UKC

Just noticed that the NHS has been told by the high Court that it can/should prescribe a 'preventative' AID's drug to gay men at a cost of £400 a month each.

Gay men it appears feel that it is there fundamental right to have risky/unprotected sex as the NHS is required to dish them out these preventative drugs i.e. screw everyone else I'm pissing in the pool.

In reply to Indy:

The NHS is free at the point of delivery. A person who has HIV is no different than a climber who has a mishap whilst bouldering. Modern life has many hazards, take your pick, but don't undermine any treatment that is effective or a persons entitlement to that treatment.

In reply to Indy:

1) "Can". The High Court didn't say anything about "should."
2) Why should we give anyone vaccinations against any STD the dirty buggers? hint: there is an answer

In reply to Removed UserDeleted bagger:


Your missing the point, this isn't a treatment after infection it's a preventative measure.
According to the news report I heard at lunch time on radio 2 there is a proportion of gay men having in protected sex with multiple partners who are at risk of hiv and they are the ones who should get this preventative drug at a cost of £400 per month.

WEAR A BLOODY CONDOM

In reply to Removed UserDeleted bagger:

The NHS is free at the point of delivery. A person who has HIV is no different than a climber who has a mishap whilst bouldering. Modern life has many hazards, take your pick, but don't undermine any treatment that is effective or a persons entitlement to that treatment.

You do know that it is a preventative drug as opposed to a treatment?
I personally think the drug is a good thing if it does indeed prevent HIV. However, why limit it to male homosexuals? If it's going to be available on the NHS, then it needs to be available for all people that are perhaps promiscuous and/or indulge in unprotected sex, etc.

In reply to Indy:

i just wouldnt have sex with someone if there was a high probability of getting HIV. that seems logical...

In reply to La benya:


It is logical, but people aren't always logical. So if I'm going to have unprotected sex, because I don't always make the logical choice, is it cheaper to give me the preventative drug or to treat me for HIV?

In reply to Indy:

The NHS didn't dispute that providing the preventative drug would be more cost effective than not providing it. The only dispute was over whose budget it should come from; the NHS said it should be paid for by the local authority and the LA said it should be paid for by the NHS. The judge ruled that it should be paid for by the NHS.

From the judgement:

"The charity argues that both medically and economically the case for NHS England to commission the drugs for this prophylactic treatment is overwhelming and indeed there has been no suggestion from NHS England that this is not the case. A quick comparison of the cost of treating HIV related infections across a person’s lifetime, compared to the relative cost of providing drugs on a prophylactic basis, shows that the savings from PrEP may be considerable. In these budgetary constrained times, when there is an ever increased focus on preventative medicine as a means of curbing future costs, the policy logic appears unassailable and, once again, it is said that there is no serious demur to this proposition from NHS England."

In reply to Indy:

Seems quite reasonable to me. The cost seems quite high but it'll likely fall in time or these drugs will fall by the wayside as better alternatives, perhaps even a vaccine emerge. Indeed those deemed most at risk may only need the drugs for a short crisis period (sex work, IV drug addiction etc). In the mean time we potentially improve a serious public health situation and save future costs (not just financial) of treating an infection and any possible associated re-transmission to third parties.
jk

In reply to Indy:

Gay men it appears feel that it is there fundamental right to have risky/unprotected sex as the NHS is required to dish them out these preventative drugs i.e. screw everyone else I'm pissing in the pool.

Apparently, they are now the drug of choice at Michael Barrymore's parties...

In reply to Dax H:


Of course. If you want a population level effect for the lowest possible cost, then these are precisely the people who you should give it too. It has the highest effect on the transmission rate (per prescription) as well as giving the greatest possible saving on HIV treatment.

It has the added bonus of giving protection to others who may be exposed through no fault of their own (accidents, infidelity etc).

In reply to FactorXXX:




Is it any different to the pill then?

In reply to Indy:

(1) Prevention is financially cheaper than managing the possible HIV infections which may otherwise result.

(2) The NHS routinely pays for oral contraceptives for heterosexual women to prevent pregnancies which could just as simply be prevented by using condoms. OP, can you think of any argument that can be reflected in this window that doesn't paint you as a homophobic wanker?

The cost is high but the drug is cost-effective. The cost will reduce significantly in the near future as patents expire.

FactorXXX - I don't think there is anything in the judgement that limits the prescription of PrEP to gay men.

In reply to Roadrunner5:


£396.10 a month.

In reply to FactorXXX:

There is a good case for offering it to IV drug users as well, but the answer to that is in the epidemiology of the disease, the mean R0 amongst homosexual (or bisexual) men is much higher than for other groups as they are the only group where both receptive and insertive anal intercourse occur in the same individual. If you are going to give it to anyone, it is to this group.

In reply to MarkJH:

There is a good case for offering it to IV drug users as well, but the answer to that is in the epidemiology of the disease, the mean r0 amongst homosexual (or bisexual) men is orders of magnitude higher than for other groups as they are the only group where both receptive and insertive anal intercourse occur in the same individual. If you are going to give it to anyone, it is to this group.

As long as it's realistically available to all high risk groups, then there shouldn't be a problem.

In reply to duchessofmalfi:


YAWN.

As for an argument.... now about men not sticking their todgers into every Tom, Dick and Harry? (pun intended)

In reply to Roadrunner5:


Well the pill costs about £50 a year not £4,800 a year and the pill has a very important feature of providing women with the ability to control their fertility in cases where sex isn't consensual or the bloke refuses or is incapable of using a condom.

So really it's very different.

In reply to gethin_allen:


The PrEP drugs are sufficiently cheaper than the 360k / year it costs to treat someone with AIDS to make prevention cost effective; a point which was not disputed by the NHS in the case.


Presumably PrEP has a similar feature of providing men (and women, for that matter) with the ability to control their exposure to contracting AIDS in similar circumstances.

In reply to Indy:

I take it you're content with sounding like a homophobic wanker then?

In reply to duchessofmalfi:

"...can you think of any argument that can be reflected in this window that doesn't paint you as a homophobic wanker?..."

I've always been told that once you have to start swearing and throwing insults around you've lost the argument.

"> The cost is high but the drug is cost-effective. The cost will reduce significantly in the near future as patents expire."

The patents will be around for a fair while yet so that isn't really an argument for today. As it is it cost near as £400 a month.

"I don't think there is anything in the judgement that limits the prescription of PrEP to gay men. "

This is true.

I really don't understand why people can't use condoms or why people want to take the risk even if they are taking this new preventative drug.
The drug is supposedly 90% efficient, so it's 10% inefficient, would you like to take the chance if there was a 10% chance of catching a life changing disease?

I really don't think this is a drug the NHS should be funding, especially with it in it's current state. There are hospitals closing wards and making redundancies because they can't afford to run them.

In reply to Indy:



How are you going to bring that about?

In reply to Dax H:

You're missing the point.

£400/month of prevention may be more valuable than £x/month of treatment.

In reply to Bob Hughes:
>The PrEP drugs are sufficiently cheaper than the 360k / year it costs to treat someone with AIDS to make prevention cost effective; a point which was not disputed by the NHS in the case.

But condoms are far cheaper and have a much higher efficacy than these drugs


You could say this, but in the case of AIDS transmission it's a 2 way thing, the giver (not sure if that's the best way to describe things) is also risking themselves as well as the taker. In the Heterosexual model the deal is more one sided when it comes to conception.

In reply to gethin_allen:


This is the issue. It's not, IMHO, anything to do with the sexuality of the individuals. Circa 5k a year worth of treatment on demand for people who deliberately indulge in high risk practices is potentially a huge cost to the NHS.

I accept we need to look at vulnerable groups, those with mental health issues with chaotic sex lives and limiting HIV spread from a public health point of view. However 5k a year from the NHS just because someone can't be bothered with condoms? Probably be cheaper to pay for the anti retrovirals for that very small subset of people than fund condomless sex for the masses.

In reply to Indy:

for the majority of people it's a pretty non headline worthy bit of news that seems to be used to create outrage for the sake of making money for the papers again.

The high court hasn't fleeced the NHS, the cost was going (possibly..it's not being enforced) come from somewhere, it was just the high court saying the NHS was best to do it instead of local councils.

Behind that story you have this shock figure going to a minority that often are treated with prejudice.
What isnt' said in the papers is as many above have explained - it's cost saving based against the treatment for those infected. Also there's other similar preventative methods that cost money but save it int he long run. think of the funding going towards preventing obesity and related illnesses. help stopping smoking. help stopping drugs, cutting alcohol, cutting protection free sex in general.

It's a complete non headline except for those who are at risk and may be relieved to see movement.

but given recent posts from you I don't think it's as much the media stirring up your hidden prejudice like it will be for most, it's that you are a pretty unpleasant individual.

In reply to Ridge:


Except that it isn't, as was shown by the charity who brought the case, not disputed by the NHS and accepted by the judge.

In reply to Indy:


Fixed that for you.

In reply to gethin_allen:



That's as maybe but for whatever reason, the group of people this treatment is targetted at aren't using condoms. So until we can find some way to get them to do so, providing them with retrovirals preventatively is cheaper than sitting back and letting them get AIDS.


No, its a one-way thing. When two people have sex, one of whom has AIDS, only the one who doesn't have AIDS yet can catch it. The person who went into it having AIDS already doesn't get more AIDS.

To be slightly less facetious the risks of giving and taking are highly asymmetrical.

In reply to gethin_allen:
I believe Truvada is covered by a number of patents due to expire between 2016 and 2024 depending on the exact claims covered but most expire in the next two years opening the way for generics in the near future.

Regardless of whether or not you understand why people don't use condoms 100% of the time it is an empirical fact that large numbers of people don't use them, gay or straight. You could put this into the category of not quite rational risk taking behaviour like drink driving, speeding etc. Just think of the number of pregnancies that occur "by accident".

From a purely health-care economics point of view it is rational and cost effective to offer PrEP to certain patients. I wouldn't offer it to everyone because the ost/risk/benefit/economic analysis doesn't add up for everyone, but, for certain groups of people, it offers positive outcomes in terms of cost/risk vs benefits/economics. Why would you withhold it if you knew that to do so would, on average, be costlier and ruin people's health? To put it another way more hospitals will close without PrEP than with PrEP.

The court case was nothing to do with the effectiveness of the treatment - simply to do with who should pay, the NHS or local authorities.

We could have a different system that said "f*ck you" to everyone whose behaviour might have contributed to their healthcare needs: f*ck you to drinkers and smokers, f*ck you to the overweight, f*ck you the lazy, f*ck you to climbers etc etc but I'd prefer a society where you didn't have to step over the dying and crippled on the way to work and we treat everyone without blame and with compassion.

In reply to Ridge:

High risk practices... Didn't this used to be a climbing forum. Who are we to judge.
Jk

In reply to duchessofmalfi:

Well said.

