BRITAIN: NHS Rejects PrEP For Second Time

The BBC reports:

NHS England has reiterated it will not fund a “game-changer” drug treatment that can prevent HIV, angering HIV charities which had been campaigning to reverse the decision. The NHS is standing firm and says it has no responsibility to provide the treatment, known as Prep. It says the onus should fall on local authorities instead.

Charities have called the decision “shameful”, and warned that lives would suffer as a result. Prep (pre-exposure prophylaxis) is a daily pill that can considerably lower a person’s chances of catching HIV. If taken correctly, it is almost entirely effective in preventing HIV.

Ian Green, chief executive of the Terrence Higgins Trust, said: “Today is a shameful day for HIV prevention. “This country used to lead the way in the fight against the HIV epidemic, but today, our national health service has washed its hands of one of the most stunning breakthroughs we’ve seen – a pill which, if taken correctly, is almost 100% effective in preventing HIV. A pill which is already available in America, Canada, France, Kenya and soon to be Australia.”

  • Gene

    1) idiocy…expected better of the English
    2) the danger…from health care to anything else, of having ONE government agency in control with the one LAST word that counts.
    3) people will get infected….how much will THAT cost? again, idiots. the NHS is a financial WRECK, but this is worse than short term thinking…this is CRIMINAL

    • Todd20036

      I can’t believe HAART. Drugs are cheaper than PReP

    • Dazzer

      While I disagree with this decision, I can understand the NHS’s reasoning when it comes to finance. Because of equality laws, PrEP would have to be available to all members of the population – either at a cost of £8.70 for the prescription if you’re working and earning or free if you’re not.

      If the tabloids talked up an AIDS scare-story (and we all know the British tabloids would do that like a shot), every sexually active person in England and Wales would be lined up at their GP’s surgery demanding PrEP. And the NHS – even in its most financially successful incarnation – wouldn’t have the billions that would cost.

      I suspect that what’s going on behind the scenes is that the NHS is starting to play hardball with Gilead. At some stage, Truvada is going to be prescribed, but it’s not going to happen at the current price. So either Gilead lowers its price or the NHS will wait till a far cheaper generic drug comes out.

      Given the cost implications, the NHS can weather out the storm from not funding the medication to gay, bi and BME (black and minority ethnic) people because we’re a minority. If HIV were just a problem that effected us, the NHS could probably find the money from behind the sofa cushions for the treatment. The economies of scale would mean that it would be cheaper to provide PrEP to prevent HIV in a relatively small number of people compared to the cost of healthcare over a lifetime expectancy that could very easily reach 60 years in the next decade.

      However, once you extend that treatment to the entire population, the current NHS budget based on National Insurance contributions wouldn’t cover the cost of this one drug, never mind the millions of others that are prescribed daily for things like cancer.

      I would love to have PrEP prescribed on the NHS, but keeping a cool head, I can understand the economic, policy-based and PR problems for the NHS if it chose to die on that hill.

      The NHS is better than most (definitely not all) health care systems around the globe – but it’s not perfect and it’s a slave to finances just like anything else.

      • Hue-Man

        Do UK doctors not tell their straight patients with zero HIV risk that they’re crazy for demanding Truvada and politely show them the door? Isn’t it almost medical malpractice to write a prescription for a powerful medication that is 100% unnecessary?

      • Bobbleobble

        Your argument is flawed in that doctors don’t simply prescribe medication because you turn up and ask for them. I’m currently on blood pressure pills because I have a blood pressure problem but a doctor wouldn’t prescribe them to some random person who didn’t have that trouble. Similarly, in spite of equality laws, no doctor would prescribe me birth control pills as a man. A doctor would be perfectly capable of deciding who is and isn’t at greater risk of HIV transmission and prescribing accordingly.

  • Oscarlating Wildely

    I thought Section 28 died with that miserable cow. Apparently, I was wrong. http://i0.wp.com/eveningharold.com/wp-content/uploads/2014/09/thatcher-zombie.png

    • m_lp_ql_m

      She has Anita Bryant’s hair.

      • Paula

        And Anita Bryant wants it back!

