Why PrEP should be available on the NHS

Ben Ramanauskas

September 13, 2019

One of my favourite plays is Angels in America by Tony Kushner. It’s a complex play which deals with many issues such as faith, identity, love, faithfulness, sex, bigotry, and death. These are all explored through the context of the AIDS crisis in the United States in the 1980s.

The play focuses on Prior Walter, a young man living in New York who has just been diagnosed with AIDS. While Prior deals with his diagnosis and confronts his own mortality, his boyfriend abandons him and starts an affair with a married Morman man, and is wracked with guilt throughout. 

Throughout the play, we are confronted by the fact that many people – mainly gay men – died agonising deaths at a tragically young age because the government failed to even acknowledge that there was a crisis. Even when it was acknowledged, funds into research and access to medication was denied to people who desperately needed it, partly due to the prejudices of the government at the time. The food writer Tucker Shaw provides an illuminating and heartbreaking account of what it was like to live during that period.

Thankfully, the situation has changed dramatically. Due to research and development, people living with HIV can now expect to live comparable lifespans to those without the disease. What’s more, those who are on effective treatment cannot pass it on to their sexual partners. This is wonderful news and is a testament to innovation and human ingenuity.

It’s also not well known. 

Thanks to research an effective treatment, it is possible that we will be able to eliminate HIV transmissions in the UK within the next few years. In fact, it is the government’s policy to achieve this by 2030.

There are two ways in which fantastic goal could be achieved, but unfortunately they are currently being undermined.

First, we need to improve awareness. Many people do not know that there are effective treatments for HIV and that those who are on it cannot pass on the virus. This is why the work undertaken by organisations such as the Terrence Higgins Trust is so important. They not only help to tackle the stigma around HIV but they also raise awareness of how to practice safe sex and reduce the likelihood of contracting a sexually transmitted disease. 

The importance of high-quality sex and relationship education is well known and was even highlighted by Spice Girl Mel B on this site. However, as has been shown in places such as Birmingham, it is often undermined by parents and pressure groups.

Of course, parents should be consulted and their views respected, but if you choose to send your child to a taxpayer-funded school, you should expect your children to be taught the values of an inclusive, accepting society. Ensuring that young people receive the right information in an age-appropriate way is vitally important. Not only does it help them to stay safe but it also helps to make society more welcoming of others.

Second, there is PrEP. People who are more at risk of contracting HIV are encouraged to take pre-exposure prophylaxis regularly. A person on PrEP cannot contract HIV from their sexual partner. Although PrEP has been rolled out across Scotland, its use is restricted in the rest of the UK. As a result, many people – many of them gay and bi men – are being denied access to a potentially life-saving drug. 

As such, it makes perfect sense to allow all those who would benefit from it to receive PrEP on the NHS. 

There will, of course, be objections to this. For example, some people might argue that it is expensive. The obvious counter to this is that, although providing PrEP will, of course, cost money, just looking at costs without any of the benefits of a policy is just lazy economics. Reducing and eliminating HIV transmissions will reduce the number of people requiring lifelong care in the form of medication and appointments. Making PrEP available on the NHS has the potential to save money in the long run.

Of course, one might point out that it could encourage risk-taking behaviour. Why can’t people just wear a condom? Again, this argument doesn’t stack up. If people are taking PrEP then they have done the responsible thing. A person taking PrEP is protected from a situation arising in the heat of the moment when there might not be a condom available or if it breaks.

Finally, it could be argued that providing PrEP would promote promiscuity. This is probably the least convincing objection. We have a health service that is there to provide care for those who need it, regardless of their lifestyles. What’s more, we should not allow our own beliefs or sense of morality to restrict the activities of others.

Of course, we need to ask questions about affordability. This has been partially dealt with as making PrEP available on the NHS has the potential to reduce costs. However, it should also be seen as an opportunity for reform. If, for example, the NHS embraced automation and AI then it could potentially save tens of billions of pounds each year. This is money which could be spent on life-saving drugs and treatment.

We can be even bolder. We could introduce an insurance-style system which takes into account the preferences of patients, unlike the current model in which everybody funds the NHS through their taxes but most receive very little benefit from it. An insurance-style system would allow individuals to choose the treatments they want and would, therefore, be better at allocating scarce resources.

This would, of course, retain the noble principle of universal healthcare, as the government would provide insurance to those who could not afford it. Dr Kristian Niemietz does a great job setting out what this model could like in the UK.

Arguments about costs aside, making PrEP available on the NHS is the right thing to do. We can eliminate transmissions of HIV and in so doing help to eradicate a disease which has taken the lives of countless people over the decades. Angels in America ends on an optimistic note about progress and change. We should channel this mindset by embracing reform and allowing those who need it to access PrEP on the NHS.


Written by Ben Ramanauskas

Ben Ramanauskas is a research economist at Oxford University and a former adviser to the International Trade Secretary.


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