Matthew Hodson is the CEO of Gay Men Fighting AIDS (GMFA), a charity set-up in 1992 to tackle gay men's sexual health. In the wake of yesterday's High Court ruling that NHS England does indeed have responsibility for commissioning HIV-preventing pre-exposure prophylaxis (PrEP) medication - and NHS England's promise to appeal - Matthew looks at the future of the battle against HIV/AIDS in the UK.
This blog first appeared on gmfa.org.uk.
After legal argument the High Court has ruled that NHS England is able to provide PrEP (Pre-Exposure Prophylaxis) to prevent HIV infections.
The NHS had argued that, as a preventative measure, the responsibility for providing PrEP belonged to Local Authorities. However, the NHS already provides other tools for prevention, including PEP, and its five year plan highlighted the importance of prevention as well as treatment.
In his judgement Mr Justice Green wrote: ‘No one doubts that preventative medicine makes powerful sense. But one governmental body says it has no power to provide the service and the local authorities say that they have no money… The potential victims of this disagreement are those who will contract HIV/AIDs but who would not were the preventative policy to be fully implemented.’
Over 3,300 gay and bisexual men were diagnosed with HIV in 2014. It is clear that unless we can add to our prevention options, we will see similar figures, or worse, in the years to come.
However, the High Court decision does not mean that people will now be able to access PrEP straight away. Instead, it sets us back to where we were at the beginning of the year. Before PrEP is made available, there needs to be a public consultation and then the NHS needs to make the decision, based on the outcome of that consultation and the best available evidence, when, how and to whom PrEP should be given.
We already know from numerous studies, including the PROUD study, that PrEP massively reduces the risk of infection. For preventing HIV, PrEP is more effective than condom use. Any further delay now simply means that more people will become infected with HIV, when that infection could have been averted.
When given to people at high risk of becoming HIV, it is cheaper to provide PrEP, which only need be taken for the period when someone is taking risks, than it is to provide HIV treatment and care, which is for life.
Let’s be clear, PrEP isn’t going to be right for everyone. I’m not advocating for all gay men to start taking pills daily. Condoms are a much cheaper strategy and with fewer side-effects (although PrEP is generally well-tolerated). We could go back and forth on the reasons why men don’t use condoms, and please don’t doubt that I’m a big advocate of condom-use, but let’s not allow men to become infected with HIV needlessly while we do so.
At GMFA we want to see fewer men become HIV-positive. We will continue to do what we can to ensure that gay men are well informed about sexual risk and how such risks can be avoided or minimised. We will continue to lobby for more money to put into prevention work (we receive no government funding for our website, FS or our sexual health campaigns) and for gay men’s health to be treated holistically, looking at all of the factors that contribute to our health inequalities.
It is not time to chuck out condoms or forget that gay men’s health needs are many and varied. There is still a need to challenge HIV stigma so that men can have more honest and more frequent conversations about actual sexual risk and to ensure that all gay men are informed and empowered to take control of their sexual health.
By adding PrEP to our prevention armoury, of condoms, testing and treatment, we have a real shot at radically reducing the number of new infections, leading at last to the end of HIV. However, we do not have PrEP yet and we must continue to lobby and agitate to ensure that all those at greatest risk of HIV infection, not just gay men but trans people and some heterosexual women too, will be able to get hold of it.
I welcome the High Court’s decision that the NHS is able to provide PrEP. We should not let tradition alone dictate how HIV is prevented. We now have all the tools that we need to effectively end new HIV infections, however, the puzzle is not complete unless we can add something more to our prevention armoury. PrEP’s effectiveness has been proven. This is no time for hesitation or procrastination. PrEP is needed now."
Follow Matthew Hodson on Twitter @Matthew_Hodson. Keep up to date with GMFA's vital work on Facebook and Twitter.
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