Should HIV PrEP be readily available?

In August this year, the European Commission approved the use of the drug, Truvada as a pre-exposure prophylaxis (PrEP) for HIV. 

The drug will be available in all EU member states and it is expected to be accessible to anyone who needs it in pharmacies across the union in the coming months.

The recent approval follows recommendations by the World HealthOrganization (WHO) in 2014 for countries to provide PrEP to men who have sex with men (MSM) and a further subsequent recommendation the following year for the treatment to be provided to all population groups who are at increased risk of HIV infection.

PrEP is a treatment of drugs that can be taken by people who are HIV negative to reduce their risk of HIV infection. The only approved PrEP drug is Truvada, which is a combination of two drugs, tenofovir and emtritabine.

Truvada has been proven to reduce the risk of HIV infections. However, it should be considered as an additional prevention measure to be used in conjunction with other proven methods such as male and female condom use, HIV testing,counselling, ARV treatment for partners with HIV infection and safe sex practices, amongst others.

It should therefore be noted that PrEP does not protect the individual from contracting other sexually transmitted diseases such as gonorrhea, herpes and syphilis.

Although PrEP is not a new drug, the WHO recommendation and recent EU approval will surely pave the way for more countries to follow suit.

South Africa, which has the highest number of people living with HIV, announced in March this year that they plan to provide not only antiretroviral (ARV) treatment to all sex workers who are HIV positive, but also to offer daily PrEP to HIV negative sex workers to prevent infection.

Other countries that have introduced the drug include the United States of America, France, Norway, Australia, Israel, Canada and Kenya.

But should the drug be made readily available to everyone?

The PrEP treatment is relatively expensive costing an estimated US$450 to US$1000 a month, which is more than what some people earn in developing countries. It will be hard for people to access the treatment without government subsidy or medical aid/health insurance. A South African news outlet estimates the cost to be from R200 (US$14.40) to R550 (US$40) per month, but that is probably the final cost after government subsidization. 

In the United Kingdom (UK), the public health service provider, National Health Services (NHS), lost a court appeal in which it argued that it was not its responsibility to provide healthcare to people who are not infected, but that it was it was the responsibility of the local councils. It was reported at the time that the NHS had put nine new treatments and services on hold pending the outcome of the appeal. With the recent ruling, the NHS will now be responsible to provide PrEP treatment. Considering the high cost of the treatment, the NHS could delay or put the treatment on hold, in respect of other priority health services, which include hearing implants for childrenwith deficient or missing auditory nerves, prosthetics for lower limb loss, and a drug for treating certain mutations in young children with cystic fibrosis.  

Taking into consideration the high cost of the treatment, the question being asked is why the public should pay for other people’s irresponsible sexual behavior, when there are cheaper alternatives that have been proven to work effectively in preventing the spread of HIV.  Meanwhile, others who need medical assistance are being denied treatment as authorities are forced to choose and prioritize between treatment.

Other experts also believe that it could encourage continued risky sexual behavior, not just among those groups of people who are already at high risk of infection, such as men who have sex with men and men who have sex with sex workers, but also the rest of the population.

PrEP could also give users a false sense of security and as a result pass the virus onto their sexual partners, some of whom would not have been informed of their partner’s PrEP treatment.

But should we be worried about the sexual behavior of those on PrEP treatment?

My concern is not so much about the behavior of PrEP users, but rather about the public having to pay (in the case of free public health services) for the treatment or the government subsidizing the costs. Why should we pay for other people’s choice of behavior? Let those who choose this treatment pay for their own medical cost, because it is after all their choice to use it, instead of the number of affordable methods available. 

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