PrEP Decision Is Game-changing — But It’s Not Over Yet

Having turned down provision of PrEP — a preventative HIV drug — last year, NHS England was today defeated in the High Court, which ruled that NHSE is responsible for funding the treatment. This decision was hailed by campaigners as a huge success for the health of people with high risk of HIV — disproportionately men who have sex with men — however NHSE immediately stated that they will appeal the judgement and raised concerns over the cost of the drug at a time when the NHS budget is under large pressure.

As many in the LGBT+ community have stated, the concerns are not valid and the lack of conviction is not good enough. The number of MSM living in the UK with HIV is rising considerably, and this drug reduces the change of contracting it by over 90%, leading the British Medical Journal to state in no uncertain terms that ‘delays by NHS England will cost lives’. It is provided in many other countries across the world, including the US, France, Canada, even Kenya, but NHS England are dragging their feet to the disapproval of many.

Claims that the drug is not ‘cost effective’ are misled, as it costs significantly more to treat HIV after it is contracted than it is to fund preventative measures and stop it spreading (not to mention avoiding the personal trauma of discovering a life-threatening virus). The lifetime treatment for one HIV infection in the UK can be up to £400,000. Figures such as £400 per month per person for PrEP sound expensive — labeled by some anti-LGBT people as a potential ‘burden on the NHS’ — but compared to that cost, and considering that it is only provided for those at high risk, and considering that the total cost of administering it will be less than 0.1% of the NHS budget, it would clearly lack all good financial sense not to provide it.

The debate over provision of PrEP is worrying for a number of reasons.

Firstly, it reinforces the trend of our health system being firmly reactive, rather than proactive with regards to medicine. Short-term spending decisions take precedent over preventing the spread of disease and viruses in the future, leading to substantially greater cost and suffering in the long run.

There is also, clearly and perhaps more worryingly, a large backdrop of moral indignation from those who appear to fundamentally oppose investment into the needs of LGBT people. Would the same debate be had if it were about saving the lives of predominantly straight folk? Would there be the same moral crusade against ‘subsidising straights having sex’? Would there be calls for straight couples to ruin their quality of life with non-voluntary abstinence?

For the same reason that we do not allow the state to impede on the rights of women to have control over their bodies, we must not tolerate suggestions that men should be stopped or shamed for having healthy sex lives with other men — indeed, it is the job of the NHS to protect them (and any other citizen) unconditionally. Many of the same cynical attitudes were heard when the contraceptive pill was introduced for women, but the same principles applied and it stood the test of time. This drug will save lives, and allow many more to have trust again and build relationships that they couldn’t before — it is completely wrong to put a price on that.

There is plenty more to say about the debate over PrEP, and with enough pressure hopefully NHS England will give in and start doing its job of improving health and saving lives, but we mustn’t, however, forget that the UK is still behind in so many other areas. There is still no compulsory sex education — let alone LGBT+-specific sex ed — which is essential more than ever to combat stigma and teach safe practices, and with regards to HIV the country still lacks a mass testing system or a proper national prevention scheme. With a new Prime Minister and a newly-appointed LGBT+ Education Secretary and Minister for Women and Equalities in the form of Justine Greening, times are changing but uncertainty still fills the air.

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