Gay Men in the U.K. Have to Lie to Get Access to Gov't-Controlled HIV Meds

England's National Health Service years behind in understanding treatment needs.


The National Health Service provides neither health, nor service. Discuss.
Credit: Jeffrey Beall

A system of fighting the spread of HIV with the help of cocktail of preventative drugs has been increasingly taking hold in the United States, especially in urban areas. It's called a pre-exposure prophylaxis system (PrEP) and the drug commonly connected to it is called Truvada. The drugs were originally used to help reduce the viral load in people who were HIV-positive so low as to be almost undetectable and non-transmittable. Later researchers realized that it was also extremely effective when used by people who were HIV-negative in preventing them from becoming infected in the first place. It's so effective that it may well make transmission impossible, though there's still research being done. It has nevertheless been approved in America for regular daily doses as a preventative measure. Keep in mind this isn't just a drug that allows people to sleep around—it allows HIV-negative people to have extremely safe, long-term, sexually fulfilling relationships with HIV-positive people.

But as BuzzFeed writer Patrick Strudwick has discovered, the National Health Service (NHS) is lagging way behind the United States in allowing its British citizens access to the drug. Under current NSA guidelines, clinics are allowed to prescribe these drugs only as a post-exposure treatment for people who have had high-risk intercourse (called PEP). They treat it like "Plan B" for HIV prevention. That's the old way of looking at the drugs. Medical professionals are currently forbidden from prescribing PrEP medications as a pre-exposure treatment, and it's going to be months before the government agency decides whether it's going to change the policy.

So, guess what people do to get the drug? They lie, obviously:

In a practice known as "clinic hopping", individuals across Britain are attending a series of different sexual health clinics as well as A&E departments and claiming they have already had risky sex in order to be prescribed Truvada. …

Greg Owen, a leading activist in the campaign to make PrEP available on the NHS, told BuzzFeed News: "It's very hard to ascertain how many people are doing this but I'm speaking regularly to people who've been clinic hopping for the last two years."

Owen, who last October set up a website offering information for people seeking PrEP, explained how clinic hopping works: "You ask for PEP and say you were trashed at the weekend or you think someone came inside you, you're given a week's worth of pills. You then have to go back for a second appointment where you're given a further three weeks of pills."

The problem for the NHS, he said, is that people being prescribed PEP but using it as PrEP only need one of the drugs – Truvada – and the other drug, Raltegravir, which needs to be taken twice a day, is going to waste. But this isn't the only extra cost for the NHS.

"As well as two pills out of three being wasted," he continued, "if a person goes to a different clinic every month and presents as a new patient they're given an HIV test every month, whereas if they were on PrEP they would only need one test every three months."

So the system has both failed to account for how the drug could actually be used, and as consequence, produces even more government waste. That's a two-fer of bureaucratic mismanagement.

It's very reminiscent of the type of story told by the Dallas Buyers Club during the early days of the AIDS crisis. The Food and Drug Administration dragged its feet in making important life-saving drugs available, prompting the need to get around the law and import the medications from Mexico.

Remarkably, Brits being Brits, at least one of the people BuzzFeed interviewed felt guilty about cheating the NHS "knowing how much struggle the NHS is under." But of course, this sort of bureaucratic nonsense is exactly why NHS is struggling. The NHS is serving its own system, not the citizens of the United Kingdom. There is a process is place for when the drug is to be prescribed and it must be followed, consequences be damned. An NHS spokesman was apparently unconcerned about these customers' needs and instead wanted to assure that there was no "widespread gaming of the system" and that any instances of misleading clinics that are found should be investigated.

In the meantime, those who can afford it buy generic versions of Truvada online, meaning they have to bypass the public health system they already pay for because it's not covering the medicine that they need.

Read more here.