In reply to Scarab9:


Every other preventative drug that does or doesn't get approved for use by the NHS gets discussed so why not this one? In all probability it will save money but it's not cut and dried. Prescribing to all sexually active gay men will be expensive (if not all then we are already making value judgements on who should or shouldn't get it). Obviously this cost should be stacked against the cost of treating new HIV cases a year, but this is only 86% effective so it will prevent ~5500 new cases per year. But, what if people's behaviour changes and the number of cases doesn't drop as much as expected? I'm not saying this shouldn't be done nor that it is not cost effective, simply that there are questions to be asked that aren't necessarily homophobic. Dispassionate yes, but then that's always the case with these things.

In reply to Bob Hughes:

Pretty sure the £360k is the average cost of lifetime treatment for HIV.
Against this, £5k a year is significant, although listening to the news it seems some groups have a 1 in 7 chance of having HIV, so it may still be cost effective.

In reply to stevieb:

Yes you're right. Thanks for the correction.

It doesn't change the basic point that the numbers were presented during the case, the NHS didn't dispute them and the judge accepted that the economic case for providing PrEP was very strong.

In reply to Indy:

Taken the same combo after being exposed to a HIV infected blood spill, definately didn't feel or think about having sex for a month. The irony of PrEP.

D

In reply to gethin_allen:



You think that's why women take the pill?

You also have a rather negative view of equality in a relationship.

I think it's primarily cycle control and pregnancy, not consent.

Looking at the cost then you have to also balance it with cost of HIV treatment.

In reply to Indy:
Suppose your partner has HIV but you don't ?

Could apply to straight as well as gay couples.

Why not use condoms ? Because they can break.

That, at least, is the argument used by the charity that brought this case

In reply to duchessofmalfi:

And how long till the UK bankrupts itself or all your tax's are diverted from other equally important endeavours and spent on the NHS instead?

I make absolutely no apology for saying that there has to be some personal responsibility in this.

In reply to Roadrunner5:


Becoming pregnant is not an illness or a disease.

In reply to Indy:


Are you deliberately avoiding the fact that the judge, the NHS and. The AIDS charity all agree that PrEP is cheaper ?


Which is fine, but it will cost more. How long before the UK bankrupts itself blah blah blah.

In reply to Indy:


I was shocked to hear on an interview I listened to on 5 live this evening that 57% of those who took part in the trial of PrEP contracted other sexually transmitted diseases during the trial period, 12 months I think.
I'm all in favour of fair access to life saving drugs but surely people have to take more responsibility for their behaviour. Promiscuity is at the root of many cases of HIV but the message seems to be getting ignored.

In reply to Indy:



I get your point, slightly, but I can't see it's much worse than taking the risk of climbing or cycling. If you have a bad accident then the resulting healthcare can run into tens of thousands. No one says you can't have it. Sustainable?Probably no. But who are we to judge people's activities?

In reply to Gone for good:


It requires treatment if not wanted so the emotional and economical argument justified the NHS funding it.

Yeah this looks like something that could not be funded but if there's a solid economical argument it makes sense. It's a dangerous road to go down saying 'well they caused this'.. Where do we draw the line? Smokers? Alcoholics? Obesity?

In reply to Dave the Rave:


Its COMPLETELY different.... when you climb you use safety equipment. When you cycle you use lights and obey the rules of the road (well your meant to!) so if anything happens then it IS and accident.

Are you saying its unreasonable for a gay man to use precautions when having promiscuous sex?

This drug isn't an enabler for gay men to have risky sex

In reply to Roadrunner5:

Where we draw the line is an interesting question and I guess one to which there is no right answer.
I would say smoking, alcoholism and obesity are addictions that deserve medical support and treatment.
I'm not sure homosexual promiscuity, which appears to be one of the main contributing factors towards the spread of AIDs, is an addiction and with well known and cheap alternative forms of protection already widely available then why should the taxpayer fund a preventative medicine that is not strictly
necessary.
Which raises another question.
When will people start to take responsibility for their own actions?

In reply to Roadrunner5:


Yes, they all have responsibilities and the NHS enforces them i.e you can only have a a gastric bypass if you lose X amount of weight or you can go into rehab if you cut down on your drinking .

In reply to Bob Hughes:


I'll have to disagree with you in this case, from what I've read it seems that in some cases (I have no idea of the numbers) neither party knows whether or not they are HIV positive so it's not so much a case of one person with HIV knowingly having sex with and potentially infecting another, it's a case of the sex happening and the virus being shuffled around and ignored. The case study I read was of a couple were one of which had unknowingly infected his partner when he didn't know he was HIV positive himself. One of the issues with the control of HIV is that it takes about a month after infection before it is detectable, in the mean time who knows what happens.

In reply to Indy:


There's a valid argument about whether such a drug should be publicly funded, given that there are alternative ways to prevent infection, with the individual taking on both responsibility and cost. I'm not sure exactly where I stand on this.


But no, you are being a prick. Gay men do not feel that it is their fundamental right. This is homophobic shite, and you are an arsehole. I don't like being told what I feel is my fundamental right by someone who is clearly as thick as two short bricks, and twice as ignorant. Now go f*ck yourself.

In reply to Roadrunner5:

Got to start somewhere if people aren't prepared to pay more taxes. So we could start with people who are willing to engage in risky activities of a sexual nature and then move onto the obese, smokers, etc. But of course we won't because nowadays you don't have to be responsible for your ownbehaviour - too many rights and not enough responsibilities. Maybe it's time to introduce charges for medical treatment.

In reply to Indy:

As a slight parallel to this topic. If you can get Prep on the NHS why can't you get all your travel vaccines on the NHS and have to pay for some?

In reply to Jon Stewart:

Gosh now that was informative!

You obvious feel that a gay man has the right to have promiscuous sex and if that is going to cost the NHS £400 and 11 year old Molly her cancer treatment then thats fine f*ck safe sex.

In reply to Indy:

You haven't even read my post. Try again, idiot.

In reply to Jon Stewart:
Hmmm so you do slightly acknowledge that it might have something to do with personal responsibility if a gay man can be arsed (no pun intended this time) to practice safe sex.

In reply to gethin_allen:


If you take the 'who are we to judge' argument, (which to be fair is a valid one), to it's ultimate conclusion, what stops 20 lads deciding to go on a shagging holiday to the fleshpots of sub saharan Africa and demanting all their vaccinations and £8k worth of Prep on the NHS?

In reply to Indy:

The issue is public funding (or, in the news story, it's actually about who's responsibility it is to fund this out of LAs vs the NHS). As I said, I haven't made up my mind where I stand on it, partly because I haven't done the research to find out exactly what the proposal is for funding - is it for people who are quite capable of taking on the responsibility, or is it for a very small number of drug-addicted high-risk individuals who are blatantly going to end up with HIV and requiring treatment (at great cost), left to their own devices?

My response to your shit post was just to let you know how shit and homophobic your presentation of the issue was. It reflects a revolting prejudice towards gay men, and a complete lack of understanding of the issue at hand. Making you look both thick, and like a total arsehole.

The way you present the issue implies that it is gay men (as a group) who have campaigned for this drug to be available to them on the NHS, so that they can go out and have sex without taking responsibility for the risk of infection. This is wrong, and it is homophobic. It's spreading a false, malicious story painting all gay men in a very negative light, relying on stereotypes and prejudice in place of information. Do I need to explain in any more detail just how shit your post was?

In reply to Ander:



There is no point missed.

If you are fearful of getting AIDs, wear a f*cking condom. Why so many apologists on here? Im not in the slightest homophobic but if I was promiscuous and wanted to get it on with all kinds of men or women then I would wear protection.

We can barely afford to treat cancer or Alzheimer's and gay men are effective being given permission to prod anyone they like without protection with complete impunity when they know full well that they are some of the most at risk people for this illness. Yes, boiled down, we are immunising people against something which they themselves with a little planning and self control can prevent, at the cost of £400 per month.

Have I entered the twilight zone or what?

In reply to Ridge:

Interestingly, if they did this (without the Prep) and furthermore stipulated that they would only have sex with a woman who could prove she had HIV, they would still only be at about 1/2 the risk of contracting HIV of a sub-Saharan African man coming on a holiday to the UK and having unprotected sex with random gay men.

Hopefully that puts the kind of risks that we are talking about here in some sort of context...

In reply to Jon Stewart:

^ This.

If it is the latter scenario, (or indeed female prostitutes with drug habits or similar), then I have absolutely no issues with this.

In reply to TheDrunkenBakers:


No, you've just not understood the story. I'm a single gay man with a job and flat and stuff, and (I'm making use of common sense here as I haven't done the research) if I went to my doctor and said: "I'm going to be spending quite a lot of time on grindr this weekend, everyone prefers f*cking without a condom, so can I have some of those pills please so I don't get AIDS", then I think my doctor would say, "no, wear a condom. Those pills cost £400".

However, if I was someone at high risk of contracting HIV due to my drug use and high-risk behaviour (always high, not much to live for, don't give a f*ck attitude), then the decision in the news would allow the NHS to prescribe the drug -essentially to save them cost down the line. The doctor knows I'm not going to take responsibility, there's no point in saying "wear a condom" because I don't give a f*ck. Some people are like that. They present problems for society that have to be managed, and which cost money. Taking a moral stance is irrelevant and fruitless. Taking the moral stance would mean that down the line when they come in suffering with some awful AIDS complication saying "sorry, no treatment, it's your own fault". It's not a doable position.

People whose lives are chaotic and awful exist in our society and they cost us money. People in the government have to make decisions about how to deal with them. Saying "wear a condom" to someone who's injecting smack with shared needles in a car park is not going to prove an effective strategy to managing the cost of HIV in England.

In reply to Jon Stewart:


Why is what I've said wrong? I'll reiterate gay men have a responsibility to practice safe sex rather than expect the NHS to be a £400/month enabler for promiscuous unprotected sex.

Would you be happy if a heterosexual couple were using NHS abortions as contraception?

In your above post you mention drug users but it was The National Aids Trust that brought the action.

In reply to MarkJH:



Not quite sure I understand the above. I'm aware female to male transmission rate is lower than infected male to female or other male, (1:1000 springs to mind?), but is our sub-Saharan bloke already infected and passing it on or at risk of infection from the random gay men?

In reply to TheDrunkenBakers:

Maybe free ropes on the NHS to prevent broken legs?

In reply to gethin_allen:


I'll admit to being facetious earlier. I'm sure it does happen as you describe.

To come back to your earlier point, that the pill is justified based on its effectiveness in the minority of cases where women are pressured into having sex without their consent, you can make the same argument here. It doesn't matter that one party doesn't care about the risk; it only matters that one party is forced, against their will, to put themselves at risk of contracting AIDS. Imagine someone in an abusive relationship whose partner sleeps around, or a prostitute with an abusive John.

In reply to Ridge:





No, he is uninfected. Risk per 10,000 exposures for insertive vaginal sex is about 4. For receptive anal it is 138! Point is that the risks per exposure for gay men are much much higher, and also that HIV prevalence in UK gay men is about the same as overall prevalence in sub-Saharan Africa. Doesn't really relate to your point, but I thought it was worth adding for overall perspective...

