HIV

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.

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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.

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  1. single payer at its finest

    1. Clearly the problem is the wrong people in charge.

      1. I blame the British subsidiary of the private-sector company that poisoned Flint’s water. We need to socialize harder.

    2. single prayer will cover it.

    3. At least they have the wrong drugs! Walmart wouldn’t allow them to have them at all!

  2. National Health Service (NHS) is lagging way behind the United States in allowing its British citizens access to the drug.

    How can you expect a bureaucracy to keep up without routine, massive budget increases?

  3. Damn private insurance. This kind of thing is why we need the government in charge of our medicine.

  4. As a goodthinkful gay man, I believe with perfect faith in infallible and omnibenevolent government and hold it as teaching necessary for salvation that a market-based health-care system would kill me.

    1. Reminded me of “Who Needs The Peace Corps?” :

      I will love everyone
      I will love the police as they kick the shit out of me on the street
      I will sleep
      I will, I will go to a house
      That’s, that’s what I will do
      I will go to a house
      Where there’s a rock & roll band
      Cause the groups all live together
      And I will join a rock & roll band
      I will be their road manager
      And I will stay there with them
      And I will get the crabs
      But I won’t care

  5. Is there anything government can’t do?

    1. Be competent, not corrupt or truthful?

  6. high-risk intercourse (called PEP)

    Interesting. Can SugarFree educate us on the subject?

    1. Poop Enters Penis?

  7. Gay Men in the U.K. Have to Lie to Get Access to Gov’t-Controlled HIV Meds is my least favorite Morrissey album.

    1. Viral Load is much better.

  8. 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).

    *shrug*

    This is how you control costs in a single-payer system.

  9. This is priceless. This is one of the few cases where the preventative care unicorn actually makes an appearance. If these people are going to be out sodomizing each other anyway, it is a lot cheaper to give them the pills up front rather than have to treat them for HIV later.

    This is exactly the kind of case that single payer advocates point to as proof of single payer being less expensive. Under the evil free market these poor men couldn’t afford pills and then will get HIV and be a burden on the system. Under single payer they would get the pills for free and the cost of health care would go down. That would be the argument. And of course, single payer denies these guys the pills, because that is what socialism does; screw people.

    1. What do you mean “these people”?

      1. The people who want the pills. Am I wrong or do they want them so they can screw and not get HIV?

      2. Well, “these people” are characterized by their endless sodomization of each other, so i think he’s referring to the British navy.

        1. If it involves rum and a lash, sure. I imagine a few of them are sailors.

          1. I guess it becomes sort of a gray area if the rum is coconut-infused.

            1. I always just assumed that ‘rum and lash’ jokes involved Pina Coladas and pink riding crops.

            2. I heard that John started a campaign to ban the Midori Sour, which is responsible for 19% of all man on man sodomy.

              1. You liar. It was the frozen Madori Sour. And that was only because I couldn’t get the Golden Girls taken out of syndication.

              2. I heard that John won’t even touch his own wang while peeing.

    2. This just goes to show how homophobic John truly is. He clearly wants those poor gay men to be exploited by profiteering companies pushing drugs on them, drugs that government scientists have figured out through objective and completely unpolitical deliberations that the gay men don’t need.

      1. John: more homophobic than Irish is racist.

        1. Whoa, whoa, whoa. Let’s not get ahead of ourselves here, Playa. Is that even possible?

            1. You’re gonna send John to Pridefest and Irish to South Central and see who looks more uncomfortable?

          1. If you crush an ant with a 10 pound weight or a 15 pound weight, does the ant care?

        2. Look Playa just because I put out for other guys and wouldn’t for you doesn’t give you the right to call me a homophobe. I am sorry but you are not my type. Matching suspenders, bow ties and pocket protectors are great, if you are into that kind of thing. I am just not. Okay.

          1. Male, female, John don’t care, long as they got plenty of cushion for the pushin’.

            1. That is right, except Playa. I got leave someone for Crusty Juggler.

              1. Playa’s a little skinny dude, because of the meth.

                1. Put a skirt on him and Crusty will be all over him.

      2. Well, we have already unmasked our resident racist and now we have our resident homophobe.

    3. I’ll need to see the actuarial projections. Better to keep them AIDS free and paying income taxes – or let them get the HIV then provide shoddy care until they croak.

      Gay men as a group probably pay lots of taxes. On the other-hand, time it right and you get the taxes and never have to pay for any benefits to them in retirement.

  10. “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.”

