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.

It is a bit nuanced I think. the HPV shot is a good comparison up to a point because I guess that cancer could also be avoided by using condoms. But the difference is that these anti-virals are hugely expensive on an ongoing basis. If it was a one-off jab costing £5 or whatever the HPV shot costs I think it would be a no brainer, but it's not.

Plus I assume you have to take this drug every day for the rest of your sexually active life, plus ongoing monitoring by the dr. Which is quite a practical burden. I take daily medication and I forget one day in three. If you were the sort of person who was willing to engage in lifelong preventive care, like this, wouldn't you be likely the sort of person who wouldn't find safe sex too problematic?

I don't know the answers, just musing, but it's more nuanced than it seems.

And just to add I have take antivirals for an illness and the one I took made you feel absolutely dreadful! If it's the same sort of thing I don't see how anyone would take them day in day out for the rest of their lives.

Was just looking at another US study on the same drug here.

Interestingly, men in the trial reported a 50% reduction in the number of sexual partners in the past 3 months (average of 12 at the start, 6 by the end), whilst condom usage rates increased by about 40%.

Men starting the trial were also given sexual health counselling and free condoms. Which suggests that the overall benefit of the drug itself may be less than expected - taking the drug or a placebo actually encouraged less risky sexual behaviour by the looks of things.

I think giving free condoms to anyone sexually active is much more cost effective

Yes, of course it is. And easier. But that isn't working for a group of high risk men. So, next step: trial taking anti virals as a prophylactic.

It would be easier for all smokers to give up, and for sexually active gay men to wear condoms. But that isn't what is happening. So, rather than theorise about what would be best, this course of action seems to me to be actually tackling a problem.

Most of us wish the problems of the world could be easily solved, they aren't though are they?

YABU - and there have been many good arguments made. It stops people getting sick. Sounds as if you are prejudiced.

I think its a going idea . if there was a pill guaranteed to reduce cancer risk by 80 per cent I'd take it and so would everyone here.
So it should be offered to anyone at high risk.

and we should pay for contraceptive/morning after pill?

It seems expensive, but its not going to be expensive forever, and the money saved isn't just the treatment cost of the patient who takes the drug and hence remains HIV negative - it's the treatment cost of all his subsequent sexual partners who he doesn't pass it onto.

There's quite a lot of well-meaning and technically correct but misleading talk about "it's not just a gay disease/most people who contract HIV are heterosexual". The infection rate for women in the UK (including those in high risk groups) is around one in a thousand, but the rate for MSM is one in twenty - and twice as high in London and Brighton - which is why this expensive drug with a bunch of side effects is thought to be worth it for this group because the risks are really really high.

Its interesting upthread that puffinsaregood says that anti virals can cause liver damage. I feel we need to get HIV into proportion. Saving someone from getting HIV and then having them die of liver failure is not a sucess. Nowadays HIV is not the death sentence that it once was. It is a condition that can be managed rather like type 1 diabetes.

Yes, of course it is. And easier. But that isn't working for a group of high risk men... It would be easier for all smokers to give up, and for sexually active gay men to wear condoms. But that isn't what is happening.

No it's not what's happening. But in both groups there's an argument to be made that people need to make responsible choices for their own safety. I don't actually think smoking is totally comparable because it's physically and (very) psychologically addictive. Whereas unprotected sex vs protected sex is a choice we ALL have to make and live with the consequences.

FWIW the gay men I know are very aware of HIV and weigh the risk appropriately. Maybe that's because they're older (mid 30's+) so were more aware of the original HIV campaigns. Some are also in longterm relationships so their risk is reduced. In other words it might be more cost-effective to spend money on HIV awareness campaigns targeting young gay men. They need to understand the consequences of HIV. I think HIV is perceived to be less scary now and more like any other STD because the treatments have improved so much.

I do think there needs to be a greater focus on personal responsibility in health - and I say that as someone who is overweight and struggling trying to deal with it.

Interestingly, men in the trial reported a 50% reduction in the number of sexual partners in the past 3 months (average of 12 at the start, 6 by the end), whilst condom usage rates increased by about 40%. Men starting the trial were also given sexual health counselling and free condoms. Which suggests that the overall benefit of the drug itself may be less than expected - taking the drug or a placebo actually encouraged less risky sexual behaviour by the looks of things.

And this is very important. These drugs are very expensive. The main benefit seems to be that taking them makes gay men more aware of risky sexual behaviour generally. It's very hard to really know how much benefit comes from the drugs themselves.

I'd be absolutely in favour of this treatment being free to any gay person who wants it. But I suppose the question of whether this would mean a stronger virus would mutate must be considered.

I'd be very surprised if this was adopted as policy by any NHS trusts to be honest. It's too expensive. I'm a GP, and we have to apply for special permission from the CCG to prescribe drugs that cost over £100 per month. It would need NICE approval first, and then it would need to be added to the local formulary, and I can't see it happening. GPs are penalised if they prescribe antibiotics that cost £5 rather than £2 these days, and hospitals are just as reluctant to use expensive drugs.