8 Oct, 16 | by bearp
Guest Post by Nathan Emmerich
In the UK, a recent high-court decision has reignited the debate about whether or not Pre-exposure Prophylaxis (PrEP) should be provided to those who are deemed to be at high-risk of contracting HIV. Despite the fact that NHS England is now appealing, it was a fairly innocuous decision: having suggested that they were barred from funding PrEP, the court ruled that it would be legal for the NHS to fund PrEP and that they should therefore consider doing so.3
What is less innocuous are debates about whether or not access to PrEP should be publicly funded at all. Whilst individuals report being able to buy a month’s supply online for around £45, the annual cost of the drug to the NHS could be more than £4,000 per patient. Although this may seem a relatively exorbitant expense, it makes economic sense to provide PrEP; doing so could prove to be cheaper than providing treatment to those who would otherwise become HIV positive.
Despite this sound economic rationale, the media, or certain sections of it, have predictably focused on one particular group who are candidates for the drug as they are at higher risk of contracting HIV: homosexuals. In particular, the debate has centred on promiscuous gay men or, to use the academic term, men who have sex with men. This includes individuals who regularly have sex with new partners, as well as those who engage in protected and unprotected group sex.
Perhaps as a result of this focus, the view that public funds should not be used for PrEP seems fairly widespread. But while public acceptance has not yet been fully achieved, the Equality Act (2010) means that it is illegal to discriminate against individuals on the basis of protected characteristics such as sexual orientation. We should, therefore, be concerned that arguments against funding PrEP might be motivated by some degree of homophobia. If this charge is to be answered then we need to consider the arguments for and against the funding of PrEP in more detail.
There are, of course, plenty of other social groups that could benefit from PrEP, including some who are stigmatised, such as sex workers, and others who tend not to be, such as monogamous sero-discordant couples (i.e., a monogamous couple, one of whom is HIV positive and one of whom is not). However, reading the commentary on this issue would seem to indicate that the disinclination to fund PrEP is not applied equally. Thus, providing PrEP to hetero- or homo-sexual couples seems to attract support, but this is not extended to those whose sexual practices involve promiscuity.
As such, it would seem the opprobrium at work in this matter is primarily directed at non-monogamous ‘lifestyles’ and with sexuality playing a secondary role.