Figures from here: http://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

In reply to Indy:


I agree completely and duchessofmalfi, whilst making what appears to be a sensible and persuasive argument above argument above which gained lots of likes seems to be ignorant of some facts. I quote:

"We could have a different system that said "f*ck you" to everyone whose behaviour might have contributed to their healthcare needs: f*ck you to drinkers and smokers, f*ck you to the overweight, f*ck you the lazy, f*ck you to climbers etc etc but I'd prefer a society where you didn't have to step over the dying and crippled on the way to work and we treat everyone without blame and with compassion."

These straw men completely bend the context which when suggested differently seem somewhat absurd e.g. we dont go about giving smokers nicotine patches or gum before they start smoking, we don't go about giving the obese a gastric band when they are still thin and healthy, we don't go about prescribing exercise fort the already fit and active and we don't go about giving climbers a plastered arm before the break it in a tumble.

This is a very difficult social issue with complex health economics but simply saying that you can do as you like and get paid for the pleasure is hardly the answer to me and lets not forget that there are a number of other pretty unpleasant cock rots which can be contracted. Why not find inoculations for all of these whilst we are at it and hand out another £400 per drug. Where do we draw the line?

In reply to Indy:


You are writing on the assumption that gay men think that the NHS should fund this drug for them, just because they want to have unprotected sex. This isn't true. It isn't in the story, it's your prejudice.

AIDS campaigners challenged a decision about whether it should be councils or the NHS that have responsibility for AIDS prevention. It isn't about gay men saying they should get this drug on the NHS so they can have risk-free, promiscuous sex. This is your homophobic assumption and it is wrong.

In reply to Bob Hughes:


Irrelevant.

Doesnt make it morally correct. Why not think twice, wear a condom.

Perhaps if we asked these at risk men to make a contribution to these drugs or perhaps the whole amount. Maybe using a condom wouldnt be such a hardship for them if they had to cough up the money each month then would it. Id quite like to have liposuction on my belly to remove a few lbs but cant really afford to pay for the plastic surgery to do this so perhaps I should ask the NHS because I may live a few months longer.

Indeed, it's a stupid example. "go and get yourself a pair of shorts and take a few walks per day until you lose it or perhaps replace those curries with some leaves for a change!!!" is the response that I would and should expect from this shire.

In reply to Ridge:


The same thing that stops me from going to my local GP complaining of a headache and walking away with a weekend's worth of morphine.

In reply to TheDrunkenBakers:


But is that the proposal? That all gay men should just be given the drug so they can f*ck about?

I think you've made a completely wrong assumption about what the proposal for funding is. Look into it.

In reply to MarkJH:

Thanks for the clarification.


I have to admit I am genuinely surprised by that.

In reply to TheDrunkenBakers:



The moral argument and the financial argument are separate. Indy was banging on about the cost to the NHS apparently oblivious to the fact that it seems more likely that administering PrEP to high risk people will save the NHS money.

The moral argument is stronger, but it will imply an additional cost. If you think it is worth the extra cost, that's ok. But arguing that telling people to use condoms, which is demonstrably failing with regard to a small section of society, will suddenly start working and save NHS money is not living in the real world.

In reply to Bob Hughes:


There is a sensible moral argument for not prescribing the drug to people who can easily make choices to live in what we can collectively agree is a "responsible way". Those arguments aren't strong or sensible when applied to many people at the highest risk of HIV infection.

In reply to Jon Stewart:




Jon, I completely respect your position and I, and perhaps everyone, including me, are is missing the minutiae on this. The BBC, from where I heard this news today, painted no picture of where and how this drug may or may not be prescribed. The example above, for the chaotic, drug addict or perhaps prostitute where condom breakages may occur makes perfect sense to me and I would have no issue with that but handing them out for anyone without question would be wrong.

In reply to TheDrunkenBakers:





Pretty poor post.

Condoms do fail. If we go to malaria countries we use repellent, take the drugs and sleep in mosquito nets...

It needn't be either or..

In reply to Indy:



It isn't completely different. You don't HAVE to climb up rocks, and the protection (ha) doesn't always work, so why take the risk?

Just go for a pleasant walk if you want to enjoy the countryside and keep healthy. Millions of people do after all.

Selfish climbers, taking the piss by going climbing and having tax payers pay for the medical treatment when their gamble with risk goes against them.

'Thinking is difficult, that's why most people judge' Carl Jung.

In reply to Roadrunner5:

When the pill originally became available this was a massive part of it, this may not be the primary reason in many cases but it's the only reliable way for a woman to be fully in control of her fertility.

Or you may have a rose tinted view and who said anything about a "relationship" in it's formal state, I'm thinking as much about a casual situation.

The cycle control part doesn't work for all women, this is a very complex thing and unique to individuals. The pregnancy thing, yes but, as stated above there are issues with consent and coercion in cases.

obviously, it's not a simple case.

In reply to TheDrunkenBakers:

I agree that it would be ridiculous if anyone could have Prep as a public-funded alternative to johnnies.

I'll take this opportunity again to point out that the way this story was introduced by the OP, as if gay men had demanded it, and then abusing them for this ("screw everyone else I'm pissing in the pool") was both totally inaccurate, and homophobic.

In reply to Timmd:




But what happens when you are involved in a car crash on the way to your country stroll?
Surely you should just get a treadmill and stay in the house.

In reply to TheDrunkenBakers:


That's because the commissioning guidelines haven't been agreed. The NHS hasn't even evaluated whether they will fund PrEP. What happened today was that the High Court decided that, in the event that somebody funds it, it should be the NHS and not the Local Authority.

The proposal for commissioning guidelines is:

"Eligibility criteria
1. High risk, HIV negative MSM / transgender women
• Documented HIV negative test during an earlier episode of care in preceding year
• Reported condomless intercourse in previous 3 months
• Likelihood of repeated condomless sex in next 3 months
• Where clinician recommends and monitors PrEP as part of active risk reduction
2. HIV negative partner of a diagnosed person with HIV who is not known to be virologically suppressed
3. HIV negative heterosexual men and women at similar high risk of HIV acquisition as 2
Starting and stopping criteria
Event driven (intermittent) schedule"

In reply to Roadrunner5:

Of course they fail, but we do our best to mitigate the risk by wearing them and their failure rate is tiny. We have some control.

In malaria countries we wear repellent, take an malarial drugs and sleep in mosquito nets because we have no control over the mosquito. We have no control over the insect.


On this we agree, but the suggestion is that we can inoculate all at risk gay men. As I concede above, we dont who or how many these at risk people are as this detail hasnt been explained. The other detail missed by the media today is what percentage of gay men regularly dont use condoms. My male gay friends in my experience, and at risk of using a too small sample, have a greater chance of having sex than my straight men friends so my definition are more at risk.

Ive never asked my gay men friends if they use protection but I would be very upset with them if they didnt knowing how much and how easy it is for them to have sex in the bars that they sometime attend.

In reply to Timmd:





Surely you would agree that most climbers take reasonable precautions to protect themselves?

If you do it rather disproves the point you are trying to make which is, I assume, that all activities come with risk.

But if you play with fire expect to be burned.

Or as Carl Jung put it:

I am not what happened to me. I am what I choose to become.

In reply to TheDrunkenBakers:

According to the court judgement the eligibility criteria would "render an estimated 8 – 12,000 gay men and a further 1,000 heterosexual individuals eligible for treatment. It postulated an estimated take-up rate of 50%."

In reply to Bob Hughes:

If people can't be bothered to use a condom, how.likely are they to take drugs daily?

In reply to Bob Hughes:

Interesting to have some proper information about the proposal - many thanks.

The criteria seem slightly more lax than I would have envisaged - I think there is a valid argument that if too easily available Prep may become a commodity, and one that encourages risky behaviour. I would suggest fairly tight criteria to guard against this, rather than looking solely at the health economics at face value.

I suppose the justification for the criteria would be that to be eligible, you have to be "doing it anyway", so people aren't being encouraged to change behaviour from protecting themselves to allowing Prep to do it for them. I would argue for slightly tighter criteria to mitigate the risk of people going to the doctor and saying "yeah, I have unprotected sex all the time, now give me those pills"- which I expect they will do.

In reply to Bob Hughes:


Peanuts then? I think the "sweet aunty Agnes being denied cancer treatment so that gays can go out bumming whoever they like" calls may have to STFU.

In reply to Indy:

As an NHS professional and having read the threads, all of them, it's an ethical debate best solved by privatising the damn thing. Oh yes privatising. Or working out an individualised payment structure that alieviates the increasing cost on tax payers at the lifestyle choices of others.

In reply to Indy: The homophobic undertones in the OP are almost palpable. This isn't just about the 'icky' gays - it's about all people who are at risk. The fact that Gay men are more likely to partake in risky sexy time is not the issue so stop making it out to be.

In reply to Gone for good:
I get what you mean, but there's people who'd see even going climbing at all as taking unreasonable risks.

What is reckless or reasonable can be subjective, do you see?

Why is climbing 'less daft' when you can actually die if things really go wrong?

In reply to higherclimbingwales:
I think it's exactly the issue and trying to use accusations of homophobia is a means of avoiding the issue.

In reply to baron:
He's talking about the tone of the OP, which only mentions gay people, where HIV rates are also going up among hetrosexual people too. Rates are rising across the spectrum, but gay men are statistically more likely to engage in risky sexual behaviour. For the whole population, it's young people who are more likely to, as well.

In reply to baron:
The accusations of homophobia have been explained in detail:


And putting the homophobia aside, the nitty-gritty of the issue (wheter this drug should be publicly funded, and for whom) has been explored quite thoroughly, thanks to some very useful info from Bob Hughes about what the proposed criteria might actually be.

In reply to Indy:

This sort of question is exactly what NICE and cost benefit analysis is all about and for. The answers are not obvious, and not always liked. And long term data is needed to see whether this drug saves money. Or whether other cheaper methods are just as effective.

All other speculation and invective is futile.

In reply to Indy:

Hmmm.

The socioeconomics of prevention are a bit complex.

In raw terms, the question is "will spending £400/month x X men x Y years prevent larger cost (X1 men x Y1 years) of quad-therapy HIV drugs?"

The problem is that availability will then distort demand. So more men will now trust the pill ('cos it feels nicer to have unprotected sex) than would have otherwise had unprotected sex.

The comparison with the pill is interesting. It's perhaps 1% of the cost of PrEP.

However, where it gets really murky is in where that cost comes from - so pay attention to this next bit.

PrEP means pre-exposure prophylaxis. It is a treatment strategy, not a product. The only licensed product is currently a Gilead medicine called Truvada. The mix is tenofovir disoproxil fumarate and emtricitabine. Interestingly the beneficial effect of Truvada is the same as that of just one of its component molecules - you can leave out the emtricitabine and get the same effect:

(see Cochrane study; should be good enough even for the pedants here: Okwundu CI, Uthman OA, Okoromah CAN (2012). Okwundu, Charles I, ed. "Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals". Cochrane Database Syst Rev 7 (7): CD007189. doi:10.1002/14651858.CD007189.pub3)

The issue is that tenofovir disoproxil is off patent (can't recall dates but yonks ago). So Gilead did their trial with the *patented* form.

