Chris Creegan

Comment | Ideas | Opinion

PrEP: a sweet pill to swallow

by Chris on 10th April 2017

It’s not often that I shed a tear at a public policy announcement. But today I did.

I cried when I heard that Scotland had become the first of the UK nations to approve the provision of PrEP (Pre-Exposure Prophylaxis) by the NHS to prevent HIV. The announcement was made by the Scottish Medicines Consortium (SMC) shortly after lunchtime.

All that will sound quite obscure to many people. And it’s true that the reason for my emotional response is very personal. My first partner died of HIV-related illness 22 years ago. He would have been 60 this coming August. Had he lived he might now be approaching old age with dignity and confidence. Instead, he hurtled towards old age in his mid-30s with fear and uncertainty and died at 37.

It is a cruel twist of fate that had he held out for just another year or so he might still be alive. His death occurred on the cusp of the introduction of retroviral drugs which stopped HIV being a premature death sentence in the UK. He didn’t but ever since I have hoped that his death might not have been in vain.

If you haven’t lived alongside or with HIV it will be harder to understand the magnitude of the arrival of PrEP and the significance of today’s announcement. But I hope you will welcome it nonetheless.

PrEP has been shown, in multiple studies, to prevent new HIV infections. What happened in the mid-90s with the arrival of retroviral drugs was a huge step forward and a relief. It stemmed the tide of death in certain communities like my own. And if you think that sounds dramatic, ask any gay man of my generation living in London then how many funerals they went to in the 80s and 90s.

What has happened today is a game changer beyond our wildest dreams back then. It means that young gay men, still amongst those most at risk of contracting HIV, can imagine a life without it. They will be able to do something we couldn’t do. They will be able to approach sex and relationships without the fear of HIV. They will be able to love freely.

This isn’t, as John Humphrys suggested on the Today programme this morning, a call to gay abandon. Humphrys stopped short of explicitly condemning gay men as promiscuous by using that well-worn cliché, ‘lifestyle choice’. But the assumption in his line of questioning was clear enough.

Rather than using the comparison of an actual lifestyle choice like smoking or drinking, he suggested that making PrEP available to gay men might be at odds with curing sick children. Thanks John. A life’s a life, you know.

My friend, George Valiotis, Chief Executive of HIV Scotland, remained commendably unflappable in the face of Humpreys’ offensive rhetoric. In doing so he made the very points that a more enlightened approach to the interview might have sought to elicit. Not least that making PrEP available on the NHS is by far the more cost-effective way of dealing with a virus that remains a major public health threat and a significant drain on resources.

It doesn’t take much to work out what the real public interest story is does it? I understand from George that he fared much better on Good Morning Scotland. Amen to that.

And there’s the thing. The announcement by the SMC today is as much as anything common sense because PrEP has been deemed a cost-effective treatment to prevent the transmission of HIV. If anyone can think of a better reason for it being made available on the NHS I’d like to know.

But, of course, the announcement is a victory for other notable reasons. It is the mark of an entirely rational choice about effective health provision in an enlightened country. It is also completely consistent with an approach to health care which says that investing in prevention rather than treating symptoms is best. It saves money and lives. So this is about reconciling values and costs.

Above all, it is emblematic of a humane society, the deliberations of whose institutions have risen above the scourge of stigma which is still pervasive when it comes to HIV.

And just like so much that has been achieved in relation to HIV, it didn’t happen by accident. It happened because George and others worked tirelessly to make it happen. So tonight I will be drinking a toast to them and the HIV activists who came before them, so many of whom didn’t live to see today.

I shed a tear today because this is the beginning of the end of HIV. And take it from me. That’s worth celebrating.

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