The court has ruled that NHS England will provide the drug that prevents transmission of the virus – here’s what you need to know
This week, the National AIDS Trust won a lengthy battle in The High Court with the NHS over the accessibility of daily HIV preventative drug, PrEP, after health bosses argued it was not their “responsibility” to provide the drug. Despite NHS England already announcing an appeal, the judicial review allows the NHS to fund a roll out for the drug. But what actually does it do?
PrEP (or Truvada) works by interfering with an enzyme that HIV infected cells use to make new viruses. Using the daily drug has been shown to reduce the risk of HIV by 86 per cent with a recent study concluding that daily access to PrEP to 25 per cent MSM (men who have sex with men) would reduce new HIV cases by 44 per cent.
For many, the judicial ruling was a huge victory for LGBT people, with PrEP setting to benefit those with multiple sexual partners to those in relationships with HIV+ people. But of course, it is far more than just gay men who are at risk of contracting HIV and the drug will benefit people from all corners of society. To make sense of what the drug is, what it will do in the UK and who thinks what, we have compiled everything you need to know about it.
PrEP isn’t for life
One of the arguments put forward by those against the drug is the cost of it to be made readily available. Don’t the NHS have bigger things to care about than gay men having bareback sex? Why should the NHS pay for a lifestyle choice? Gay men pay taxes the same way straight people do and have the right to access healthcare based off of lifestyle choice.
As it stands, monthly access to PrEP will cost the NHS £400, with many dubbing it as “not worth it” while 5,000 people are being diagnosed with HIV year on year in the UK with their treatment costing near on £400,000 over the course of their lifetime. PrEP isn't for life, with many taking it in temporary stages, be that two months or six years. As people’s circumstances, relationships and sexual desires grow and change, as will their need for PrEP.
If you have 4,000 men on the drug, it only needs to stop 43 of them contracting HIV to pay for itself. One of the biggest concerns people have with the drug is its inability to prevent other STI/STDs. PrEP will be provided via prescription with medical education and advice with a reminder of the risks of condomless sex, Hepatitis C, Syphilis, Gonorrhoea and other sexually transmitted infections and diseases.
It is a step forward in tackling London’s chemsex crisis
As Grindr continues to be the “uber for sex”, with dick available at the tap of a finger, and gentrification takes savage aim at London’s LGBT venues, it is the chemsex crisis that PrEP will help change. “Chemsex” refers to the use of certain drugs (any combination of crystal methamphetamine, mephedrone and/or GHB/GBL) used before or during sex by gay men, usually in group “chillouts”. 80 per cent of gay men using drugs for sex inject, often sharing needles and putting themselves at high risk of contracting HIV.
When a gay man’s high is about to kick in, how can he make sure the stranger he is about to have sex with at a chill-out has put on his condom? In a Tina-fuelled blur of anonymous nameless faces, what happens when one person steps out of line? if group sex is occurring, how is it determined who did what and when to who and how? A disinhibited gay man going under because of the amount of meth he has taken cannot physically be responsible for whether his sexual partners have put the protection that they promised to on.
David Stuart of sexual health clinic 56 Dean Street told Dazed: “Chemsex can be very attractive to people navigating complex sex and romantic lives. While the use of drugs (or “chems”) can seem to resolve some of these complexities, the powerful, disinhibiting high they offer, can easily translate to poor choices and poor condom use. Many sexual health clinics are reporting higher numbers of gay men using chems for sex, and the role chemsex is playing in increasing sexually transmitted diseases is indisputable.”
It is not a get out of free jail card for gay men to live “hedonistic lifestyles”
It’s 2016, and the Daily Mail’s front page today scrawls that the roll out of the drug is a “skewed sense of values” in a splurge of slut shaming and homophobia. It has been HIV’s stigma that has held the game-changing drug back. PrEP is designed to prevent HIV infections amongst those of us who sometimes exercise poor judgment in regard to consistent condom use. Poor judgements form negative societal values which lead a narrative of stigmatisation. This stigma of unsafe sex has been used as a ironically metaphorical-condom, creating a barrier for those who need PrEP and the drug itself. HIV isn't a death sentence anymore, but the stigma ruins lives and it is the duty of the NHS to have the medical desires of the public at best interest.
PrEP’s long overdue public availability does not mean that gay men are suddenly going to stop using condoms and start breeding like rabbits, nor does it promote unsafe sex. To assume we live in an age where everyone just whacks on a condom before sex is ignorant and something that is not going to change. The drug being made available does not necessarily mean that condom usage levels will change or whether PrEP users will always have unprotected sex. Condoms aren't 100 per cent effective and it’s just an added barrier of protection for many, but a barrier that could and will save lives. Saying that PrEP shouldn’t be used as it’ll encourage unsafe sex is no different to claiming that we vaccinate against flu just so we can sneeze on each other.
“HIV isn't a death sentence anymore, but the stigma ruins lives and it is the duty of the NHS to have the medical desires of the public at best interest”
The drug that makes PrEP - Truvada - is already used by the NHS
The NHS offers Post-Exposure Prophylaxis (PEP) as emergency treatment for those who have had sex in a risky setting to help prevent the contraction of HIV, similar to the concept behind the morning after pill. PEP is made up of two Raltegravir tablets and one Truvada tablet; aka PrEP. A monthly supply of PrEP through privatised healthcare or from online drug stores can cost up to £350 a month, making it out of reach for all but the most wealthy. This has led to ‘clinic-hopping’ becoming a daily way of life for many people, travelling between sexual health clinics to claim they’ve been in high-risk settings and had unprotected sex to receive Truvada in the form of PEP. It’s a controversial move, but one which articulates the desperation so many people have for the drug to be made available.
PrEP will benefit more than just the gay community
Recreational drug users are at high risk of HIV with clumsy shared needle usage and higher chances of sexual assault and abuse. Similarly, sex workers across the UK are paired in a myriad of sexual encounters that may put them at risk. For ethnic minorities who are still more likely to contract HIV and those who are economically not able to fork out private healthcare funds for the drug, providing PrEP readily and free on the NHS will inevitably change and benefit the lives everywhere you go. The drug has shown amazing results in the USA and has even been rolled out in Kenya. In no ways is PrEP the answer to HIV, but it’s another vital building block into fighting new cases of the virus in the UK.