Some philanthropist needs to repeat the trial and registration with the generic molecule. All the problems then go away because it would be cheap as chips.

This is classic brand lifetime extension by pharma (trust me, I made a career of it). Fair play to Gilead for developing the original molecule, but this extension is taking the piss.

In reply to JJL:
Fascinating stuff. I'm continually flabbergasted that we think the current funding model for the pharmaceutical industry is not barking f*cking mad. Why on earth would we choose a policy of unaccountable companies holding populations to ransom? It's bonkers - the research should be internationally funded from gvts as a %GDP.

In reply to Indy:

I'm guessing this is a troll?

What about these:

motorcyclists
climbers
walkers (how many slip and break an ankle / leg each year?)
fatties
smokers
people who drink too much
lazy arses

etc etc.

This lot cost the NHS shedloads. Get those gas chambers ready.

In reply to all:

If it transpires that this drug is effective in massively reducing the risk of HIV infection, then should people that are routinely exposed to possible infection in their jobs be offered it as a matter of course?

In reply to Jon Stewart:

Indeed. The problem is that it now costs about a billion (round terms) to bring a medicine to market (taking all the failure costs in). And takes 10 years(round terms). Patents are only 20 years, so all avenues get exploited:
- formulations (e.g. once daily; slow release; buccal melt; etc.)
- new indications (e.g. moving from asthma to COPD)
- combinations (e.g. HIV, asthma especially)

The last category is rich because it offers convenience. In the early days of HIV therapy (say late 90s), we did an experiment issuing people with different coloured smarties for each drug (triple therapy then) and asked to measure compliance. Some need a fatty meal some x hours before food, some a non fatty meal etc etc. It was nigh on impossible to comply. Dual pills made compliance much easier. We now have quad+ therapy. This has made HIV a chronic, life-long, manageable condition rather than a fatal one. It's also opened opportunities par excellence for cynical brand extension.

In reply to Peter Metcalfe:

I'm guessing this is a troll?

What about these:

motorcyclists
climbers
walkers (how many slip and break an ankle / leg each year?)
fatties
smokers
people who drink too much
lazy arses

etc etc.

This lot cost the NHS shedloads. Get those gas chambers ready.

That would effectively mean inventing a immortality drug!

In reply to Indy:

''It reflects a revolting prejudice towards gay men, and a complete lack of understanding of the issue at hand. Making you look both thick, and like a total arsehole.
The way you present the issue implies that it is gay men (as a group) who have campaigned for this drug to be available to them on the NHS, so that they can go out and have sex without taking responsibility for the risk of infection. This is wrong, and it is homophobic. It's spreading a false, malicious story painting all gay men in a very negative light, relying on stereotypes and prejudice in place of information. Do I need to explain in any more detail just how shit your post was?''

In reply to digby:

what like the cancer drugs fund ?

In reply to JJL:

>In raw terms, the question is "will spending £400/month x X men x Y years prevent larger cost (X1 men x Y1 years) of >quad-therapy HIV drugs?"

not quite - surely you have to factor in the qualis for the suffers life as well, that would make it more valuable.?

maybe Wellcome would fancy stumping up the funds for research - think of the impact case study !

In reply to Timmd:



Have just seen the front cover of The Times on the way to work and it absolutely sums up my thoughts on the subject perfectly....

"HIV drugs puts other treatments at risk" these other treatments inc a drug for children with Cystic Fibrosis that helps them to breath.
I find it utterly sickening that people from the gay community are throwing around words like 'homophobic' to justify there demands for a hugely expensive drug that enables them to engage in a reckless lifestyle at the cost of people with conditions that they have got through no fault of there own.

In reply to Indy:

Would you deny that you are homophobic?

In reply to higherclimbingwales:


Rubbish my point here is that this drug will turn into a lifestyle choice. Why should the NHS fund gay men having a "risky sexy time" to the tune of £5000/year over a child with cystic fibrosis with breathing difficulties?
Now thats the uncomfortable truth you refuse to acknowledge.

In reply to duchessofmalfi:


Yes. Are you racist because the UK has different border contols for Indians/Africans and Americans/Austrailians ie. whites

In reply to Jon Stewart:



Yes I agree. Although what isn't defined are the "start criteria" and "end criteria" which would limit use as well as oversight by a clinical practitioner as part of an overall risk reduction plan.


There is also the possibility that someone who is at high risk and eligible will act less carefully as a result of taking the treatment. In the test, they found that the incidence of other STDs was the same in both the test and control groups, suggesting that taking the treatment did not affect behaviour. But then, it is an artificial situation with people being monitored regularly so its hard to extrapolate that to the real world.

In reply to Indy:

I'll treat the rest of your posts as if they are as accurate, meaningful and sincere as your last one.

In reply to Indy:


How many times do I have to explain that it is not the gay community that are campaigning for this drug to be freely available before you will accept it?

The AIDS charity (that's not the same as gay men, nor the gay community, by the way) mounted a legal challenge against the NHS decision that it was not the responsibility for the NHS to fund AIDS prevention. How can you fail to understand that this is not the gay community demanding free access to the drug?

Your attitudes and comments are homophobic:

1. You assume that gay men want access to this drug for free so they can have unprotected sex. Perhaps some do, but as far as I know, no one claiming to represent the gay community has said this. Perhaps you can show me where the gay community have made these demands to justify your horrible remarks? Or retract it, and admit that it's a prejudiced lie aimed at all gay men, and that you are a homophobic dickhead.

2. You set the needs of "deserving" patients, children with conditions "they have got through no fault of there own" against gay men with AIDS who you seem to think don't deserve healthcare because it's their own fault. This isn't how NHS funding works, as people have tried to explain several times, but you refuse to engage with.

I'll have another go:

By funding this drug for people who are likely to contract HIV (it doesn't really matter whether you consider it their own fault, the cost is the same), less will be spent on treatment later down the line, which means more money will be available for your "deserving" cases, the children with cystic fibrosis, etc.

It looks as if you're not going to get any of this, because you're not reading and digesting what people write. Obviously, calling you a homophobic dickhead, which you so blatantly are, is not going to make you more open to this information, but then I'm pretty pissed off that you're telling me that as a gay man, I demand that the NHS pays for my reckless lifestyle instead of paying for the treatment of children with cystic fibrosis, when this is a horrible, homophobic lie.

In reply to lithos:




QuALY is a devil-spawn confection.

In reply to Indy:

If I was dating someone that was HIV positive I would want to take the drug, even with using condoms. Condoms break, so why would I want to take the extra risk? What makes you assume it is aimed at people that want to go out and screw a load of random people? Very small minded.

Being a climber you should know about managing risk. You don't climb on a single half rope despite it being strong enough to catch a fall. Belt and braces.

In reply to Jon Stewart:

http://www.bbc.co.uk/news/health-36683073

"HIV drug 'gave me the confidence to trust again'" This is a story about a gay man saying that the drug was good for him because it allowed him to choose to have unprotected sex with people that experience has shown him he should not be trusting because they'll lie/hide information. The requirements to be high risk were surprisingly low he says, in that you need to be a person that has had unprotected sex recently and intend to do it again in the near future. That's not surprising at all is it? If you have unprotected sex with multiple partners you're high risk, of course you are.

How are we supposed to take that except that it's gay men (not all gay men, of course) saying that it should be available so that they can have unprotected sex with less risk?

In reply to FactorXXX:


The potential benefits would have to be weighed not just against the financial cost but the side effects of long term use. It may be that for people at relatively low (but still elevated over that to the general population) risk the drug does more harm than good (obviously on average).
jk

In reply to JoshOvki:


60% of new hiv infections where in gay men yet they only make up 1% of the UK population.

In reply to Indy:


You appear to be trying very hard not to understand. Speaking as a member of the 'straight community' I think the accusations of prejudice seem well aimed, the alternative is that you're too daft to understand the case put to you but we know that isn't the case.
jk

In reply to Indy:
Your point?

http://www.aidsmap.com/Estimated-risk-per-exposure/page/1324038/

Have a read of this, or just look at the bit "Estimated HIV transmission risk per exposure for specific activities and events"


Vaginal sex, female-to-male, studies in high-income countries - Risk 0.04% (1:2380)
Receptive anal sex with condom, gay men, partner unknown status - Risk 0.18% (1:555)

Even with a condom a gay man is more at risk of contracting aids than a straight man without a condom!

In reply to JoshOvki:

Safe sex? Which oddly is more likely to prevent HIV than this NHS bankrupting lifestyle drug.

In reply to Indy:

I have updated my post above.

In reply to FactorXXX:

You would not want that, even the new generation anti HIV drugs do have unpleasant and potentially dangerous side effects. Post exposure prophylaxis is usually enough if at risk of occasional exposure (lab worker, paramedic, etc.).

CB

In reply to JoshOvki:
Yes you've updated it to confirm that safe sex is a massively better way to protect against HIV than this uber expensive lifestyle drug.

In reply to Indy:

Safer but still incredibly risky. How can you be so closed minded?! As a gay man you have a 1:555 chance of contracting AIDs from having protected sex.

I give in. It is pointless debating this with you.

In reply to lithos:


What do you mean? If you mean the cancer drugs fund is futile, then yes it is without proper follow up data, which has not been done. It was created in an emotive response to the rigours of NICE.

In reply to JoshOvki:



I'm not sure if the commissioning rules would include giving the prophylactic to gay men who practice safe sex.

As I understand it the risk of catching HIV with prEP is 10%.

That would tend to suggest that the best solution is - wear a condom.

In reply to off-duty:


Of course it is, but there is a group of people who, despite 30 years of telling them to do so, don't wear a condom, either as a regular practise or because from time to time they have unprotected sex with someone they have been dating for a while.

So what do we do?

In reply to Bob Hughes:

If they either can't be bothered or remember to wear a condom, can we be sure that they will either be bothered or remember to take these (rather expensive) pills.

In reply to Bob Hughes:



I think it was suggested that partners of those with HIV would be eligible as " high risk".

Looking at the risks linked to above - the highest risk is receptive anal sex - so there is a pretty strong argument to give the drug, it's not specifically the actions of the person at highest risk that make them vulnerable - ie they aren't the one wearing (or not) the condom itself.

In reply to FactorXXX:

I don't think anyone is really routinely exposed to infection through a job. Occasional exposure to possible infection - there's PEP for that, and the occasional nature means that people know when it's happened and chase it up.

Despite our workplace trying to make it as hard as possible to get PEP... but that's because they're idiots...

In reply to digby:


exactly

In reply to Indy:



ARE the gay community actually demanding that they're given the drug?

Where did you learn that they are?

