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The PrEP dilemma - risk and reward

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The PrEP drugs are highly effective in combatting The PrEP drugs are highly effective in combatting HIV

The science of economics throws up some wonderful idioms. One of my personal favourites is ‘moral hazard’ – a situation where somebody takes unnecessary risks, because they’re not footing the bill. There is no field of human activity in which it is cited more than healthcare. When people wait in line to be treated on the basis of clinical need, there is nothing more infuriating than an idiot in a worse way jumping the queue.

It could be a drunk with a cracked head trumping your fractured wrist at A&E, or the wilfully obese supersizing their own share of the NHS budget. But the misconception that the NHS should be a reward for virtue is never far away.

The latest manifestation of this is the furore over NHS England losing its court battle over funding PrEP drugs which can prevent people being infected with HIV by their sexual partners. It will potentially land the NHS with a £10–£20million bill for supplying the expensive drugs to people who could reasonably be expected to use condoms.

It’s an easy sell for outrage. No-one wants to subsidise people who are having more sex than them. But it’s also a concern for HIV educators who have tried patiently to win the argument against risky behaviour. However, PrEP works. The drugs have been hugely successful in cutting HIV infection in the US, particularly among people with multiple partners who don’t use condoms. Like I said, horny idiots: £20million may seem a galling sum to spend on them, but currently new HIV cases add a lifetime cost of £1.5 billion to the NHS every year. So think of the money we will save, and let he who is without sin withhold the first pill.

Mike Shallcross, acting editor, Independent Nurse

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