Bioethics Blogs

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP.

Guest Post by Nathan Emmerich

In the UK, a recent high-court decision[1] has reignited the debate about whether or not Pre-exposure Prophylaxis (PrEP) should be provided to those who are deemed to be at high-risk of contracting HIV.[2] Despite the fact that NHS England is now appealing,[3] it was a fairly innocuous decision: having suggested that they were barred from funding PrEP, the court ruled that it would be legal for the NHS to fund PrEP and that they should therefore consider doing so.3

What is less innocuous are debates about whether or not access to PrEP should be publicly funded at all. Whilst individuals report being able to buy a month’s supply online for around £45,[4] the annual cost of the drug to the NHS could be more than £4,000 per patient. Although this may seem a relatively exorbitant expense, it makes economic sense to provide PrEP; doing so could prove to be cheaper than providing treatment[5] to those who would otherwise become HIV positive.

Despite this sound economic rationale, the media, or certain sections of it, have predictably focused on one particular group who are candidates for the drug as they are at higher risk of contracting HIV: homosexuals. In particular, the debate has centred on promiscuous gay men or, to use the academic term, men who have sex with men. This includes individuals who regularly have sex with new partners, as well as those who engage in protected and unprotected group sex.

Perhaps as a result of this focus, the view that public funds should not be used for PrEP[6] seems fairly widespread.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.