        • Johnny Wyeknot

          And her unicorn statue too.

  • Sam_Handwich

    and yet…
    All girls aged 12 to 13 are offered HPV (human papilloma virus) vaccination as part of the NHS childhood vaccination programme.

    http://www.nhs.uk/conditions/vaccinations/pages/hpv-human-papillomavirus-vaccine.aspx

    • William

      Boys should be vaccinated as well.

      • Todd20036

        Wish I was

      • Hue-Man

        7 Canadian provinces will offer free HPV vaccine to boys by the end of 2016. Holdouts – Saskatchewan, New Brunswick, Newfoundland & Labrador.

      • Robert Pierce

        That’s already been approved for boys just recently.

    • BobSF_94117

      HPV vaccination is one (or two?) shots, not a life-time monthly regimen.

  • PickyPecker

    ::

    • TuuxKabin

      Thanks all giver gods and goddesses, too bad her spirit/mentality didn’t die with her.

    • PrP

      That joke doesn’t work in this context. The point is to mock people who are “kicking a dead lion”, who blame for problems of these days somebody/someting that doesn’t exist anymore.

  • Bill

    It sounds like they think all the right kinds of people get HIV.

  • John

    This does not make much sense from a purely public health perspective.

    • David L. Caster

      Doesn’t make much sense even from a purely economic perspective.

      • Rillion

        It makes perfect sense if your main concern is a one year government budget.

        • David L. Caster

          There is that.

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    • ChrisMorley

      This is what the committee making this decision resolved, that it:

      “acknowledge that the Secretary of State [for Health] could delegate the power to commission PrEP to NHS England via Section 7a [of the Act dealing with commissioning] but note that this would need to be accompanied by appropriate funding”.
      https://www.england.nhs.uk/wp-content/uploads/2016/05/sscc-paper-prep.pdf

      They are blaming outside lawyers for telling them they don’t have the power to commssion providing PrEP to those at risk, for what looks like a financial reason.

      • MarkOH

        “…for what looks like a financial reason.”
        Sigh, so much preventative medicine is prevented for financial reasons when the long term cost is so much more.

        • Gene

          it would be good preventative medicine…and a cost saver down the line…but, right now…the NHS is just…broke. so, a short term savings..and pat on the back for keeping a quarterly budget under limits, is what they are aiming for

        • Ginger Snap

          They want our $$$$$$ long or short term your health has nothing to do with it.

          • MarkOH

            “They want our $$$$$$ long or short term your health has nothing to do with it.”

            Who do you mean by “They”?

          • Ginger Snap

            Big medicine/healthcare businesses.

          • MarkOH

            oh, the nebulous “them”.

      • Dazzer

        This has the mucky, grubby fingers of that mispelled Secretary of State Jeremy (H?)unt all over it.

        This is his MO. When makes one of his mostly fuckwitted decisions and it looks like it’ll go tits up, he immediately blames someone else.

        He did the exact same thing when he was trying to close Lewisham Hospital.

        The sorry excuse for a window-licking, knuckle-dragging, mouth-breather that controls out health service is a serial moron.

    • londonbuddy

      But if you have an ‘accident’ and are exposed to HIV, then you go to
      the nearest clinic and you get a 30 day supply of HIV medication. it’s
      called PEP and it’s free,

      https://www.gmfa.org.uk/pep

      Really not that different. Just supplied when needed,

  • RainbowPhoenix

    Weinstein must be happy about this.

    • David L. Caster

      I believe he may have provided them with some measure of cover.

  • ErikDC

    Remember boys and girls, the NHS is the health care model Bernie Sanders wants the United States to emulate.

    • William

      It far surpasses the clusterfuck of healthcare in the US.

      • Gene

        I have lived in both nations and would STRONGLY argue against that William.
        its a great system for a broken leg…a childbirth…a flu…but the wait times for so many things are so bad…and I am not just talking about hip replacements or cancer treatment…I mean waiting to get treatment for psorisis or gout. etc….does it have its advantages? yes. do they outweigh a Swiss model (which we are working towards)of a heavily regulated marketplace system, hell no. And, sad to say, the first Canadians and English I got to know well, I got to know well working in a hospital when in college. they had been told “no” by their national healh systems, and while many died, many did recover while in treatment here….I imagine that, as much as my time working in the City, colors my view on the subject
        (( we ARE a clusterfuck…but, one one stuck in total beaurocratic amber))

        • Todd20036

          Ah, but what if you caught the flu, while giving birth with a broken leg?

