Comment

Sex, PrEP and the moral backlash

A High Court decision on the funding of a drug that prevents HIV has been condemned for encouraging hedonistic behaviour by gay men. The row shows that the prejudice of the 1980s lingers on.
HIV drug

A High Court decision on the funding of a drug that prevents HIV has been condemned for encouraging hedonistic behaviour by gay men. The row shows that the prejudice of the 1980s lingers on

The announcement this week that the National AIDS Trust had won its High Court challenge for Pre-exposure Prophylaxis (PrEP) to be provided by NHS England has made the headlines.

Picture: Alamy

HIV/AIDS activists' argued successfully that costs for prevention as well as treatment of HIV lie within the remit of the national organisation. NHS England, which has said it will appeal the High Courts decision, maintained that the costs of funding PrEP should be met by local authorities as part of their existing responsibilities for public health.

Inevitably, much was made in the media coverage that followed the decision about the costs of the treatment 400 per person per

...

A High Court decision on the funding of a drug that prevents HIV has been condemned for encouraging hedonistic behaviour by gay men. The row shows that the prejudice of the 1980s lingers on

The announcement this week that the National AIDS Trust had won its High Court challenge for Pre-exposure Prophylaxis (PrEP) to be provided by NHS England has made the headlines.

HIV drug
Picture: Alamy 

HIV/AIDS activists' argued successfully that costs for prevention as well as treatment of HIV lie within the remit of the national organisation. NHS England, which has said it will appeal the High Court’s decision, maintained that the costs of funding PrEP should be met by local authorities as part of their existing responsibilities for public health.

Inevitably, much was made in the media coverage that followed the decision about the costs of the treatment – £400 per person per month – as well its use by gay men in a research trial.

The furore was a reminder of a dark past and the 'moral' rhetoric about HIV/AIDS.

Thirty years ago, I qualified as a nurse from Sheffield City Polytechnic (now Sheffield Hallam University). 1986 was the beginning of the 'AIDS pandemic'. Across the world, young men were dying.

My early years as a nurse working in sexual health were shaped by the effects of AIDS on society. As a nurse/outreach worker at that time, I witnessed individuals and communities disrespected, abused and vilified for belonging to what were deemed 'risk groups'.

Advanced understanding

The successful use of PrEP to prevent transmission of HIV is a milestone in our battle to manage and minimise the effects of this terrible disease. It signals the achievement of science in advancing our understanding of HIV/AIDs to the point where it is now a chronic condition rather than a life threatening one.

People living with HIV are no longer dying in the UK within weeks of diagnosis as they were in the 1980s, but are able to fulfil their life plans – and society benefits as a result.

News stories and commentaries on the PrEP decision asked whether 'public money' should be spent on a drug to prevent a condition which is easily managed through simple condom use. This appears to be a valid question. But the question was followed by concern about the 'risk' of encouraging hedonistic lifestyles, promiscuity and lack of responsibility among gay men.

What struck me was the link made between prescribing a drug to prevent HIV transmission and enabling gay men to take less responsibility for their health. In 1986 some people also argued that sexual health and prevention of suffering from sexually transmitted disease was a questionable use of public money in cases where individuals should exercise 'control'.

Questions about self-control are not raised about new innovations for contraceptive drugs. Would the £400 per person cost of PrEP be less of an issue if it was a preventive drug focused on heterosexual relationships rather than gay men?

Human rights

It seems that while the treatment and management of HIV/AIDS has moved on, the views of many have not.

Questions about who should pay for advances in medicine and whether spending is warranted in relation to cost are always valid. However, we must not lose sight of how easy it is to return to the marginalisation and 'immorality' discourse which hampered our efforts in the past.

Sexual health is an essential part of our rights as human beings.

While we are right to ensure that scarce resources are used appropriately to the benefit of the whole population, let us not forget the mission of the NHS at its inception, which is still written in the Five Year Forward View – ‘high quality care for all, free at the point of need’.

Laura Serrant

Laura Serrant is professor of nursing at Sheffield Hallam University

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