On 2 August the High Court ruled that NHS England was able to commission PrEP.

NHS England did not take this ruling with good grace. Immediately they announced that they would appeal the decision. An inflammatory press release was put out describing PrEP as a prevention tool ‘for men who have high risk condomless sex with multiple male partners’ and warning that provision of PrEP would result in other treatments not being funded.

It wasn’t subtle. Despite enormous progress in LGBT equality over the last twenty years you don’t have to travel too far to find those who aren’t all that comfortable with gay men, let alone the thought of gay men being gay with other gay men.

The nudge of ‘gays cost the taxpayer money’ swiftly lead to the kind of homophobic tropes in reports of the story that we hoped we had left behind in the 1980s. PrEP was described as a ‘lifestyle drug’ (it’s a drug which prevents someone from acquiring a virus). The health needs of gay and bisexual men were pitched against the health needs of others, often children, so that columnists could imply ‘innocent’ without having to use the actual word.

Let’s address some of the misreporting.

PrEP is cost effective. One of the reasons why the case went to the High Court was because NHS England, with its great purchasing power is going to be able to negotiate much better prices for the drug than Local Authorities would be able to. The financial modelling has been done and it concluded that PrEP, when given to those people whose likelihood of acquiring HIV within the next year was 5% or higher (and GUM clinics can identify who these people are) is cost effective. And this is at current prices, not at a reduced rate which NHS England may be able to negotiate, let alone at the massive reduction in cost we’re expecting next year when the drug comes off patent. Money spent on providing PrEP to those most at risk will save money on HIV treatment and care in the future, freeing up resources for other conditions.

The High Court decision does not force NHS England to provide PrEP. Rather it confirms that NHS England is able to commission preventative treatments, as it already does in the case of statins, for one example. There are a number of stages before the decision is made as to whether PrEP will be available on the NHS, including a public consultation. Even if things go smoothly from here, which seems unlikely given the tone of NHS England’s response, PrEP won’t be available until the Autumn, by which time another 700 or so gay and bisexual men will have contracted HIV, infections which may have been averted if the process for PrEP had not been delayed.

There isn’t any call for PrEP to be provided to all gay men. For one, many gay men don’t want to take it. However, there are clearly some gay men (and trans men and women, and heterosexual women too) whose risk of acquiring HIV is so high that they would benefit from PrEP.

PrEP works. Numerous reports of the story question this, based on results from trials where adherence was an issue. When people are adherent, PrEP is extremely effective at preventing HIV infection; when they’re not, it isn’t. This makes it all the more essential that PrEP is provided only to those who want it, who will benefit from it and who will be motivated to take it. In the UK’s PROUD study, where participants were gay men at high risk, PrEP was observed to be so effective that they had to close the control wing of the trial, so that all participants were offered PrEP, because the number of infections observed among those men was so high that it was not considered ethically acceptable not to offer them PrEP.

PrEP isn’t going to replace condoms. I’m always going to bang the drum for condoms, they’re cheap and they prevent other STIs, such as gonorrhoea or chlamydia, too. However, some people are not always able to negotiate condom use, because of their lack of confidence, or because they’re depressed or drunk or high. PrEP could be there for the periods in an individuals’ life when for whatever reason they aren’t able or willing to demand condom use. Unlike HIV treatment, PrEP isn’t for life.

It’s not helpful to pitch the health needs of one group against another. That’s a game that can never end well and, in this instance, it is where the homophobia of the responses has been most striking. The £20m, which has been quoted as the potential cost of PrEP makes up just 0.02% of NHS England’s annual budget. The NHS spends almost five times this amount on aspirin. The NHS provides treatment for many conditions which are caused by smoking, drinking or poor diet. Once you start the game of ‘this shouldn’t be funded because x brought it on themselves’ it doesn’t stop.

It’s not just gay men who are calling for PrEP to be made available. UNAIDS and the World Health Organisation are calling for expanded access. The British HIV Association, the British Association for Sexual Health and HIV, the Local Government Association and the Patients Association and many, many others have all joined calls for NHS provision of PrEP. 

Emotions around HIV and around gay sex have been manipulated and the losers are likely to be the hundreds, maybe thousands, who will acquire HIV when their infection could have been prevented.

Let’s be clear: PrEP can prevent HIV infections. PrEP is for when risk is greatest, unlike HIV treatment which is for life. PrEP, provided to those at greatest risk, will save the NHS money.

And I shouldn’t need to say it but, given the coverage of the PrEP High Court decision, I feel obliged to: The lives of gay and bisexual men, as well as the lives of trans men and women and the lives of men and women of sub-Saharan African origin, are as valuable as the lives of any others.