My gay friend Aiden from my teenage years isn't calling for it (he's happily monogamous for the record - not living a reckless lifestyle), and Jon Stewart on here doesn't seem to be calling for it so he can have a reckless time either, is there some kind of advocacy group from whom you've heard a statement being given?

You must have come across something?

In reply to JoshOvki:

If you were dating someone with HIV who was on ARDs there would be no reason for you to take PrEP since your partners viral load would be effectively zero. Plenty of risks associate with these drugs for no benefit. In any case unless you are huffing class A's its total anti-boner. Although I did manage to inelegantly drag myself up Napes whilst on PEP.

D

In reply to Timmd:


Well Owen Jones thinks "The NHS must show it cares about gay men’s lives – and roll out PrEP HIV drugs", so taking your n=1 approach to things, that must mean the gay community are calling for it.

https://www.theguardian.com/commentisfree/2016/aug/02/nhs-prep-hiv-drugs-ga...

In reply to MG:

How so?

In reply to off-duty:

fair enough.

In reply to Timmd:

Well you take one or two people you know and use them to argue there is no call for this. Owen Jones, one person, argues the opposite. Using your approach therefore there is a call for it. Of course both positions are taking the odd person and trying to make a general claim, which is nonsense.

In reply to MG:
Well done, you've proven me wrong based on how I've put things while jugging other things during my day.

There's nothing to prove the general thrust of Indy's point of view, which is that the gay community is asking for this drug at the tax payers expense 'so that' gay men can live a reckless lifestyle and have unprotected sex.

In reply to MG:

Which it's why it's so wrong of him to imply as much. All it does is so the seeds for negative stereotypes & assumptions about gay men. So that, if somebody thinking along those lines happened to meet my friend, or anybody else, there's the risk of them thinking badly of them based on their stereotypes they have in mind, rather than the person in front of them. It's why generalisations are flawed.

In reply to Timmd:

They aren't flawed they just have limitations. They are essential to make any sensible decisions at a societal level.

In reply to MG:
What's the difference between a flaw and a limitation?

In reply to thomasadixon:



I've seen this and it's the story of a guy who was given the drug as part of a trial, and he says it was a good thing. As you would.


Take it for what it is. One of the people on the trial - but presumably most or all of them, thought it was good. They were sought out and given it for free. They didn't campaign for it, and they don't represent gay men, they're just the people on the trial, saying precisely what you'd expect.

Are you saying that this guy's story justifies the remark "Gay men it appears feel that it is there fundamental right to have risky/unprotected sex as the NHS is required to dish them out these preventative drugs i.e. screw everyone else I'm pissing in the pool."?

In reply to Jon Stewart: .


Exactly!

In reply to Timmd:

A small scale map isn't flawed but it has limitations.

In reply to MG:
We seem to have tuned down an informative semantic scenic route. Quite an interesting one.

If generalisations have their limitations, then to apply them to a group of people who are going to be different from one another, with the expectation that they will all conform to it, is 'flawed'. Which means Indy is wrong to generalise that gay men are wanting tax payers to pay for medication for them, so they can live reckless lives.

Sorted - semantically speaking.

In reply to Timmd:

Rubbish. Indy is just wrong if he is doing that. Generalisations are perfectly useful and reasonable.

In reply to MG:
It actually seems you 'are' an argumentative type after all?

If the limitation of a generalisation is that not everything or everybody is going to conform to it, then how isn't it flawed to expect them to?

Good grief, Charlie Brown...

I never said anything about useful or reasonable. At least things are clearer now.

In reply to MG:

For all this arguing the toss about the value of generalisations, is there enough evidence to state that the gay community *generally* wants this drug to enable a reckless lifestyle?

In reply to Jon Stewart:


That is such a great post. I just wanted it repeated further down the thread.

In reply to Indy:


No soloing, no chop routes and definitely no winter climbing then.

In reply to Indy:

High Court are absolutely right.
The fact that the drug might cost £400 a month is irrelevant. As is the reference to sexuality.
We all piss in the pool, in our own way.

In reply to Removed User:


But loitering around public toilets on a friday evening hoping for a bit of unprotected gay sex in one of the cubicals, now thats fine...... obviously.

In reply to birdie num num:

Of course they are. And when you or one of your relatives spends 16hrs on a bed in a hospital corridor thats fine too. As is the child denied drugs as millions are spent on lifestyle drugs for the gay community.

In reply to Indy:

When are you going to answer the point that the justification for the decision was to *save* money?

In reply to Indy:

So is this about the morality of cruising, or the cost of Prep? You're not doing a very good job of showing you're "not homophobic". Do you think I might be insulted by your post? Because it's horrible about gay people? And yet you're not making homophobic remarks?

You're a f*cking prick.

In reply to Jon Stewart:


It wasn't. It was just a decision about who was to pay *if* the drug is made available. Whether it will be or not hasn't been decided
https://www.theguardian.com/society/2016/aug/02/nhs-can-fund-game-changing-...

In reply to MG:

That's true. The justification for funding however is on the health economics.

In reply to Jon Stewart:

The overall cost benefits to this will be complex and subject to many variables,,,, the headline figures are a very simple and mid-leading.
That aside, my concern is the idea that a court can direct the NHS to fund a preventative drug which is very much not the norm in current commissioning strategies....certainly not in mental health where I work. Acute care only has become the norm with any other funds being directed towards admission prevention whilst therapeutic services have been significantly reduced.
I'm not sure about this ruling on a number of levels....

In reply to abr1966:

I'm not sure about it either, particularly the seemingly lax eligibility criteria, although these aren't set yet. But, if its going to save lives and money, telling LAs, who've got no money, to pay for it seems pretty ridiculous.

In reply to Jon Stewart:

That practicing safe sex is far far safer at preventing HIV than this uber expensive lifestyle drug

In reply to Jon Stewart:

Using one supply of this drug to prevent one case of HIV clearly makes sense, but how many people will be supplied with this drug and how many cases will it prevent?
I don't know the numbers to calculate if it's cost effective to supply 100 doses to prevent 10 cases of HIV? (Edit to add - actually this is wrong - RISK of HIV is 10% )

[Edit to add - found some numbers ]

Back of envelope calculation suggests 100 prEP for 1 year = £480,000

"Care and antiretroviral therapy consisting of four drugs was calculated to cost between £22,775 and £48,000 per patient per year depending on an individual£s health."

http://www.aidsmap.com/Annual-UK-HIV-treatment-and-care-costs-could-reach-7...

I did some calculations then realised I'd got my 10% and 90% mixed up - anyone want a shot ...

In reply to Indy:

So trying not to reply to you but...

"lifestyle drug
noun
noun: lifestyle drug; plural noun: lifestyle drugs

a pharmaceutical product characterized as improving the quality of life rather than alleviating or curing disease."


Do you feel the same about:
Transgenders taking hormones?
People with anxiety disorder taking SSRIs?
Women using birth control?
etc.

Or is it just the gays you don't like?

In reply to Indy:

Since when has it been acceptable to be so rampantly homophobic on UKC? The mind boggles!!

In reply to malx:

What like criticizing Israel is antisemitic or calling for border controls is racist sort of homophobic?

In reply to JoshOvki:
The GOLD STARDARD (by a very large margin) for protection against HIV is safe sex.

What do you have against safe sex?

Hint: the answer doesn't involve screaming "homophobia!" which seems like the answer to any inconvenient question.

In reply to Indy:

Will they not just have to take their chances on the postcode lottery where many preventable treatable diseases/conditions are , or are not, funded depending on the individual health authorities view on what they think they should spend their money on.

In reply to Indy:

You are accused of homophobia because:
1. You characterized the campaign as "gay men feel that it is there fundamental right to have risky/unprotected sex as the NHS is required to dish them out these preventative drugs" without acknowledging that there are plenty of gay men who don't feel that way, notably Jon Stewart, or that the National Aids Trust, which brought the case, is not an organisation of gay men
2. You characterized gay men as "sticking their todgers into every Tom,Dick and harry"
3. You have characterized gay lifestyle as "hanging around the public toilets hoping for a bit of unprotected sex"
4. You have utterly failed to engage in the debate over cost-effectiveness of PrEP
5. You seem a lot angrier at gay men than you are at the drugs company whose attempt to extend its patent means that the PrEP treatment costs 400 pounds a month instead of "peanuts," according to JJL

If you wanted to fall back on the "Political Correctness!" defense you should have been a lot more careful with your earlier posts. Right now it looks disingenuous.

In reply to Indy:

Nothing at all. What do you have against making it safer?

In reply to JoshOvki:

But its not safer as you choose to ignore.

In reply to Bob Hughes:

I will answer your slanderous allegations tonight as I've I got some important meetings this afternoon.

In reply to Indy:

So using the drug and a condom is not safer than just using a condom?

In reply to Indy:

Hopefully some diversity training.

In reply to Indy:
I agree with you on this matter, and I don't consider myself to be homophobic. One of my friends is gay and has married his partner and is in a monogamous relationship and always has been. He feels that this policy will lead to more promiscuous behaviour within the gay community. Like me he is not homophobic.

In reply to JoshOvki:


Are you suggesting this drug be given to condom using gay males ?
I didn't think that was the criteria - and at 4800 quid a year that's quite expensive.

In reply to off-duty:


To me this sounds like a huge range of people, and covers people that may have had sex once without a condom (I imagine this also covers breakages). It also covers a huge number of hetrosexual people who may be in a monogamous relationship with a partner that is bi.

1:8 gay men in london are HIV positive, that is quite expensive too, more we can do to reduce this the better.

In reply to icnoble:

As far as i can tell, no-one on this thread has claimed that you can't disagree with the NHS paying for PrEP whilst at the same time not being homophobic. The problem people have with Indy is the way he has justified his objection to the policy.

There is a very interesting debate to be had on the moral hazard of offering preventive treatment. The NHS already provides treatment to people with AIDS, regardless of how they catch it. The NHS also already provides the same pill we are discussing to people who think they might have got AIDS. Think of it as the morning after pill. It available regardless of how you may have been exposed; whether through your job, or having unprotected sex. n that sense the cost to the NHS already exists today.

If there is a way to reduce that cost by offering a preventive treatment then that should - and is being - be considered. In the best-known study there was no increase in risky sex (as measured by the transmission of non-AIDS STDs) in the group which took PrEP. It doesn't necessarily follow that, that will be translated into the real world but it is a data point.

One of the financial models assumes an increase in risk-taking but that didn't significantly affect the result, because the treatment is so effective.

Which leads to a very interesting moral question - lets assume that provision of the treatment is cost-neutral taking into account an increase in risk-taking. The number of people living with AIDs (no longer a death sentence but pretty bloody inconvenient) would be reduced but at a cost of more people taking more risks.

Are we comfortable with that?

In reply to Bob Hughes:



I am, because it would reduce the risk to everyone. This healthcare professionals, "waste disposal technicians", anyone at risk of coming across a needle. Lets remember that this drug is also aimed at drug users who are also high risk.

