To think that the nhs should not pay for anti viral drugs for healthy gay men

[ReallyTired]

www.bbc.co.uk/programmes/p02ks961

Gay men who want to be promiscuous should use condoms to protect against AIDS and other stds. I don't see why someone choosing to have unprotected sex should have this drug paid for by the nhs. Is someone with a lifestyle chaotic enough to have unprotected sex with lots of partners likely to remember to take the pill every day? i feel that £420 per month is a lot to spend on a healthy person who chooses to indulge in risky behaviour.

If these anti vital drugs are used in healthy subjects is there a danger of complacency. I also think that the AIDS virus might mutate and become drug restistant like bacteria and antibiotics.

OP yanbu

You are getting a hard time here - I guess people want to feel holier-than-thou at your expense while ignoring the issues.

To those accusing you of being a homophobe - there must be a reason why the NHS would be targeting this treatment at part of the male gay population. Are they being homophobic? Of perhaps they have done their research?

Like a pp said, there is already a very effective prevention out there - condoms. Some people won't use them; they have got complacent with AIDS, they see it as treatable and a chronic illness rather than the death sentence it was in the 80s.

I like the analogy with lung cancer. Imagine that the NHS decided to fund preventative anti-cancer drugs for those smokers that refuse to give up. It might be cheaper than treating lung or throat cancer (bearing in mind that not all smokers will get cancer). But wouldn't it be easier altogether to give up smoking?

The drug resistance is a red herring, you are not really proposing a model of how the virus evolves in this setting. For the virus to become resistant in somebody, it is replicating inside them with the expected numbers of mutations and a mutation confers resistance - ideally, taken properly or in combination, the drugs prevent replication. However, resistance happens when you have a viral load that is being allowed to multiply - why taking drugs wrongly or for too short a time is dangerous, not taking them when no virus is present. If you are arguing complacency over time, then maybe, but it doesn't actually make sense just because you have heard of it and can make a tenuous connection.

YABVVVVVVU

Preventative medicine protects the whole community, flu jabs for the healthy but at risk just one example.

The study on Gay men helped prove preventative anti viral medicine works and now that study can be used in the larger community. We should be thanking these men for taking part in this study.
So many people, gay/straight, men/women throughout the world can now benefit from this knowledge.

thanks runner you sound like you know what youre talking about
having sex is not smoking!

On the main point, going on about how people should behave is just ranting, unless you can add something valuable to the enormous amount of work in Health Protection that people have been doing for years. People don't make the decisions you think they should, look around you at how fat we are, how much alcohol we drink etc. These are complex issues and every little helps.

I support this in the short term (for holidays or students years even) and for people in relationships with HIV positive partners. I think the regular visits to the doctor, blood tests etc would get wearing but people undertaking them would be well informed on their sexual health and health aware. I can see that after a few years taking this drug you might say to yourself, I need to make some lifestyle/health changes and stop taking this but you would be less likely to go back to high risk behaviours. That is just my thoughts, but I think the advantages might be more far reaching.

Having unprotected sex puts you at risk of catching a deadly disease.

Does this really need to be spelled out? Maybe this is what the issue is?

You'd rather pay to treat HIV after they get it? Or would you rather leave them to die horribly if they can't afford HIV treatment? Those are pretty much the other available choices.

We've been telling people that unprotected casual sex is risky. As Dr Phil might say, how's that working out for us? Telling people not to have sex DOESN'T WORK, whether it's to prevent pregnancy or to prevent STDs. There's a reason why forms of contraception other than condoms are popular with straight people. If straight people would rather not use condoms every time they have sex, why is it so surprising that gay people might feel the same way?

If you think, like some of the people who oppose the HPV vaccine, that this is going to lead to an increase in promiscuous gay sex, it probably won't. The HPV vaccine doesn't lead to an increase in teenagers having sex. People don't decide to have sex or not simply based on whether they might catch an STD. HIV and other STDs wouldn't be nearly so much of a problem if they did.

If the NHS had unlimited resources then I don't think there would be much of a discussion. But unfortunately it doesn't. The question is more about whether it's a good use of resources when there is another option for prevention which is much much cheaper (i.e. condoms).

BTW I'm undecided on this.

Having sex is not like smoking. Smoking is stupid and only a detriment to your health. I think most people would agree that sex, though not necessary for life is an important part of life for most people, and if there are health risks we should try to mitigate them, not just tell people to abstain.

If a condom fails for pregnancy you have the MAP and you have abortions. You might also be using other contraception. If it fails for HIV that's it you're fucked (assuming you actually catch it ofc but that's the same as for pregnancy).

My only concern is that it will reduce condom use. HIV might be the worst thing you can catch but it's not the only one or the only really bad one! It makes me cringe to read about women who don't use condoms on dates because they're on the coil or pill. Makes me wonder if that's what's behind rising rates of HIV in women too

I’d be worried about the possibility of this making men in the gay community more laissez faire about their sexual health. So much was done to promote safe sex in the 1980’s and 1990’s and most of the focus was on preventing HIV/AIDS. If that risk is drastically reduced by (expensive) preventative drugs and they don’t have to worry about getting anyone pregnant, many may very well think that they don’t need to have safe sex, thus increasing the occurrence of other STI’s- especially if they’re young and weren’t around in the 80’s. That’s before you think about the possibility of misuse and failure of the drug to prevent transfer. I firmly believe that education and encouraging people to think about who they’re having sex with and promoting regular screening is the answer, not mass medication. Just because we can do this doesn’t mean we should, especially when the financial pressure the NHS is already under is considered.

