Homophobia and PrEP in the UK

Published 09, Aug, 2016
Author // Megan DePutter

Homophobia and HIV stigma run high in the UK, with the Daily Mail leading the charge, as Megan Deputter relates.

Homophobia and PrEP in the UK

The Daily Mail has published some rubbish in its time, but yesterday’s news takes the cake.

One of the first things I did since starting my new role as Training Manager at Terrence Higgins Trust Scotland is develop an HIV Awareness training course. In my introduction to the topic, I provide an overview to where we are with HIV today. In a nutshell, I explain, we have grown immensely in our ability to understand, prevent and treat HIV. But stigma is stubborn. Stigma has been with us since the advent of the disease and we haven’t been able to get rid of it since.

Yesterday’s response to the ruling about NHS England and PrEP just proves this point.

For Canadians who might not be following this development, an excellent summary was provided on PositiveLite.com by Keith Alcorn here. Also useful is the official press release issued by Terrence Higgins Trust, which can be read here.

I was frankly surprised when I moved to the UK and discovered that PrEP was not available through the NHS. This is a problem because people who are at risk have limited options in accessing the medication – they can either pay privately (the prices are prohibitive to almost everyone) or order them cheaply off the Internet from India, without being able to verify the legitimacy of the drugs. It’s not something to gamble with; buying Viagra off the internet and failing to get an erection is one thing but trying to prevent HIV infection is quite another.

Incidentally, I’ve run into more than a few people who believe that Canada has privatised health care. It’s surprising to me, given that the public health care system is an important part of the Canadian identity. Perhaps the myth of privatised health care in Canada is due to the assumption that an expensive drug like PreP would only be covered in a privatised context. I always explain that we do have a public health care system and that PrEP is offered, though hefty co-payments can still provide a barrier to access.

"When discussing PrEP with members who are not directly involved in the HIV community, the response usually slides into the ‘enabling’ debate – it’s this idea that PrEP will enable and promote risky sex."

I am still learning more about how sexual health and prevention services are funded an offered in England and in Scotland, but my limited understanding on this topic is that the issue seems to boil down to whose responsibility it is to fund a costly drug. NHS England wants to avoid this responsibility by putting it on the shoulders of local authorities who are not financially equipped to do so. But since learning about this debate, I have taken the assumption that there is more to it than that, that stigma and homophobia must enter into the equation.

When discussing PrEP with members who are not directly involved in the HIV community, the response usually slides into the ‘enabling’ debate – it’s this idea that PrEP will enable and promote risky sex. I don’t think that someone can argue for the lack of availability of PrEP without explicit or implicit judgements about condomless sex and about condomless sex among gay men in particular.

So yesterday we saw an extreme example of this attitude in the atrocious Daily Mail headline:

NHS fights back against ruling forcing it to hand out 'promiscuity pill' that prevents HIV as the £20m cost will hit its ability to treat cancer and give limbs to amputees

Here’s how the news clipping summarised this topic:

"NHS set to prescribe a drug to prevent HIV despite concerns it's expensive.

There are also worries the new pills could encourage 'sexual risk taking'.

High Court judge ordered health officials to provide the daily Prep pills.

The move comes at a cost to taxpayers of up to £20 million a year.

NHS said ruling would delay funding decision on 13 other treatments."

The article  included such gems as, "The HIV drug the NHS must offer would be given to up to 10,000 gay men who don't have HIV but are at high risk of being infected through unprotected sex. But critics, including one Aids charity, warn it is a strategy 'fraught with dangers'.

They say it could encourage men to have sex with multiple partners without condoms and may even lead to higher HIV rates as it is not 100 per cent effective."

The authors also felt that, for some reason, the Christian Action Research and Education charity would have a relevant and valid opinion on the subject: 'We have really serious concerns about the NHS spending tens of millions on a drug that we believe could facilitate more risky sexual lifestyles. Given the risks of increased promiscuity associated with PrEP, this would be an expensive and potentially irresponsible action.'

The entire Daily Mail article can be viewed here.

While the Daily Mail is known for its ‘extreme’ views, (that’s my way of avoiding calling it out and out a fascist paper) I think that it speaks to surprisingly common attitudes towards gay men and their risk to HIV infection.

Debates about harm reduction can follow the similar trajectory – that by offering supplies to make using drugs safer, we enable people to use drugs or even encourage their use. But inherent in this particular discussion is flat-out homophobia as well as age-old HIV stigma that suggests people who are at risk or who are infected with HIV deserve it.

While working for HIV/AIDS Resources & Community Health, we did a lot of work on homophobia, addressing the links between homophobia and HIV. Homophobia impacts HIV infection and prevention in many ways, and this is just one example. Even though PrEP has been proven to be highly effective (contrary to the misinformation fed by the Daily Mail), and would help to prevent HIV infection among high risk groups including gay men, access to it is blocked.

A rebuttal to the Daily Mail can be found in the Guardian here. ‘We already live in a world where gay and bi men are often mocked, attacked, isolated and bullied for being who they are. Being labelled as careless and undeserving of HIV prevention is unacceptable, irresponsible and disgraceful behaviour that we should have left far behind with Benny Hill, shoulder pads and Bros.’

In some upcoming training courses I will be integrating exercises to consider the role of media in perpetuating or challenging myths about HIV. At least the Daily Mail has handed me a perfect example to work with.

About the Author

Megan DePutter

Megan DePutter

Megan DePutter is the Training Manager for Terrence Higgins Trust in Glasgow, Scotland. A relatively recent transplant from Kitchener, Ontario, Megan enjoys exploring the city of Glasgow and all it has to offer while moaning about the weather.  Megan has worked in the voluntary sector for more than 10 years and spent 5 of those years working in the HIV field where she honed her passion and commitment to addressing the needs of people living with and at risk of HIV and AIDS. Megan manages the Learning Centre at Terrence Higgins Trust in Scotland to provide a range of HIV and sexual health related training.  

Her blogs represent her own opinions.