When a conservative Christian journalist writes a story about a highly-praised AIDS drug headlined “Killing Grandma for Gay sex” and an AIDS activist describes it as a “profit-driven sex toy for rich Westerners”, you know that you’ve uncovered an ethical controversy.
This month the UK’s National Institute for Health and Care Excellence (NICE) issued a published an evidence summary on the use of Truvada, a lucrative Gilead drug for HIV pre-exposure prophylaxis (PrEP). In a number of other countries, Truvada has already been rolled out as a way of keeping gay men safe from infection with HIV. If taken every day, it prevents infection – a kind of pharmaceutical condom.
The controversy in the UK is not so much over whether it works, but whether it should be government funded. “There is little doubt that Truvada is effective in reducing HIV acquisition in high-risk people who are HIV-negative,” says the NICE advice.. “However, issues relating to uptake, adherence, sexual behaviour, drug resistance, safety, prioritisation for prophylaxis and cost-effectiveness are also important to consider, especially at a population level.
In August, the High Court ruled that the UK’s National Health Service had to supply Truvada because children with cystic fibrosis, amputees and blood cancer victims could be disadvantaged. It would cost the NHS up to £20 million a year. Outraged critics said that the money would be better spent on treatments for sick people rather than healthy people engaging in risky behavior.
On a public health level, there are concerns about whether the men could commit to taking the drug regularly. It might also lead them to neglect condom use and to expose themselves to other sexually-transmitted diseases like syphilis. Kevin Fenton, the former chief of HIV/AIDS for the Centers for Disease Control and Prevention, said a few years ago: “Some studies suggest that even a small increase in risk behavior due to a false sense of security about the pills’ effectiveness could actually increase HIV infections, an outcome we cannot afford.”
On an ethical level, there are fears that it would promote promiscuity. Dr Peter Saunders, of the UK Christian Medical Fellowship, told the Daily Mail: “This is a strategy fraught with dangers. Making Prep freely available to already promiscuous homosexuals could well encourage more sexual risk taking and more sexually transmitted disease as a result. The best way of preventing HIV infections is by avoiding the high-risk sexual behaviours that lead to it. Those who rely on it for protection against HIV are effectively playing Russian roulette.”
British actress Sally Phillips has made a magnificent documentary about Down Syndrome for the BBC. (You can watch it here on a dodgy YouTube link.) Her own son Ollie has Down Syndrome and Ms Phillips is convinced that Ollie has been a jolly good thing for her and her family. It grieves her to see that most mothers treat a diagnosis of Down Syndrome as a catastrophe. In the UK about 90% of women abort their Down Syndrome child after screening; in Iceland 100% of mothers do. That's 100%.
Ms Phillips tells the camera, as she chokes back tears, “The type of characteristics that these people share are so benign. It’s like when the Western explorers encountered the dodo. This nice, curious bird comes up and gets … wiped out. Through not being suspicious enough. Or violent enough.” This makes her concerned about what the Brits call NIPT (non-invasive pre-natal testing) which is being rolled out across the country.
The documentary is unashamedly emotional. That’s the way it should be. Thank God somebody has the courage to feel emotional about Down Syndrome people. I started to get angry when I read a scathing review in the New Statesman dismissing the doco as “profoundly anti-choice”. But there’s no point in being angry with someone whose attachment to an ideology blinds them to the splendour of being human.
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