OPINION: Careless talk costs lives

Gscene columnist Craig Hanlon-Smith urges NHS England to prescribe PreEP now to save lives, then engage in debate about behaviour tomorrow.

Tuesday’s High Court hearing at which it was determined that the NHS, can fund HIV preventative treatment PrEP has lit alight social media. The problem with a concise limit of 140 characters is that one’s opinion has to be kept to the basics and Twitter may not necessarily be the most appropriate medium with which to join in the debate.

We’ve all been guilty of it. I recently leapt into the lions’ den of football management to the tune of a sixteen word limit with interesting results. I have not changed my opinion on the subject at hand but concede that given the opportunity to publish 1000 word articles whereupon I can justify my ultimate conclusion with six different pieces of evidence, Twitter is possibly best left to posting links to longer articles, such as this one. And so, in response to those incensed at the suggestion PrEP should be available on the NHS and wishing all manner of death and destruction upon an apparent sexually promiscuous homosexual community, I have this to say.

The prescription of PrEP is a strategy aimed at saving lives. It is an HIV infection preventative measure that has up to a 90% success rate across various trials, and although not inexpensive, is a fraction of the cost of treating an HIV infection itself.

Are there some, who given the opportunity may pop a pill, throw caution to the wind and share themselves amongst the sexually active multitudes with wild and gay abandon? It’s possible. Am I wholly comfortable at the idea that preventative treatments come in chemical form rather than education, discussion and behaviour changing support? No. But let’s list that as second on the priority menu.

First and foremost is the opportunity to prevent further infections and save lives and we will not change behaviours by merely ranting or condemning swathes of the population in a tweet. The behaviour will continue but without the protection. Give people PrEP what’s the problem?

Of course I have the advantage of being old enough to remember when AIDS came trucking into view the first time around and the destruction left in its wake. Through my work with GScene and Mad ‘Ed Theatre I have met countless older LGBT people who talk about the AIDS holocaust, of sections of the community numbering first hundreds, then thousands, disappearing into death as if overnight. Of families burying their sons, brothers, nephews, cousins. In the years before legal partnerships and same-sex marriage, of long-term partners evicted from their homes following the death of their twenty-seven year old lover who had died without leaving a will. Of boyfriends and partners denied hospital visiting rights because they were not listed anywhere as ‘next of kin’. Disease does not only ravage the body of the sick, it infects our social stability, tears apart communities and unlike mankind, it knows no prejudice. PrEP, had it been around thirty years ago, could have prevented such suffering, well it is around now and we would be fools to argue against it.

During the early 1980s as AIDS was developing, Governments were slow to act. Health minister Norman Fowler was warned by Prime Minister Margaret Thatcher that if he proceeded with his proposed course of action he would be known as the ‘Minister for AIDS’ and his career would end. He ignored her and the ‘Don’t Die of Ignorance’ campaign was born. Although sometimes criticised for its iron fist of fear approach, the UK has half the number of HIV/AIDS cases of France, where no such campaign existed. Action helps, inaction and more ‘wait and see talk’ will kill people.

When US President Ronald Reagan finally mustered up the interest to utter the word AIDS in 1987, his focus centred entirely around infections from blood transfusions and drug addicted mother to baby transmissions. He was unable to bring himself to say the word ‘gay’ once in his key AIDS address preferring to skirt around the issue. I know that as a community we are often quick to point that AIDS is not only a gay disease, and it isn’t, but we remain uncomfortable that the possibility of it looms large over our heads like a storm cloud. He was not alone in his dithering. Scientists argued with one-another over the origins of the virus more concerned with their own race to the Nobel prize than improving public health.

Sections of the gay community fought between themselves over their rights to sexual liberation versus community education and prevention and ultimately too much talk killed people. In the US in 1987 there were 15,000 HIV/AIDS cases, by the end of the millennium there were half a million. Not taking enough or the right kind of action will infect and ultimately kill people. PrEP can stop this and the time for talk, legal appeals and injunctions is running out.

Of course we should examine our behaviour, of course it is irresponsible to have countless sexual partners, sometimes hundreds and to not use condoms to protect ourselves, but it is also irresponsible to overeat high fat, high sugared convenience foods, not to undertake any exercise, to drink excess alcohol, to use drugs and to smoke. Our health services treat all of these social issues, to refuse PrEP to people who need it would be both discriminatory and stupid. Save lives today, and then let’s talk behaviour tomorrow.