Tuesday, February 21, 2006

Here we go again ...

"If there is something that somebody could take that might alter the consequences of what they do, they may be as a result of that more likely to engage in at-risk behaviour" … sound familiar? Definitely reminiscent of the ‘arguments’ against the morning after pill but this time Dr Stammers of the Christian Medical Fellowship is arguing against the HIV treatment Post Exposure Prophylaxis (PEP). Big in the news today because of a judicial review of government policy relating to the provision of this treatment brought by a gay man who contracted HIV and was unaware of the availability of PEP…under article 2 of the HRA if you’re interested (right to life).

PEP is a treatment which can potentially prevent contraction of the disease if taken within 72 hours of possible infection. It’s a course of drugs which lasts several weeks. The Department of Health guidance suggests that this treatment is available to any person needing it, but the decision ultimately rests with the PCTs and it seems that the treatment is primarily available only to health care workers who may be at risk of infection.

The debate surrounds the issue of whether it should be prescribed, in particular, to gay men who have risked contracting the infection during intercourse. It is here that the ‘moral’ considerations creep in, and they are so similar to those issues surrounding the morning after pill for women. Dr Stammers argues that this treatment would have a dangerous effect on prevailing sexual practices, encouraging promiscuity as the gay community are relieved from the fear of HIV. He states that the difference between possible infection in a work setting and possible infection from sex is that the health worker has done nothing to encourage the infection (fair enough!) and will be unlikely to invite the risk again. Conversely he suggests that gay men are likely to take more risks as a result of the potential availability of this treatment. The representative from the Terrence Higgins Trust on the Today Programme noted that their research does not support these suggestions and that individuals who have received the treatment are more likely to practice safe sex in the future.
In the current trend of news reports discussing the withholding of treatment this debate is interesting. However it differs from herceptin, for example, on economic grounds. A course of PEP costs as little as £600-£1000 and could potentially save the NHS vast amounts of money if it prevented contraction of HIV. Therefore it seems that the primary ground for withholding this treatment, and for the lack of publicity surrounding it, is a moral one. It was this element of the discourse that caught my attention – the dominant conservative, male, white, heterosexual majority dictating who should receive treatment and why…very familiar. In this case fear of HIV seems to be a means of controlling the sexual freedom of this particular sector of society, just as potential pregnancy is to some a justifiable means of preventing women enjoying the same degree of sexual freedom as heterosexual men. If the treatment is available it should be given, nobody should have to use subterfuge and deceit in order to obtain it (as one speaker on Law in Action did). It is so wrong to withhold treatment in order to control the actions of one section of society, yet again and again this keeps happening. Every time the HPV vaccine that could prevent cervical cancer comes into the spotlight the same ‘moral’ issues surrounding sexual behaviour arise. The only moral issue that I can see is the lack of access to treatment, which appears to be used as a form of punishment for behaviour deemed unacceptable by those in control. Quality of life and life expectancy could both be dramatically improved by access to simple, cheap and effective treatment yet it is withheld. The reports into this treatment have frustrated me so much, and I’m unconvinced that the judicial review process will do much to alter the situation. I’ll keep an eye on the case though and post any updates.


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