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NHS told to fund preventive HIV treatment

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The NHS has been told to prescribe a drug that would prevent men who have sex with men from contracting HIV.

A High Court judge yesterday ordered health officials to provide the daily 'PrEp' pills, which currently cost £400 a month when privately prescribed.

Many, including Christian Concern's Chief Executive Andrea Williams, have raised concerns that this treatment will encourage a risky and promiscuous lifestyle.

Prevents transmission of HIV

The pills contain pre-exposure prophylaxis (PrEP), an anti-retroviral drug which stops the HIV virus being transmitted between partners where one is HIV-positive.

It has been shown in tests to reduce the risk of HIV infection by up to 90%, and is already used in other parts of the world, including the United States, Australia and France.

Legal challenge to NHS

The National Aids Trust (NAT) brought a legal challenge against the NHS England, which argued that as it is a preventative drug, it does not have the power to prescribe it. It recommended that this responsibility should fall to local councils.

The High Court has now ruled in favour of NAT, with Mr Justice Green saying:

"In my judgment the answer to this conundrum is that NHS England has erred in deciding that it has no power to commission the preventative drugs in issue."

NHS England intends to appeal the decision.

'Challenge is underlying behaviour'

Commenting on the ruling, Andrea Williams said that this treatment would not solve the underlying problem.

"Of course, it is important that we protect people and seek cures from disease," she said.

"However the real challenge here is the underlying behaviour and lifestyle which is risky and damaging to good health and proper relationships."

Dr Peter Saunders of Christian Medical Fellowship (CMF) has also raised concerns about the ruling on his blog.

He notes that the drug is not a "foolproof" prevention, partly because those taking it are unlikely to do so regularly.

"According to the CDC (Centers for Disease Control) PrEP is for people who do not have HIV but who are at substantial risk of getting it. It should be used in combination with other 'HIV prevention' methods, such as condoms, but even in these circumstances is not foolproof.

"The CDC reports studies have shown PrEP reduces the risk of getting HIV from sex by more than 90% when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently.

"But these figures are what is achievable with good adherence (consistent use), and many of those most at risk are very likely not to adhere with taking the pills regularly."

'Risk compensation'

Dr Peter Saunders also points out that other sexually-transmitted diseases are more likely to be contracted if men use PrEp as an alternative to condoms.

"Furthermore the drug's use may in fact lead to a paradoxical increase in other sexually transmitted infections (gonorrhoea, chlamydia etc) by encouraging more high risk behaviour from those who have been lulled into a false sense of security.

"This well-known phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as 'risk compensation'."

He concludes that rather than dealing with the symptoms, society must look to the cause.

"We need instead to address the underlying structural drivers and social context of the HIV epidemic and ask what it is that actually leads people to behave in this way."

Related Links: 
High Court rules in favour of NHS providing 'HIV prevention drug' but big questions remain (Christian Medical Comment)
Aids charity wins battle over funding for HIV preventative treatment (Telegraph) 
NHS told to fund preventive HIV treatment (Mail) 


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