In reply to JoshOvki:



That is a very wide range of people. And it's a very expensive prophylactic.
Coupled with that 1 in 10 will still be infected - as opposed to about 1 in 500 with condom use.

Combination therapy as you suggest (and as mentioned higher up the thread from the court judgement is that around 9000 people are now likely to be eligible ) - will cost 43 million quid.

Is that genuinely worthwhile - 900 still potentially infected, unless they all use condoms - Which drops those at risk from 18 to 2. So effectively 43 million to prevent 16 people catching HIV

In reply to Indy:


That's brilliant. Do you mind if i use it for my out-of-office response?

In reply to icnoble:
I thought this was perfectly clear already, but just in case:

No one has accused Indy of being homophobic because he doesn't agree with Prep being funded on the NHS. My own view is that quite tight eligibility criteria should apply to mitigate the moral hazard/commodification, while the health economics should be examined in detail (exactly what NICE does). Homophobia isn't part of the substantive issue under debate.

Indy has, while making only the most pathetic attempts to join in the interesting discussion, made a string of overtly homophobic remarks, listed above. Its the remarks that display his prejudice and malice, not the view that this drug shouldn't be funded on the NHS.

In reply to Indy:


That's a good start, something which is mostly true (the uber expensive bit is questionable).

So lets follow the argument through. We tell gay men to use condoms to prevent infection, through public health information, sex ed in schools, through charities, getting the porn industry on board, etc. So, most gay men follow this advice, they don't want to be taking tablets all the time, and might be in relationships, mostly celibate, or shagging about a lot but safely. Great.

But, the fact remains, like it or not, that some gay men don't follow the advice and have unprotected sex, promiscuously. This is a fact that has to be dealt with, and here are some options (you might be able to come up with others if you think I'm missing some):

1. Treat the hiv/aids with a lifetime of drugs. This is very expensive, and not brilliant for the patient.

2. Don't treat the hiv/aids, and tell the patient that they should have worn a condom. This is very cheap, but the patient dies, and leaves the NHS in an impossible position policy-wise, as now its only treating disease where the patient is not "at fault". So now, no care for smokers, fatties, sports injuries, etc. All in all, not a viable option.

3. Offer Prep to the high risk patients who ignore all the condom advice. Reduced infection rates and cheaper than 1 (provided the eligibility criteria are right, i.e. High risk patients correctly identified, everyone else uses condoms).

4. Offer Prep to anyone and everyone, abandoning the safe sex education as now we can all shag about with impunity (or 90% impunity anyway).

So out of these 4 options, i think the best one is 3. Which do you think is best, or do you have another option?

In reply to off-duty:


I don't understand where the 18 to 2 comes from. Can you explain it?

In reply to Bob Hughes:


9000 candidates - currently using condoms - risk is 18 get infected (1 in 500)
All now are given the drug as well (risk of drug us 1 in 10) - so it's 1.8 infected or for the sake of simplicity - 2

In reply to Jon Stewart:

Has anyone addressed whether the people being targeted by this will actually take the drug? They seem to be the exact group that wouldn't/ couldn't remember, would flog the drug (addicts) etc. Has this been built into the costing that NICE have done?

I find it astonishing that anyone would be so blase about potentially catching HIV, so as to go at it condom free with someone that they know does have or could have the virus. I think this is where the struggle to understand comes from. regardless, apparently these people exist and if it helps the wider population to give them preventative medicines then that should be seen as a good thing.
FYI, hasn't Australia recently become 'HIV/ AIDS free'?

In reply to La benya:
Think you may have misread/ misunderstood something. Whilst Australia has , in the main, very good hiv/AIDS policies ( including prep) I don't think it would recognise that description

In reply to toad:

yup! you're right, clearly didn't take in the article i read.

https://www.theguardian.com/society/2016/jul/12/aids-is-no-longer-a-public-...

In reply to off-duty:
Ah ok. Got it, thanks. Yes i don't think it's intended for regular condom users as the guidance includes monitoring by a clinician as part of a risk reduction programme.

In reply to La benya:


It's included in the failure rates in the trials. Two of the people who contracted hiv during the PROUD study were found to have not been taking the treatment for some time. (Again, translating this percentage to the real world may over estimate compliance)

It also seems that the treatment is fairly robust to taking it irregularly. You don't need to be taking it every single day

In reply to off-duty:

There's a good discussion of the cost effectiveness here:

http://mobile.aidsmap.com/Second-UK-cost-effectiveness-study-finds-that-lar...

It reports a second model which shoes the treatment to be less cost effective than the figures presented in the high court case, mainly because the background AIDS rate in STI clinics (max 5.2%) is nowhere near as high as that in the PROUD study (~9%) and that the cost of treating AIDS is expected to decline after 2020. They conclude that unless the cost of PrEP falls it's not cost effective.

Also interesting that, apparently, high-risk gay men are usually only high risk a period of about a year - after which their behavior changes. (It doesn't say why or how but presumably they start seeing someone long term.) The implication for treatment is that typically you'd expect to spend a years worth of treatment on any one person.

In reply to Jon Stewart:

Option 3 is the most sensible course of action.

400 quid is peanuts. £10-20 million a year to help reduce aids in this country?

No brainer.

In reply to La benya:


Consider all the risky things that you have known young men in general do, particularly when high on drink and drugs. Add a dose of internalised homophobia (ie not comfortable with their sexuality, so on some level thinking they deserve it if they catch the virus) and other troubles. Mix with a 'chemsex' culture in many big cities that supports these views. It happens,sadly.

In reply to Indy:


A couple of people have explained, very patiently, why your remarks are homophobic. I've explained it in detail, and called you a f*cking prick (which I don't apologise for, you are a total arsehole), so I won't pretend I've done it calmly or with even a modicum of respect.

But the point is, no one's screaming "homophobia" - they're explaining, quite carefully and in detail, why your remarks are revolting. Try listening to other people, I guarantee you will learn something useful.

In reply to FreshSlate:



No, it is a "brainier" if that money could be better spent in other ways.

In reply to MG:

As the NHS agreed it would cost more not to spend that money then I can't really see what the fuss is about.

Imagine if we could all but elminate HIV in this country, that would lead to a large reduction of costs for generations to come. Not really seeing a downside here.

In reply to Bob Hughes:


That really gets to the heart of it - and thanks for the link to the other study questioning the cost-effectiveness too. That part seemed obvious (a few pills for a short period of high risk to prevent a lifetime of treatment), but is not as clear-cut as I'd thought.

In the case of it being cost neutral (which it could be, more or less), that's a really fascinating question. Although my conclusion is probably "meh". At the end of the day this could be viewed as two different ways of having safe sex: one you have to pay a few quid for a pack of johnnies, the other, you have to go through the bureaucracy of the NHS to get your hands on. Condoms offer lower risk, and are no hassle to obtain. Prep is harder but cheaper to acquire, higher risk, but offers condom-free sex. Maybe it's six and two threes as to which is the more appealing option, depending on your priorities.

Is there a moral difference? I would take the view that on an individual level you can make the choice to save the NHS money by using condoms, which is the right thing to do. But on a policy level, I don't think there is a moral question: I don't care who has sex with whom, how many times, nor what method of HIV protection they choose (so long as they don't put other people at risk by being dishonest). It's just none of my business. So Prep is the slightly riskier option by a few % points - people taking more risks, their business. I don't really see why anyone else should care.

So, if the health economics don't stack up, I don't see a much of a case for Prep. Whether it's cost effective is, for me, the crucial issue, the moral argument is all a bit too Anne Widdecombe for me.

In reply to FreshSlate:



More like 40 million + . And to help reduce it by how much exactly? 1 case, 16 cases, 100 cases?

Seems to require a bit of brain power to me.

In reply to Indy:

Did you know a third of people with HIV in the UK are women?

In your opinion is it the hanging outside of public bathrooms for unprotected sex or the sticking of their todger into every Tom, Dick and Harry that has led to this figure?

In reply to FreshSlate:


Indy also seems unaware of the inventions of the internet and the mobile phone, and how these have had an impact on how gay men go about getting a f*ck. I guess that perhaps public toilets may still have their place for some people, but it's pretty old-school and certainly an acquired taste - and probably not the pivotal issue in this debate.

In reply to off-duty:
Your estimate is based on 100% take up rate of every single person who is elligible.

With the assumption that they all take it all the time as well and not periodically or during times of increased risk.

That figure is not remotely realistic, although I'd be comfortable even if it did cost that much.

If it prevented HIV in 5% of people it was to prescribed it'd be a good return.

In reply to FreshSlate:

There have been some valiant efforts, but I don't think this thread is going to crack the figures on this one! The link Bob posted is excellent and shows just how unobvious the answer is.

In reply to FreshSlate:





The figure clearly is realistic. It's the estimate used in the court case.

You think it's a good return based on what? It's a public policy question about where finite resources are spent.

The returns of this investment don't appear to add up financially.
If you want to argue that saving one life is worth it, then consider what that money will now NOT be spent on. It was reported (the daily mail unfortunately ) that a number of other new treatments for other illnesses and patients have now not been rolled out as a result of this case.

In reply to Jon Stewart:

Agreed - any efforts to pinpoint the figure is speculative.

But in the grand scheme of things it cost £9.3 million to send the pro E.U leaflet to every household. That's all dead money. Send that twice more and there's likely enough money to fund a drug which can help prevent the transmission of HIV and perhaps save money in the long run.

Even if it turns out as a net cost:

"NHS spends money on preventing HIV"

Shocker.

In reply to off-duty:




I don't think we know that yet, the PROUD study showed good cost effectiveness, but this has been called into question (see Bob's post above, where the assumptions and effect on the modelling are discussed).

Looks very much like we would need to suck it and see.


Let's see this before believing it please. Sounds like bullshit of the very highest order: decisions about specific treatments based on this ruling? Really? How does that work?

In reply to off-duty:


Could you elaborate? I'm not sure how 'it's in the court case' disputes that not every single person who is elligible will take any given drug.


This clearly seems to be contentious. We've had everything from cost effective, cost neutral to this in this thread.

If every decision the NHS made stacked up financially it'd be paying us national insurance not the other way round. I think there's a strong case for spending money in this area, we can argue until the cows come home about more 'deserving causes' but hiv/aids is still a serious condition that needs to be addressed.

In reply to Jon Stewart:



I agree - the numbers are certainly not clear (my numbers are all back of the envelope anyway)


It quite possibly is bullshit of the highest order - it was the Daily Mail!
Just trying to highlight the difficulties of budgetary decision making - if it's spent on prEP its not spent somewhere else.

http://www.dailymail.co.uk/news/article-3722686/How-blameless-sick-paying-p...

In reply to FreshSlate:

Your comment "it's not remotely realistic" - clearly it is. You can dispute the exact numbers but it is certainly a realistic figure.


With your initial contention being that this is a "no-Brainer" - which it clearly isn't. Hence the discussion about numbers.


