Comment: Privately prescribing HIV-preventing drugs could do more harm than good

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Tom Hayes, the editor of beyondpositive, an online magazine for people living with HIV in the UK, discusses a clinic’s decision to privately prescribe HIV-preventing PrEP drugs that remain unavailable on the NHS.

A well known Sexual Health Clinic in London has started privately prescribing PrEP to those who can afford it, but it this ultimately the best way forward?

This week 56 Dean Street, part of Chelsea and Westminster Hospital NHS Foundation Trust,  opened its doors and started privately prescribing PrEP (Pre Exposure Prophylaxis) – to those who can afford it.

Whilst circumnavigating the system at a cost may be good for a few, will it cause longer delays for those waiting for the NHS to start prescribing PrEP?

The NHS is holding off on prescribing PrEP (either free of charge, or with a prescription fee) whilst it conducts consultations and cost-analysis, the current soonest we can realistically expect it is late 2016 / early 2017.

The LGBT community is already community divided. As letters of a rainbow we don’t always see eye-to-eye, and then within those letters we have our own factions – bears, twinks, cubs, daddies etc. Further still within those groupings you see divisions based on HIV status “Positive, Undetectable, Negative…” and now “on PrEP” – if you can afford it.

My fear is that what Dean Street has done here, which looks and feels like a great “stopgap solution” will, whilst people wait for PrEP on the NHS, be slowly replicated across the UK . Then before you know it we’ve got a network of clinics prescribing Truvada, albeit at a price, and it’s not a huge stretch of the imagination to see the NHS and/or Department of Health saying in 2016/17.

In this current time of austerity prescribing an expensive HIV drug to those without HIV, when existing prevention methods such as condoms and PEP are available, isn’t something this government or NHS can justify. But for those who need it the third sector, and a number of clinics, have embraced the free-market and are prescribing PrEP privately.

Those rich gay men who can can afford privately prescribed PrEP (current UK list price: £355.73) will go away happy and safe whilst those who need it, those who really need it (people who engage in sex work, people in violent relationships with no control over prevention, people in serodiscordant (mixed-status) relationships, men who have sex with men on low (or no) income, those who have come here seeking political asylum, the trans* community) will continue to go away empty handed, and live a life with a high life-time risk of contracting HIV.

PrEP is an amazing thing. Trying to circumnavigate the system and help your population is an amazing thing. But be careful how you do it, because you may well simply make matters worse.

This article was first published by beyondpositive.  Tom Hayes tweets at @UKPositiveLad