Years from now, when history notes how the fight against HIV/AIDS changed in 21st-century Britain, Gold and Azad will be featured prominently. More than anyone else, Gold, the CEO of the National AIDS Trust, and Azad, the charity’s director of strategy, ensured that the pill that prevents HIV would become available to those who need it.
The National AIDS Trust (NAT) is a relatively small charity with limited funds – and certainly not with the kind of budget that can bring a major lawsuit to the High Court. But that is what it did when NHS England announced in March that despite 18 months of consultations with HIV groups about the prospect of commissioning PrEP, the process would be derailed – ended, and with it any hope of ensuring those most likely to become infected could have access to the drug regime.
The NAT objected. They consulted lawyers. They met with other HIV charities, experts, and HIV patient groups. And they strategised. In June, they sent a legal letter to NHS England, which initially prompted a decision to reconsider ending the path to commissioning. This reconsideration failed to deliver, and so NAT filed legal papers to the High Court. NHS England had claimed that it could not, and therefore would not, commission PrEP because HIV prevention was the responsibility of local authorities. Unfortunately for NHS England, it had not considered what Azad had.
As Gold and Azad discussed the case with lawyers, he suggested something that would prove a pivotal part of the legal arguments: PrEP was not, strictly speaking, prevention but treatment because the drug (known by the brand name Truvada) did not prevent the virus entering the body, but rather dismantled it once it had.
With Azad’s strategising and Gold’s stewardship galvanising support from across the HIV sector, the NAT won the legal battle. However, NHS England not only released a press release saying other patient groups would be affected, but also appealed against the decision, prolonging the legal battle, which again NAT could scarcely afford.
When BuzzFeed News met Gold and Azad at the Court of Appeal in November, just before the decision, there was considerable anxiety in the air. Minutes later, the judge rejected the appeal. The NAT had won again. Four weeks later, NHS England announced that 10,000 people would be prescribed PrEP over a three-year trial, after which a larger rollout would happen.
“This has the potential to have a transformative impact for thousands of people,” said Gold. The game had been changed.