Which doesn't actually address the issue - finite amount of money, if you give to one treatment you take from another.
Or you argue for more money - but you still have a decision to be make about where that money is spent - HIV, Cancer, hip replacements etc etc.

In reply to off-duty:

Have you read that article!? What in the name of f*ck does Prep have to do with cataract surgery?!

Astonishingly shit - every time I see the Mail, I think someone's taking the piss and are showing me a satire instead, but no, it really is that shit!

It's perfectly clear where Indy gets his "information" (aka prejudice and lies) from...all together now, "I gather all my views...from the Daily Mail"

youtube.com/watch?v=5eBT6OSr1TI&

In reply to Jon Stewart:

I agree, lot of spin, prejudice and muddying of the waters in the article, but ultimately their point is valid if unpalatable - a finite pot of money means one patient's gain is another's loss.

In reply to off-duty:
That "point", hidden as it is within an ocean of toxic shite, applies only once its shown that Prep is a net cost to the NHS. The decision was made on the basis if it being cost-effective.

So it is thus far a long way from being valid.

In reply to Jon Stewart:


I agree - the question from a public policy point of view is "Is it cost effective ".
That may be as simple as saying - it saves us money in the long run, or as complex as saying we are prepared to spend £ X to prevent one case.

As I understand it, the case wasn't about its efficacy, so much as about who should fund it - NHS England or local authorities.
It doesn't appear to be a green light -

http://www.independent.co.uk/life-style/health-and-families/health-news/pre...

In reply to off-duty:

The NHS's definition of cost effective is - according to what I've read - less than an additional 30,000 euros per person. which is potentially still a significant cost increase. Having said that, 30k is the standard and it is the same standard for all treatments.

PrEP only becomes cost saving if the price reduces significantly.

In reply to Jon Stewart:



Perhaps theres the answer right there.

In reply to Jon Stewart:
I presume that the point that NHS England is making is that, even if PrEP brings economic benefits in the future (not clear but for the sake of argument), they still need to find money for it in this year's budget.

[edited because i'm not sure i correctly understood the link i posted...]

In reply to off-duty:

Again - still doesn't explain the assumed 100% take up. That logic is clearly flawed, I'm not sure how realistic a number can be when it's based on every single person who is elligible for a prescription taking that prescription.

Odd you post a link which quotes a £10-20 million pound figure and quotes several health bodies saying that the drug is a good idea. Do you only read the bits you want?


I think the amounts are trivial in relation to NHS spending. It's debateable that it would cost anything at all so, would I lose any sleep from the government stumping up £400 a month for each of a extremely small minority of people at high risk of getting aids? Nope. Could it be the wrong decision? Yes, but it's no HS2, it's peanuts.



We'd literally have to evaluate every single treatment available on the NHS, the cost effectiveness of each and the impact on public health of each. Have you done this?

Suddenly everyone becomes an expert on national health expenditure and is prepared to trawl through pages of reports when it comes to arguing that money shouldn't be spent on gay people.

It may be that it's not worth it, just like a lot of treatments, but I've not seen a 200 page thread on the cost effectiveness of 'quality of life' hip replacements and the like. Let's be honest, this is being heavily scrutinised, particularly on here, because of the gay angle and the perceived immorality of homosexuals.

In reply to FreshSlate:


I'm not suggesting the drug is or isn't a food idea - I (along with several people on this thread) are just trying to tease out the numbers behind any decision on its cost effectiveness.

You jumped in pooh poohing the numbers as "not remotely realistic" - that's what I've taken issue with. They are realistic - they might be debatable, but they are based on figures put forward in the court case, and as such they are certainly not plucked out of thin air.



I'm glad "you" think so. The fact you keep saying "it's trivial" "it's a no-brainer" "its peanuts" etc doesn't magically make it so. As you demonstrate by now trying to justify that expenditure - by setting it against other government projects, and weighing it up against the number of people at risk.


I haven't, but somebody has to - it's how public policy decisions are made.
You are aware that there are lots of treatments for lots of conditions and cost vs clinical judgements have to be made on many of them?



If you say so. It doesn't suddenly make the discussion less valid. Your position now appears to be - if you suggest the numbers don't add up it's because you're a homophobe - which is a pretty poor argument, bordering on laughable.

The suggestion we discuss hip replacements or similar is exactly where this discussion does lead - it's a public policy question, and in fact it might be that prEP is far more effective way of spending money than hip-replacements. That's part of the discussion and debate that you appear not to want to engage in because, in your opinion, it's simply a "no brainer"

In reply to FreshSlate:

"Let's be honest, this is being heavily scrutinised, particularly on here, because of the gay angle and the perceived immorality of homosexuals."

Correct. While much has been said here about medical efficacy, cost effectiveness, societal benefit etc the centre of gravity in this thread revolves around homophobia. There have been some utterly disgraceful homophobic opinions expressed here under a (very thin) veil of reasoned argument about these issues. Anyone posting in support of the OP should either accept themselves as homophobic or examine their conscience and their posts carefully.

In reply to duchessofmalfi:



It's not clear who exactly you are condemning with that vaguely worded criticism.
It reads dangerously close to the "if you mention immigration you are a racist" rhetoric of recent times.

In reply to off-duty:



Again you're still not answering the point of how figures bases on a 100% takeup rate, which is not remotely realistic, can be... remotely realistic. "Put forward in court case" does not = realistic. We're going around in circles now but feel free to keep making the same assertion, I'm out.


It is trivial, do you have any idea what ~£20 million is in the scheme of the NHS budget? It's trivial, peanuts, etc. etc. in a purely relative sense. I'm going to defer to the NHS's judgement here, either way.


Don't forget you're responding to a thread where the O.P has called out gays for 'taking the NHS for a ride'. There's a great deal of homophobia in this thread and it you do yourself no favours by ignoring it.

If you examined every ~£20 million the NHS you actually wouldn't have any time to do anything else. If you think the numbers obviously do not stack up, then the NHS will see this on reviewing the case for offering the drug and will spend the money elsewhere. I'm sure this happens for many drugs, so why the court of justice on UKC?

If they do spend the money, the O.P and others will believe that the gay community got one over on the NHS, a bit sad really.

In reply to FreshSlate:


Actually you may be right - I can't find the reference that I used for the 40 million estimate and most (including NHs) appear to be quoting 10-20 million.


Trivial, peanuts etc - the NHS position is the same position I put forward. It costs money. A decision has to be made on whether it's Cody effective, and if you fund it, you don't find something else.

https://www.england.nhs.uk/2016/07/spec-services-investment/

Or do you still maintain that the NHS are wrong and its a " no brainer".


Wait..what...?
Rather than pick up on the fact that this is actual quite a complex issue of public policy, coupled with a tricky moral question due to the fact that the cheapest and most effective preventative method relates to the use of condoms in consenting sexual activity, which in itself brings out a direct comparison (on many but not all levels) to the supply of the pill - you appear to be using a cry of "homophobia" to attempt to avoid having to actually think about what you are proposing as a " no brainer".


I'm not sure if the numbers do or don't stack up, I'm trying to figure them out.
On the other hand - unless you have suddenly changed your position - you don't even appear to consider that the numbers are worth thinking about. Which is at best idealistic and a bit naive.



Yes. That would be sad. It shouldn't really be an argument to fund or not fund a treatment though.
Conversely they might well be right if we were to base our decision to fund it on y and wour suggestion which appears to be that we shouldn't think twice about spending 20 million without any consideration of effectiveness or cost/benefit.

In reply to FreshSlate:
Erm, so are you

In reply to Jon Stewart:



You can rant till the cows come home that everyone that disagrees with you is homophobic but you have repeatedly refused to answer or address the root issue.

The gold standard for preventing the transmission of HIV is safe sex. It's as you well know a substantially more effective way of preventing HIV than prescribing the uber expensive drug Prep.

Advocate a website for the LGBT community said.....

"HIV infection rates across the country’s general population have been fairly stable for the last few years. But one group showed a SIGNIFICANT increase in HIV infections: men who have sex with men, or MSM, aged 13-29"

It goes on to say....

"91% of participants say they know how to protect themselves from HIV"

"The vast majority of respondents considers ***********, or unprotected **** sex, to be dangerous. Yet 46.4% of respondents have engaged in ******** (unprotected) sex"

So I'll ask you again..... why do you feel that the NHS should fund an informed lifestyle choice over a say a 5 year old child with cystic fibrosis who has breathing difficulties.

In reply to Indy:

Sorry what is the relevance of the child with cystic fibrosis? Has the NHS said if we fund PREP then we aren't funding cystic fibrosis care? I find interesting every time you mention this you bring up the most emotionally extreme example you can think of. No measured example or anything. Why?

Your OP was pious and judgemental. It came across as some who couldn't be bothered to find out more before posting.

If the NHS has to fund this then it may find ways to fund PREP and everything else - its not binary. And has already been mentioned there is a good chance that this will save money in the long term because of the reduction in further infections.

From experience there is a world of difference between the approaches of sexual health clinics in some where with a large proportion of gay people to other places. Talking to sexual health clinicians, many of the men are involved in 'chemsex' and are distinctly at risk and PREP would help in this situation. Condoms are one of several answers. PREP is another way. Having spoken to a retired NHS psychiatrist (who is gay) about chemsex and the sex party scene in particular, he is thinks there is a link between the self esteem, behaviours and poor mental health which gay people are more prone to suffer from. Having access to open and non-judgmental services is crucial to changing behaviour.

Paul
(gay and HIV positive for over 10 years)

In reply to Indy:



I have answered this point directly, so I will repeat my answer, which you have either ignored or not understood.

Safer sex is clearly the best way to prevent HIV so we tell gay men to use condoms, through public health information, sex ed in schools, through charities, getting the porn industry on board, etc. So, most gay men follow this advice, they don't want to be taking tablets all the time, and might be in relationships, mostly celibate, or shagging about a lot but safely. Great.

But, the fact remains, like it or not, that some gay men don't follow the advice and have unprotected sex, promiscuously. This is a fact that has to be dealt with, and here are some options (you might be able to come up with others if you think I'm missing some):

1. Treat the hiv/aids with a lifetime of drugs. This is very expensive, and not brilliant for the patient.

2. Don't treat the hiv/aids, and tell the patient that they should have worn a condom. This is very cheap, but the patient dies, and leaves the NHS in an impossible position policy-wise, as now its only treating disease where the patient is not "at fault". So now, no care for smokers, fatties, sports injuries, etc. All in all, not a viable option.

3. Offer Prep to the high risk patients who ignore all the condom advice. Reduced infection rates and cheaper than 1 (provided the eligibility criteria are right, i.e. High risk patients correctly identified, everyone else uses condoms).

4. Offer Prep to anyone and everyone, abandoning the safe sex education as now we can all shag about with impunity (or 90% impunity anyway).

So out of these 4 options, i think the best one is 3. From your posts, you seem to advocate either 1 or 2 (but 2's not a serious option), or perhaps one that involves somehow making gay men wear condoms every time which is so stupid I didn't even put it down.