Also I thought (may be wrong) that most people who caught HIV these days identified as heterosexual; surely by this logic anyone who’s having lots of sex should be able to receive preventative treatment rather than targeting gay men?

Imagine that the NHS decided to fund preventative anti-cancer drugs for those smokers that refuse to give up. It might be cheaper than treating lung or throat cancer (bearing in mind that not all smokers will get cancer). But wouldn't it be easier altogether to give up smoking?

my God I would support such a drug. A drug to prevent a life threatening disease, yes please! People know the dangers of smoking. They do it. As I said upthread - people are human and make mistakes. They don't behave as we would all wish. What with being human and free will and all.

People know the risks of unprotected sex, some still do it. A drug to prevent a life threatening disease, yes please! This drug is available. Why wouldn't you utilise it.

If the OP can come up with some credible reason why it is not cost effective I would love to hear it but saying "just use a condom" is blinkered.

Also I thought (may be wrong) that most people who caught HIV these days identified as heterosexual

No, that is not correct. You are still much more likely to be at risk if you are a gay man.

It will also help to prevent spread don't forget so one person being treated may actually prevent 10 people becoming infected and those ten infecting others and so on.

So you can't just work it out based on the cost of preventing the disease for one person vs treating one person

If you have limited resources, it sounds like that's precisely when you shouldn't be choosing a more expensive option (treating HIV in people who get it) to encourage people to use condoms.

Absolutely Nancy.

The stats state that the fastest growing cohort contracting HIV/AIDS these days are heterosexuals. That is us 'normal' folks who are not using condoms and putting our own straight selves at risk!

But HIV/AIDS is still most prevalent in the gay community.

I read upthread a bit about LGBT suicide rates... would like to add that fear of HIV/AIDS is another factor in those rates. So preventive medicine is needed there too.

The bottom line, that is being ignored a bit, is that this is the reality. NICE have done their sums and it is cash cheaper to prevent rather than cure this trial group. It may well turn out to be cheaper to prevent rather than cure a wider cohort in the near future (drug licenses have already been mentioned) and who knows. If we nice, normal heteros keep on making shite sex choices, maybe we will all get the same meds too.

In the meantime, focus on your own sexual health, and that of your kids.

I once worked in this area.

These drugs do cause side effects, often pretty unpleasant such as nausea and diarrhoea, and also there are some serious side effects such as permanent liver damage, so I don't think many people would take them lightly. Also they would need to see a doctor regularly for monitoring blood tests.

They would be useful for hiv negative people in a LTR with an HIV positive person, and also the subgroup of Men who have Sex with Men (MSM) who are very promiscuous. In some cities 1/10 young gay men are HIV positive, and so you could easily be exposed to hiv with just a few sexual partners.

It doesn't add up financially yet.

You need to give 13 men the drug for 12 months to prevent 1 extra HIV case.

At £360 per month that would cost £56000 per year to prevent one case of HIV. The cost of treating one person with HIV for 12 months is £7000.

So I can't see this being approved by NICE any time soon unless the cost of the drug is reduced significantly.

Also it wasn't a randomised controlled trial. They compared HIV rates in men who were taking truvada daily vs those who weren't. You wonder if taking truvada every day would have made the participants think twice about putting on a condom and therefore skewed the results.

Sorry meant to say rather than it not being a randomised controlled trial, it wasn't blinded - participants knew what they were taking.

Bores everyone off thread...

Lots of interesting information on this thread, thank you to all the posters that are giving the information about stats and the trial.

I think those of us who were around in the 80s will never treat HIV lightly

I guess if the NHS did stop funding things that could be avoided with a condom, all maternity services could be closed down, that would save loads of money. Personally, I'd much rather we had a properly funded NHS, one that provided IVF, cancer treatments, obesity treatments and help with giving up smoking and decent mental health services for children and adults rather than setting people with different needs against each other.

Germany spends 2% more of its GDP on healthcare, if we were to do the same, it would cut out all of these awful self servicing arguments and we'd all get the health care we needed.

Sounds like a money making scheme for the drugs companies. When they create a drug they car most about profitability so don't want something too good that cures it or is only needed once a month.

I thought HIV was becoming a lot less transmitable these days as the virus is getting weaker?

I like the analogy with lung cancer. Imagine that the NHS decided to fund preventative anti-cancer drugs for those smokers that refuse to give up. It might be cheaper than treating lung or throat cancer (bearing in mind that not all smokers will get cancer). But wouldn't it be easier altogether to give up smoking?

This. It isn't fair to label the OP as homophobic on the basis of what she's written. I think giving free condoms to anyone sexually active is much more cost effective. I do feel that people of both sexes need to take greater responsibility for their sexual health. I would rather see that money ploughed back into a public health campaign reminding people of all sexual persuasions that HIV / Aids hasn't gone away. I'd also rather see if poured into searching for a cure. In fact, the more I write, the more convinced I am that it's wasteful.

They did control for things like condom usage rates, by looking at rates of other STDs as well as HIV. Those didn't go up in the people using the drug. That suggests that using drugs to prevent HIV is not encouraging more people to have risky sex, or alternatively that the threat of HIV is not making people have safer sex.