          • Gene

            airlifted back to the states 🙂

            I have to mention that when I FUCKED UP…way past the normal “sprain” my right ankle when in Canada…after the…oh dear god…like4 hour wait, the care was excellent, and I was wrapped, secured, given pain meds and antibiotics (there was a nasty cut involved) and sent on my way…in theory they should have charged my American insurance company..but just went “nahh…stay safe, and have a good evening!” and helped me hobble to the door.

            “how nice!” I remember thinking.
            “how…utterly financiallly iresponsible…SOMEONE paid for that care, and it should have been me!” but, the taxi was already on its way, I was mildly stoned from the painkillers, and was leaving early the next day…sad to say I never followed through. 🙁

          • Hue-Man

            Emergency Rooms in Canada do more billing and collections than family physicians because they see more foreigners. My doctor’s practice sends one bill to the single-payer medical plan and he probably never sees an actual invoice.

            One of the provinces tried sending an “invoice” to its residents to show what their medical services were costing the province. They were thrown in the recycle bin because as a patient, there’s nothing you can do about it so why think about it? Duh.

            I had the opposite experience with emergency surgery in the U.S. It was 100% covered under my employer’s plan but I saw the invoices when I got home. I almost had a heart attack thinking about what would have happened if I had to pay such a huge amount without the insurance.

        • nowhereman

          I am poor and have a bronze plan under the ACA because if I didn’t I would have to pay a fine. I’m almost 100% subsidized, and it is expensive ($1400 per month, $4500 deductible) and it covers pretty much nothing. I’ve only used it once in 3 years, and it wouldn’t even apply my doctor’s office visit towards the deductible. What we have now is crap.

          • Gene

            but its working towards a more efficient system…and,were you to be in an auto accident, cancer, etc. it would save you from bankruptcy, and quite possible, death

        • Robert Pierce

          Our NHS still delivers health care more universally than most others for next to nothing to the consumer over and above what we pay in national (health) insurance. It has been grossly underfunded by the current Tory government as part of its austerity cuts agenda. In spite of its flaws and all systems have them, the majority of us would NEVER give up on it. It’s served us well. I for one would never want to see it privatised nor would the majority of us.

        • hiker_sf

          If we are going to look at the extreme examples of failure in socialized medicine, we have to do the same with out own fucked up system. I have coverage in two different countries and it is a relief that I don’t have to be a healthcare insurance expert to figure out which plan I need EVERY YEAR.

  • idiot polbots never seem to understand, so who knows why we keep electing them all over the place. spending less now = spending much, much more later. this is true in things like the environment, or infrastructure. it’s also true of diseases. no one really cares if some people find talking about this particular disease ‘icky.’ those are stupid people who should be shown the door when the adults are ready to talk.

    once again, who is behind all this? the religious freaks. why are “our” leaders pandering to people who believe in Noah and want science classes to be based on that story? health policy is nothing if not the definition of “it affects us all.” proven science alone must determine national health policy. there is no “win” in allowing a potentially lethal disease to spread, when there is a chemical method of controlling it.

  • James

    It is a shameful day. It’s shameful that a national health service doesn’t know the adage about an ounce of prevention being better than a pound of cure.

  • londonbuddy

    But if you have an ‘accident’ and are exposed to HIV, then you go to the nearest clinic and you get a 30 day supply of HIV medication. it’s called PEP and it’s free,

    https://www.gmfa.org.uk/pep

    Really not that different. Just supplied when needed,

    • Paige Turner

      No its completely different.

      I have been on it once and it left me in bed sick for a month. It is extremely toxic and unnecessary.