I can't answer the question any more directly and fully than that. I agree that gay men at risk *should* wear condoms. Given the fact that some don't and HIV is therefore still transmitted, there are different policy options for this problem. I believe that with the correct eligibility criteria, Prep would be the most effective, including cost.

Now let's tackle the homophobia point.


The only person who I've said is homophobic is you, and again, I've addressed precisely this point in detail and you have ignored it. In my very first reply to you, I said:


...and then went on to say why I found your comment "Gay men it appears feel that it is there fundamental right to have risky/unprotected sex as the NHS is required to dish them out these preventative drugs i.e. screw everyone else I'm pissing in the pool." to be homophobic.

Since then, I've explained again:

No one has accused Indy of being homophobic because he doesn't agree with Prep being funded on the NHS...Indy has, while making only the most pathetic attempts to join in the interesting discussion, made a string of overtly homophobic remarks, listed above. Its the remarks that display his prejudice and malice, not the view that this drug shouldn't be funded on the NHS.

I can't be any clearer. I can't make this simpler for you to understand. I can only advise that if you're about to publicly make a remark that you're not sure whether it's homophobic or not, err on the side on the caution and shut the f*ck up.

In reply to paulcarey:


From The Guardian.....
"A warning from NHS England that it cannot confirm funding for drugs to treat rare conditions including cystic fibrosis in children if it is to pay for an HIV prevention pill. Other treatments at risk of losing funding include a drug to prevent low sodium levels in the blood of chemotherapy patients, a childhood narcolepsy treatment and brain implants for children with hearing problems"

From everything thats gone on so far I don't think thats the case. Maybe if you tell the NHS where the unlimited money pit is we can go from there?

Yet again my basic question hasn't been answered....... Call me judgemental and pious but safe sex is the gold standard why should the NHS fund an uber expensive drug leaving others without because a section of the gay community feel that they have a right to engage in promiscuous unsafe sex?

>Having access to open and non-judgmental services is crucial to changing behaviour.
Even without this drug the HIV rate has significantly increased in 13-29 year olds despite decades of advice/information etc. Whats to say that this drug won't just encourage and extend the practice of promiscuous unsafe sex? "Its OK dude I'm on Prev"

In reply to Indy:


The issue for the NHS is that this is a judgement saying that a preventative health measure should be paid for from their budget. I can see why they will want to resist this, as it potentially opens the door up for other similar preventative measures. The statement is highly political - the mentioning of specific treatments that are competing is presumably based upon what's in the NICE process at the current time, I think in reality you could say that Prep will compete with *every* other treatment. The statement deliberately ignores the complex issue of long-term savings in HIV treatment which Prep may result in, because they want the door to remain closed to paying for preventative medicine full stop (and so they should - they don't want their budget spread more thinly, they presumably want the spending to happen, but just from elsewhere in government).

This is why I've stressed that the economics has to be looked at very carefully.

From the evidence which is linked in this thread, it appears to be not at all clear cut whether Prep represents a cost or a saving to the NHS. My view in light of this evidence is that the eligibility criteria should be designed in order to make it a saving - which is a difficult but hopefully possible task. We're entering a world of guess-work here because the research hasn't given us the definitive answers, but my guess is that by limiting the availability to only those at the highest risk, the NHS can save money in lower infection rates (since it has to pay for treatment) and in doing so mitigate the risk that the drug becomes a commodity for gay men who go out shagging ramdoms a lot.

You need to acknowledge that this is a complicated issue. It isn't a choice between doling out to Prep to anyone who wants a night out on the pull in gay bars at the cost of millions to the NHS, or saving the lives of children with cystic fibrosis, as some of the media would like you to believe.

What's your view on the cost of diabetes to the NHS? That's £1.5m per hour. The cost of Prep could be met in a few minutes if a lot of the fatties out there ate a few less marsbars and switched to diet coke. So why not aim your bile and hatred towards diabetics - is there something *particular* about the lifestyle related disease that gay men suffer that makes you feel that they are so undeserving of care from the NHS?

It's a really interesting, complicated issue, and there has been a great discussion on this thread so thanks for raising the issue. However, it would have been much better if you'd just said (in Lemming style) "so should the government fund this drug?" and then f*cked off without saying anything else.

In reply to Indy:

Because it is cost effective -- they save money. What they spend on prevention is less than the amount they would have to spend if they didn't reduce transmission. The same principle applies for much of the NHS spending. Lifestyle has nothing to do with it.

Ultimately it means they can then save more children cystic fibrosis, if that's they want to do with their savings.

In reply to Indy:


There are two reasons, one economic and the other moral.
The economic reason is that providing PrEP might very well lead to a reduction in cost to the NHS
The moral reason is that the NHS bears the costs of a wide range of idiocy and irresponsible behavior, including people getting drunk and fighting at the weekend, drink-related liver failure, complications related to smoking, the consequences of people playing dangerous sports etc etc etc. why should we single out reckless gay men?

You might argue that there is a difference between clearing up the mess afterwards and providing preventative protection. That's a fair point and gets to the question of moral hazard. i think the answer to that question is how PrEP is implemented (with the correct controls / guidelines) not whether it is implemented.

As an aside, the cystic fibrosis treatment in question costs upwards of 200k pounds per patient per year, so in this context PrEP is nowhere near "uber expensive".

In reply to Indy:

Yes the gold standard of sexual health is not to have sex at all. But I think thats unlikely!

All NHS England are going to do is assess where prep sits with cost effectiveness compared with other treatments for other illnesses. "Dr Jonathan Fielden, NHS England’s director of specialised commissioning and deputy national medical director, said they were setting the ball rolling so PrEP can be considered for funding following the high court ruling.

“Of course, this does not imply that PrEP – at what could be a cost of £10m-20m a year – would actually succeed as a candidate for funding when ranked against other interventions. But in those circumstances, Gilead – the pharmaceutical company marketing the PrEP drug Truvada – will be asked to submit better prices, which would clearly affect the likelihood that their drug could be commissioned,”

As others have said it may well be that the cost benefit analysis shows that the prevention in infection may deliver benefits that enable all of these treatments to be available. Which is presumably what you would want as well?

It doesn't surprise me the rate of infection of HIV in 13-29 year olds is on the increase. Attitudes to HIV are changing because it isn't a death sentence any more and sexual health prevention needs to reflect this. We don;t have marble tombstones falling across our TV screens like the mid 80's campaigns scaring the be-jesus out of people.

As i said before prep should form part of the strategy to dealing with HIV prevention, along with access to sexual health services and more sex education.

In reply to off-duty:

Fair enough.






As a member of the public, I'm fairly happy for the NHS to make this decision based on information I couldn't possibly have access to. What we have is this thread is moral outrage at the idea, and then subsequent digging to find any holes in the rationale of prescribing this drug.

I'm happy to leave this to the experts, are you? It's a no brainer for me, I'm not going to worry about how this 20 million is spent.


I do think the numbers are worth thinking about, but you get to a point where a sum doesn't warrant a trial by the public and the media, and best just let the NHS get on with it's thing. If people like Indy want to fashion signs saying "wear a condom" then fine but even if I disagreed with it I'd move on.


I don't think it warrants this level of scrutiny from the general public, I don't think slurs and moralising about what homosexuals should and should not do, should dictate the medical treatment they are entitled to. Though I'm not saying this was your approach at all.

If you've got a better argument than 'it *might* be better spent elsewhere' then I'm all ears.

In reply to FreshSlate:



Well the NHS didn't want to spend the money. They wanted the decision left to local authorities. The implications of spending the money clearly still worry the NHS, hence the rather negative response to losing the case.
The experts aren't united UN what they think is the best way forward.

You entered the thread suggesting that of course the money should be spent - it was a " no brained".

Now it appears you are saying -" I don't care how the money is spent" and seemingly - " I don't see what the thread is about"

I've no idea why you bothered posting if that's your position.


As mentioned, the NHS aren't keen. You seem to have changed your position from "spend regardless" to " I don't actually know" or maybe "I don't actually care".

If you'd started by saying what you actually meant, it would have made things a lot clearer.


I'm not sure its a slur to discuss why people don't use a much more effective and cheaper treatment. There may be a £20 million project that could nudge behaviour - that might be even more effective for example.
Slurs and moralizing are unnecessary though.


1) Is it cost effective - will the amount spent actually reduce future spending on treatment.
2) How much will it reduce the number of HIV cases by. Eg - if we get 10 less cases then, somewhat brutally, is it worth 1-2 million per person.

My argument has never been I think "it might be better spent elsewhere". My argument against your "spend it on hiv, it's a no brainer" has been, and remains - "it is not a no brainer, it is a difficult public policy decision that amongst other things includes decisions about what is and isn't funded by the NHS, which can't just pay for everything and anything "

On the other hand your position appears to have changed from " spend the money regardless, stupid" to "I don't know/don't care how the money should be spent. In fact I don't know why this thread exists. Oh - and if you disagreed with me before it's because you're homophobic"

In reply to paulcarey:

Exactly, Paul. It's not like PrEP is the *only* way the NHS is tackling the HIV endemic in the UK, they are also trying to get increase safe sex practice, something the OP seems ignorant of.

In reply to Jon Read:


The only thing I'm ignorant of is why the hell gay men are knowingly having unsafe sex when there's a risk of getting HIV.

In reply to Indy:


Probably the same reason that heterosexual men (and women) knowingly have unsafe sex. I'll make the rather wild assumption that you know the answer to that.

In reply to Indy:


Did you ever to formulate a coherent defense against the "slanderous allegations"? I was looking forward to it.......

In reply to Removed User:


I've been accused of being pious and judgemental and I completely again because NOBODY gay or straight should be having promiscuous unsafe sex in this day and age.

There are according to Office for National Statistics 545,000 people in the UK that identify themselves as gay or lesbian. A quick and dirty assumption says that 50% are men so that equates to 272500 gay men. The National Aids Trust says there are currently 45,000 gay men living with HIV. Statistically a promiscuous gay man would meet and have unprotected sex with an HIV positive man every 15 partners. I suspect if you looked at this in more depth it would be much much more likely than 1 in 15 just look a the fact that 60% of new HIV infections are in gay males.

The number of HIV positive heterosexuals in the UK with HIV according to the Terrance Higgins Trust is 54,000. The office for National Statistics said that 92.8 per cent of adults identified themselves as Heterosexual/Straight. With an adult population of 38 million it would mean that there are about 35 million heterosexual adults. You'd need to have promiscuous unprotected sex with 4450 people to statistically meet 1 with HIV.

In reply to Bob Hughes:



Completely agree it shouldn't...... If you say that Prep should be given to gay men then why shouldn't the NHS fund preventative measures for obesity? surely it would be cheaper in the long term for the govt. to do every ones shopping then set up kitchens and then taxi round the prepared food. It doesn't do this because although it would probably be cost effective in the long term all it would do is ENABLE and promote an undesirable lifestyle.

Cystic fibrosis isn't a lifestyle choice