving to Manchester who aren't able to afford to live in bigger cities like London anymore, so there's that. There's also, we have a number of different universities.

We have, you know, a thriving gay village in the city center, so There are a lot of younger people, a lot of queer people, a lot of LGBT people moving to Greater Manchester.

I think there is an issue with health funding and the amount of services which are available to meet that need and really work with all of those people who are coming to Manchester.

And again, it goes back to that issue of not enough space in services. And that's nothing against the services. Services are working really, really hard and are at absolute capacity. But we just need more. We need expansion to meet the need.

Phil Samba (Host)

Lauren also talked to me about what she’d like to see happen in Manchester in the future.

Lauren Duffy

There are lots of things I would like to see for Manchester in terms of sexual health. I think the biggest thing is just investment. We need more money, we need more staff, we need more space.

We need lots more decentralisation as well of sexual health services. So community -based services being able to do more primary care and general health services being able to work with sexual health more competently.

And again, it all comes down to investment, it comes down to training. But we know that there are so many people in Greater Manchester who just aren't able to access the sexual health services that they deserve to be able to access.

Phil Samba (Host)

This isn’t the first time a QueerAF podcast mentioned this bigger picture issue - in case you didn’t catch What The Pox? 

Last year, the documentary investigation into the MPOX outbreak painted the bigger picture of a crumbling and underfunded sexual health service in the UK and England. 

But crucially, it spoke about how we had the tools to prevent sexual health issues like MPOX, and HIV. But we just have to use them. 

So what do we learn from the history of the fight for PrEP in the UK? That’s in the final episode of The Other Blue Pill.


Season One
More Queer Health Stories