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The NHS and PREP HIV Medication


Michael_3165

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There has been a high court ruling yesterday that allows the NHS to provide the PREP treatment for those suspected of being high risk for HIV infection. This ruling is going to be appealed by the NHS who believe it is the responsibility of local councils to provide funding for it as it is preventative rather than active treatment.

I know it is a very sensitive subject but the question still remains. Should the National Health Service (NHS) fund a drug that costs £400 a month per patient to combat HIV? The alternative is paying upward of £700 for actual HIV medications. There are several aspects of this story that I will outline now: 

1) Should the general public fork out money for HIV patients? We are not talking about cancer, dementia or other drug types where there is no personal contribution to the disease or illness. Most people won't get cancer or dementia through any behaviours (usually). It could be argued that the majority of those with a HIV diagnosis have so due to life decisions - occasionally broken condoms, blood transfusions and mother>baby infections occur but I would hazard a guess that IV drug use and unsafe sex are a huge contributing factor. At the same time we cannot just write off people - some very talented people with families and friends and lives to live just because of a stigmatised diagnosis. 

2) Where does personal responsibility end and state responsibility begin? If a person has a diagnosis of HIV through lifestyle choices should it be down to the state (i.e. taxpayer) to mop up the financial burden for those poor choices? If the state doesn't pay for PREP drugs then HIV will continue to persist and more people will possibly be infected longer term. We also need to be realistic. Some people will not, no matter what, make changes that benefit themselves. This situation has been going on since the 80s and is prevalent in countries where condom use is frowned upon (for religious reasons often). We have to face a situation that we can't change. 

3) Does the benefit of PREP outweigh the cost? HIV drugs cost around £7000 a year plus 6 monthly blood tests for the monitoring of those drugs in the system. We then have to take into account the impact of HIV drugs on the body and the potential financial implication for those physical complaints those drugs can create. Is paying for PREP a better deal than funding a lifetime of HIV drugs? I think that condom use is the best form of protection and that PREP should be for those who, for whatever reason, condoms haven't been effective. 

4) Does making PREP more widely available condone unsafe sex? Does not having PREP available give the message that one should take personal choices more seriously? If you know that you cannot get PREP and that you would have to experience the unpleasantness of HIV drugs, would that in any way influence your lifestyle? We cannot deny the fact that there are some people who take risks with their health no matter how many ad campaigns 'educate' otherwise. Anyone that denies that are fairly delusional. The question then is WHY are people risking their own health? 

5) Are there ethical dilemmas with not funding PREP? I would say that we have a few issues here. If we fund PREP at £400 a person per month but we don't fund some cancer drugs, dementia drugs etc are we acting ethically? If we don't fund PREP and we have more people with the full blown HIV infection we will have to fund more in the longer term... is that the right thing to do?

6) If we fund PREP what else should we fund? Gym classes for obese people? Gastric band/bypass surgeries? Smoking replacement therapy? Liver transplants for alcoholics at the expense of the middle aged healthy man or woman with no alcohol abuse? I know the NHS do some of these things already but we get into that whole debate about who we help and who we don't. If we refuse PREP drugs to high risk HIV patients should we refuse the transplant for the alcoholic or the gastric band for the compulsive eaters? Is that different because it is an addiction? 

These are QUESTIONS. In no way are they judgemental toward those with HIV or a high risk of HIV. Nor are they judgemental of whether or not PREP should or should not be public funded. I would like to know from a UK perspective but welcome perspectives from countries without fully funded public health services...

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If you must know I am gay and I have many gay friends - a few of which have HIV or Hepatitis C. I am asking QUESTIONS. This is not about being gay, straight, right, wrong etc. I am asking the questions that I am interested in hearing the response to. Unfortunately I will always get some people who cannot think and jump on me for simply raising a relatively important question (even on a wrestling forum). 

 

I am interested in the ethical dilemmas of the NHS and this is a good example of those decisions that must be made by people in power. Someone in power has to make these decisions. I firmly believe in treating all people fairly in the NHS (and generally) but there are people at the top of the NHS and other organisations that have to (unfortunately) prioritise things at the expense of others.. 

 

Put it another way...

