It was announced a few days ago that Pre-Exposure Prophylaxis, or PrEP, will be made available on the NHS from next month. This antiretroviral medicine, if taken every day, can almost completely stop any acquired transmission of HIV during unprotected sex.
It feels fitting that I write a piece about HIV in a climate where every single facet of society currently panics over the Coronavirus. There is still the unknown about this virus including how contagious and how dangerous it is. This leads to the feeling of dread, worry and overall anxiety and there is only hope that treatments can be developed and even better, preventative measures can be found. It is a useful time to think back to the climate of the 1970s and 80s and HIV and the feelings of the unknown, and the deaths and devastation.
This roll out of PrEP on the NHS is aimed at “at-risks” groups who do not wear condoms with particular focus on men who have sex with men as well as heteosexuals where one is confirmed to be HIV positive. Within the former group, the prevalence of HIV transmission can be very high and pockets of outbreaks do occur for reasons of the act of penetrative anal sex and the fact some homosexuals do have a higher number of different casual partners. PrEP is a preventative measure that in part aims to see the UK have in a decade’s time no new cases of HIV.
The National Health Service should provide PrEP. In the long run, it will save an enormous amount of money as the treatment of HIV is incredibly more expensive than giving out this drug. I know campaigners have fought for many years to get this in place. It is a great achievement that it is soon to happen. The NHS however did put up a great resistance stating a few years ago that it would not fund it. They were taken to court and Freedom of Information request revealed that the NHS spent approximately £115,000 fighting the court case. During the intervening years whilst this it was happening, charities in London, which is a HIV transmission hotspot, were encouraging gay men to buy it themselves online. This led to a massive drop in new cases. When the NHS lost the court case, they decided to roll out a trial for a couple of years. I was offered it about a year ago but opted not to. I will explain why in a bit.
Of course, there is criticism that the NHS will be funding what some deem as a lifestyle medicine. They state it will encourage men to bareback more often, be more promiscuous and more risky. However, I do not deem PrEP to be a likely cause. Society’s attitudes are changing and condom usage generally is dropping. People; gay and straight and anything in between have often sought condomless sex. In fact it has been done since time immemorial. Perhaps this is because skin on skin contact is apparently better than placing a piece of latex in between and creating a barrier. The feeling however does not triumph the safety precaution. It may be the case that simply having a condom to hand, or rather to penis, isn’t always possible. Think of the times when you have been errr, caught short and the implications that a discussion about one or actually wearing of one can have on the act that was about to happen. There are a myriad of reasons for not wearing a condom. If there is concern about the NHS funding PrEP compare it to the debate around hetereosexuals having “bareback” sex yet being prescribed the pill on the NHS a preventative measure to stop someone becoming pregnant. Condoms could stop pregnancy.
In brief, I mentioned earlier that I would explain why I turned down the trial of PrEP. The reason starts off with exploring my relationship with the topic of HIV. Just a moment ago I stated that skin on skin contact is potentially better. This is what I have heard but I cannot verify this as I have never actually done it. A condom has always been used when I partake in penetrative sex. This comes from the massive worry I have that a momentary decision not to wear a condom could mean I get a virus, HIV, for the rest of my life. This is not a case of ignorance. I am fully aware that there is now treatment available which would that if I were to have HIV, mean a tablet could be taken every day and the viral load would become undetectable. This equates to the HIV being untransmittable, commonly referred to a U=U. Treatments are now so effective that if taken daily, it is possible to live a normal, long, full life.
The stigma surrounding someone with HIV continues to pervade my mind and I don’t know why. I have disregarded some people who have typed to me on Grindr because I know they have HIV. I have never said anything horrible nor abusive regarding them being HIV positive but simply the act of declining to meet or not continuing is in itself stigmatising enough as it may be able to be deduce my thoughts. I wish I wasn’t like it. I think for me it is a more than a worry or fear; it is a phobia. The men who typed to me were undetectable. I knew this, yet I still acted the way I did. Perhaps it is because the power is not in my hands. There is the risk and therefore worry that the guy has not correctly administered the tablet. Why is there this worry? Why would he not have taken the tablet? It is the stigmatising of the HIV-positive person that is perhaps somehow making me feel maybe that they are not careful people, as they managed to get HIV, and therefore would forget to take the tablet correctly. This is so wrong but perhaps explains my mindset. The introduction of PrEP changes this by placing the responsibility of self-protection in my hands.
As I sat opposite the Doctor in the Sexual Health Clinic a year ago, he offered to put me on the trial waiting list. I declined. I did this for three reasons. One I was not expecting it to be offered it and to be honest it completely caught me off guard. Two, as it was a trial and limited by definition so it meant that if I did go on it, someone else who needs it would have been denied. And three this fear or phobia that I have may have meant that even if I were to go on PrEP, I would probably have ended up wearing a condom anyway to doubly sure. This news now that PrEP is to be made available on the NHS is so huge, for the reasons mentioned above, but personally for me, it may alter my relationship to penetrative anal sex and this ridiculous fear. I hear what from you are saying – my possible actions are what I said would not happen but I feel I wear a condom or insist on one to be worn simply because I have this fear of HIV. I don’t believe my risk taking actions will be altered because of this.
By chance a few days before the news regarding PrEP was announced I was browsing through the documentaries on Channel 4’s All 4 and stumbled upon one that piqued my interest. In light of all of the noise regarding the current pandemic, I watched the entitled ‘Epidemic: When Britain Fought Aids‘. It explores the history of AIDS and HIV in the UK, has interviews with notable individuals, talks about the massive Public Health information campaign and how overall British society’s attitudes towards sex were changed. I strongly recommend.
Worldwide, millions and millions have died since the start of the HIV pandemic. It is believed there are 103,800 people living with HIV in the UK. The Terrence Higgins Trust estimates that roughly 7% of those who have it do not know they are positive so could pass it on. It is hoped that through a series of treatments, condoms, PrEP and perhaps even a ‘cure’, all new HIV transmissions will one day be eradicated.
It is important to get tested to know your status. For more information regarding HIV, check out the NHS website. https://www.nhs.uk/conditions/hiv-and-aids/
Thanks for reading or listening,
Samuel x