      • Silver Badger

        Most of us have few problems tolerating Truvada. You sound like one of the unlucky ones. Compared to some of the older HIV meds I’ve been on, Truvada is a walk in the park. Be safe and keep it unnecessary. 🙂

        • Paige Turner

          Please re-read my comment. You have not understood it properly/

          PEP and PrEP are very different things.

          PEP is NOT Truvada.

          My comments were about PEP.

          I am currently on PrEP (12 months) and there are few side effects. I was one of the first gay Men in Sydney to be on the trial.

          I am evangelical about PrEP and believe that all sexually active gay Men should be on it.

          • Silver Badger

            OK. Pep is an unfamiliar term which I thought was a typo. Don’t forget your post and the post you answered are from people in different countries than I. Sorry if there was any misunderstanding.

          • Paige Turner

            PrEP is Pre exposure prophylaxis (Truvada)

            PEP is Post exposure prophylaxis

            They are standard medical terms used for the drug regimes involved.

            Education on these things is imperative in the LGBTI community. If we cant get the basics right then we will struggle to eliminate HIV.

          • Silver Badger

            Thank you for the information.

          • Paige Turner

            Information is power

    • SomePerspective

      So… you think its exatcly same to take a tetanus vaccine as getting the diease, suffering it and then “just curing it”? Great! You just solved a huge health problem and saved billions of money for many countries. According to yourself…

      • londonbuddy

        I didnt say they were exactely the same. And who mentioned anything about getting the disease and suffering from it??

  • Mike Thakar

    Truveda costs $14,000 per year per person. Condoms cost, at most, a couple hundred dollars per year. 1.5 million SMS +/= in the UK. For every 10% of SMS, costs $1 billion/year. So if half SMS go on PrEP, its $5 billion/year. Or, 1% for condoms.

    I, for one, would prefer seeing that money go to further developing a cure.

    • Paige Turner

      Perhaps you should factor in the cost of treating someone for a lifetime if they sero-convert and use those costs as a benchmark?

      Also, PrEP is 99% effective if taken daily. Condoms are around 80%

      Looking for a cure is a waste of time when you can eradicate the virus in a generation instead.

      The NSW government (Sydney, Australia) has expanded its PrEP “trial” and has a goal of endng HIV by 2020.

      Truvada has been approved by the Therapeutic goods administration in Australia as a pre-exposure drug which is the first step in getting it on to the PBS (Pharmaceutical Benefits scheme). This is a government subsidised program for certain drugs

      http://endinghiv.org.au/nsw/stay-safe/epic/

      Call it “Combination Prevention”, or, “Prevention Revolution” or the “New Prevention Paradigm” – it’s about ending HIV. 2020 marks the end of the decade and it can also mark the end for new cases of HIV.

      From the ending HIV website;

      HOW DO WE DO IT?

      By ensuring that:

      EVERY sexually active gay man tests at least twice a year for HIV,

      EVERY gay man diagnosed with HIV has access to treatment as soon after diagnosis as possible, and that

      EVERY gay man continues to stay safe by using condoms and/or using sexual risk minimisation strategies

      • GetReal

        “Looking for a cure is a waste of time when you can eradicate the virus in a generation instead.” C’mon, get real! Thats just like saying; “We should demolish our justice system, because it WOULD BE useless as if all just stoped making crimes, THERE WOULDN’T BE ANY PROBLEMS OR ANY NEED FOR PUNISIHING OR COMPENSATION FOR THE VICTIMS”. Thats complete and fucking infantile bullshit. People are reckless, do mistakes and make crimes on purpose. Same goes for things that are not punished by law. Its just reality and if you want to help the cause, then you have to be realistic. That’s very much like Nixon’s “war on drugs”. Infantile idelogical puritanism JUST DON’T WORK IN REALITY!

        • Paige Turner

          Using all Capitals means that you are shouting, crazy, trolling or in this case all 3.

          Perhaps understanding how PrEP works and using it yourself may open your eyes to the reality that it is possible to halt HIV transmissions by 2020.

          Best of luck with your abstinence and condom message. 30 years on, its just redundant

        • Paige Turner

          Stop shouting. Using capitals makes you look crazy.