 

You have £500,000 

 

A care home costs £100,000 a year - thats five people funded for care homes

Breast screening can be given to 300 women for £250,000

Anti-HIV drugs cost £400 a month or around £5000 a year

Cancer treatment is £20,000 a year...

School Vaccines cost £100 per child - there are 600 children in a school

 

You have to pick what should and shouldn't be spent on. You have no more than £500,000. Do you go for the five people that need care homes that have paid into the system for decades? Do you pay for preventative things like vaccines for hundreds of children with that money? Do you look at diagnostic tests to prevent suffering? Do you enhance the quality of life for those with a risk of HIV? What about the family member that can't get cancer drugs because there isn't enough funds? There is not an infinite budget and so decisions like these are taken by the big wigs of the NHS every day. 

 

 

The question is less around the PREP and more around those dilemmas. If YOU are the one in charge of the purse strings what do YOU prioritise? Where does refusing to pay for PREP and other medications lead? Do we stop paying for cancer drugs? What about heart operations? What about liver transplants? It is a slippery slope if you start saying no to one group of people what stops you saying no to others? Is it 'fair' to refuse one group and not another? How do you make those decisions? 

 

 

Chilly and Co... please wind your necks in unless you have anything productive to say... Thanks in advance. 

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From a purely financial POV Prep is by far the best option as a long term plan (also I'm told that the generic version should be available in about 2 years, making it about 20% of the price it currently is). As for point 4, people said the same about the contraceptive pill.

Thanks for the adult response :) 

 

Unfortunately the NHS is about the finances and that was my point to the whole conversation. We can't change the fact that some people have HIV through no fault of their own and yes PREP is the most financially viable option. Especially as non-treatment only leads to greater suffering and longer term costs (human, financial and to society). I agree we need PREP though whether the NHS is the body to fund it I personally don't know. I don't know the stats of people living with HIV in the UK. 

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Come on, he just said that he'd like to know. It's just QUESTIONS. There's nothing in his past postings that have lampshaded how Michael_3165 is basically a cold-hearted libertarian type.

My 'past postings'... I will openly admit that I believe people need to have greater freedom AND responsibility for their lives. I do not believe in a state that nannies people because it is the type of world I detest. However when it comes to vulnerable and the poor I am more than sympathetic. For example, I tend to believe big business is the root of evil because of the way they CAN (not always do) exploit the lower paid workers in the UK. At the same time we have gotten into this situation where you can't do anything without offending someone or getting some sort of legal challenge willy nilly. 

 

What is the problem with personal responsibility? Surely we should celebrate a society where people can do as they choose (within the law) and have freedom and autonomy? At the moment we have freedom and autonomy WITHOUT the responsibility that comes along with the right. I cannot understand how that equates at all. If you want x,y and z then you must accept that it comes with a responsibility to yourself, others and society. (Not YOU, you know what I mean!)

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Being gay doesn't remove the prejudice from your opening post. It's not just QUESTIONS as you make your personal opinion perfectly clear in your post QUESTION comments. Anyways...

 

I know nothing about PREP. Is it entirely preventative? Does it mean that the Freddie doesn't even carry the virus and therefore can't pass it on? If so, surely any price is worth removing HIV from the planet.

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I know nothing about PREP. Is it entirely preventative? Does it mean that the Freddie doesn't even carry the virus and therefore can't pass it on? If so, surely any price is worth removing HIV from the planet.

It is solely preventative I believe. It must be taken daily and before exposure. It prevents the virus duplicating after first exposure but doesn't roll back the effect once you are a host.

 

That my understanding. The ruling by the court now leaves the case with NICE to discuss if the nhs will distribute it. They may not.

 

Given 30 years ago it was an misunderstood death sentence it's amazing to see something like this so close to mass availability.

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Would prep not have the same awful side effects as pep? paramedic/firefighter friend of mine had to take pep for a month after a junkie spat blood in his eyes. He had nausea and diarrhoea for the whole month. Bloods were negative after thankfully.

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I've actually worked with HIV medication quite a bit so hopefullly I can be enlightning. No it isnt entirely preventative my recollection is 92-99% so it is very effective. Although I'm sure those figures are based on 100% compliance which certainly isnt a guarntee

 

ARV's do carry alot of side effects as well so that would need to be taken in to consideration

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