    Am i to understand that people are ALSO barred from paying for the drug out of pocket without a prescription from NHS?

    IOW – I understand that the UK National Health system may have its own policy on how these drugs are treated. That policy might be very stupid for any number of reasons…. But are people still forbidden “access” to the drug outside of the NHS system? is there anything stopping UK patients from getting ahold of it themselves?

    1. Would paying out-of-pocket for any drug even occur to a Brit at this point?

    2. ah… ok… the last sentence =

      ” 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.’

      Am i supposed to be horrified that their one-size-fits-all system fails to cater to the whims of every single narrow band of the population and their behavioral choices? Isnt that exactly what one should expect from a one-size-fits-all system?

      As long as they’re not banned from accessing the drug, i’m having a hard time seeing what’s supposed to be even the slightest bit surprising.

      1. Presumably prescription drugs legally require a prescription.

      2. My understanding is that the UK in particular and the EU in generally have a thriving grey market for pharmaceuticals, but I don’t know how close it comes to an outright black market.

        1. If it’s unregulated and/or happening outside of the reach of regulators, it’s a black market.

          1. if something is distributed by an ‘unregulated’-but-legal-sales-channel, that’s the technical definition of a grey-market

            the classic example are “duty free” airport-retailers. but online-generic-drug sales probably also fit the bill in places they’re legally allowed to distribute

            1. I’m having a harder time telling the difference between “unregulated” and “illegal”. I mean, seriously.

      3. I’ll go with “the gubmint not explicitly interfering with you receiving proper medical care” for $200, Alex.

        SLD applies.

    3. Additionally to my above point –

      under the ACA, many health insurance plans in each state are being forced to modify their formularies to meet the act’s cost-savings measures.

      (some of which i think is specifically mandated, some of which is just coming as a cost-saving consequence of coverage expansion increasing in other areas)

      as a consequence a lot of smaller-specialty drugs are getting chopped from plans-on-offer in the US. meaning, when Obamacare kicked in, a lot of people were not just faced with getting new coverage, but were facing the possibility that their current drug-regimens would not be available at all in their current state and would have to either move or switch drugs.

      (*this happened to a buddy of mine – and i may be wrong about the details, but if i recall, he was actually going to be *banned* from using his previous drug because going outside the limited formulary would violate his terms of coverage. He ended up moving to PA to keep his existing treatment.)

      the point here is that a wide range of Americans already face these sorts of issues under our existing system, and they often don’t have the option to pay out of pocket and just ‘deal with it’.

  11. There is a process is place for when the drug is to be prescribed and it must be followed, consequences be damned.

    I believe this is also known in England as “keeping a stiff upper lip”. You do your duty without whinging, even if that duty involves a cavalry charge straight into a Russian artillery battery or marching off a castle parapet whilst playing the bagpipes. (heh – I said duty.)

    1. Bend over and think of England.

  12. The forms must be obeyed.

  13. Clear spent a month talking to a woman who put off meeting, until she admitted it wasn’t her in the pictures.

    *sigh*

    I know a guy who did some online dating and he got really, really fed up meeting women whose online pictures weren’t within the same decade or three.

    1. If the pictures looked current to him maybe he is older than he thinks too

      1. I think he believed them on their age. So he figured they just looked really fit.

        He also absolutely refused to use a ‘glamour shot’ of himself because he didn’t want to see the look of disappointment on their faces when they showed up to the date. Which I can get behind 100%. Don’t over-promise. Eventually the hat’s going to come off.

  14. “Medical professionals are currently forbidden from prescribing PrEP medications as a pre-exposure treatment…”

    The doctors work for the government not for you

    It’s true here too if you’re on insurance. Doctors work for insurance companies and insurance companies work for the government.

  15. Sucks to be them.

    HAHA, get it?

    1. No matter the outcome, ‘Go fuck yourselves.’ is an appropriate response.

  16. I hate to give him credit, but Cameron has apparently made some reforms to the NHS that will allow more space for market action.

    1. Australians too cheap to buy those furry eucalyptus-munchers some PrEP?

  17. It’s a bad policy. There are lots of bad policies in the amazing free-market US system too. This is not an indictment of single-payer healthcare. You people have let your brains pickle a bit in my absence, huh?

    1. “Policy”

      “Amazing free-market”

      One of those words doesn’t mean what you think it means.

      1. Here’s a primer on prog code:

        free market: cause of wrong results
        government: solution to wrong results
        regulated: producing the right results, no matter what the inputs are
        unregulated: producing wrong results, no matter what the inputs are

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