      • Mike Thakar

        Read the studies! PReP/Truveda is only 99% effective when used in conjunction with condoms!

        And, how pray tell, can they achieve “a goal of ending HIV by 2020”? Are you going to be sending all of us HIV+s to death panels?

        • Paige Turner

          I have read the studies and have also been on PrEP for over 12 months. I remain HIV negative and am 49 years old. I have lived through all of the horror of HIV.

          The message “condoms or die” just doesn’t resonate any more.

          There has been 1 sero-conversion on PrEP under very unique circumstances and considering how many sexual encounters this constitutes, makes it almost a vaccine. It is indeed 99.9% effective.

          Using scare quotes and bolding is more of a reflection of the impotence of your position than a position of power.

          It is time to grow up and stop being scared of HIV and instead respect it and use the tools available to eliminate it.

    • Edmund Allin

      From a quick internet search, in the US, buying an annual supply without health insurance does indeed seem unlikely to be less than $12,000. In the UK (which is what this article covers), the cost (without health insurance) is unlikely to be more than than £750 or about $1,100 – and that is without the bargaining power of the NHS thrown in. £750 annually comes to £62.50 per month, the same price as about 18 pints of beer per month. 🙂 In turn, 18 pints per month is about equal to 41 units of alcohol, which is about 70% of the monthly maximum recommended for men.

      That is to say, this is not hugely expensive in the UK.

    • YourNameHere

      That would require people to act responsibly.

  • thom

    has any government official in the US endorsed the use, education or availability of PrEP?
    I don’t think I’ve heard Obama mention it.

    • robirob

      He didn’t, because otherwise we would have been graced with right wing pundits reasoning that Satan’s number one minion, Obama, makes a mockery of God’s Will by preventing gays from dying from AIDS the way God intended it.

      • irbo

        Oh please. They mock and call dems all sorts of names no matter what they say. The idea of “trying to dodge” some topics as prevent their mocking and critisim is ifantile and useless. And if somebody is so wussy and weak that he/she cannot push the agenda he/she feels right just because somebody call him/her names or mock him/her, then there’s even a lot reason to do that and then politics isn’t his/hers game.

  • David Hobson

    yes- buth the sad thing is- it’s almost never taken correctly- most of the guys I know who are on it, use it just so they can not use condoms.

  • Ginger Snap

    I’m still not on board with enriching the already wealthy to prevent HIV. We are at a point now when HIV drugs preventative and sustaining should be dirt cheep. If our governments would grow some balls or big clits and put a fault to Big Pharmacy rape I might be fully on board. Big Pharmaceutical has no concern for anyone’s life just our $$$$’s.

    • Edmund Allin

      From a quick internet search, in the US, buying an annual supply without health insurance seems unlikely to be less than $12,000 in the US. In the UK (which is what this article covers), the cost (without health insurance) is unlikely to be more than than £750 or about $1,100 – and that is without the bargaining power of the NHS thrown in.

      The price difference is an outrage.

      • Ginger Snap

        Good to know, but here in the US we seem to be funding the world’s access to cheap drugs. I do know that other countries have govt involvement in the health care system and drug pricing controls which makes HIV care affordable.

        • Edmund Allin

          In the case of some new drugs such as Truvada, you may well be right. But drug development is complicated as drug companies are truly multinational. For example, Pfizer, a US company, developed sildenafil, more commonly known as Viagra. However, it was developed by their research team in England. And if Pfizer had been able to do that funny deal with Allergan and move its HQ to Ireland, would it really have become an Irish company? (The reverse is true, too, of course. Many companies in the US are owned by European (in particular) pharma concerns.)

          One thing I do know: US drug prices can be unreasonably high for all but the most basic stuff like aspirin. You remember the brouhaha over the guy who raised on Daraprim (developed 60 years ago) from $13.50 to $750 *per pill*? In the UK, generic versions can be bought for about $0.10. The funny thing is that most people were happily paying through the nose before, and only got angry when the price became even sillier.

  • Blake Jordan

    The NHS is funded through taxes right?
    So MSMs, who want to use PrEP, should reduce their tax contributions accordingly, and then get the PrEP themselves with that money…

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