Reading the news and Tweets from fanatical PrEPsters you might think that the NHS PrEP Impact Trial is a great success. That we’re well on the way to “ending HIV” as they like to claim.
News reports and politicians tell us that “many” clinics are now full for gay men. Ten days ago NHS England announced plans to double the number of places on the Trial. It sounds as if there is high demand for PrEP doesn’t it? A resounding success…
But what is the reality?
We don’t have stats for England yet but last September the BBC reported that, one year after the Trial had started in Wales, only about 55% of people were still on PrEP. While around 45% had dropped out.
It seems reasonable to assume that the figures for England will be similar.
When a person abandons their place on the Trial it isn’t available for someone else. That place is dead for the duration of the Trial.
Remember this when you see the PrEPsters whining about clinics being full up. It is partly due to timewasting gay men who drop out, leaving only around 55% of the places active.
This 45% drop out rate may be the real reason why NHS England now proposes to double the number of places. So that in the end it will have enough data to assess how effective PrEP has been.
Is this a success story? We think not.
Consider the cost to the NHS. All the wasted time and money involved in the initial testing of people who then stopped taking the drugs within months. Money that could have been spent on something more worthwhile and places on the Trial which could have gone to someone else.
Why are people dropping out in such large numbers? We think for some of the reasons we have written about in the past.
There can be side-effects to taking PrEP. Sometimes these are just when someone starts the drugs, but in other cases they don’t go away. Then there are concerns about impact on health if taken over a long period; kidney function and bone density being two that we know of, so far.
Some gay men may have discovered that being on PrEP isn’t the wonderful life they were led to believe by the one-sided publicity.
The PrEPsters told us repeatedly that PrEP was needed because some gay men couldn’t get it together to use a condom. We said that in that case they would probably struggle to take the meds daily and get their sorry asses along to the hospital for the mandatory three-monthly check.
This could help to explain the drop out rate. We wouldn’t be surprised if some men who lead chaotic lives sign up to the Trial more than once over its duration, taking up two or more places.
The quarterly checks aren’t going to go away, because the NHS is concerned about drug resistance developing if PrEP is misused.
Many gay men are single. If you’re only having one fuck a month you probably won’t feel that PrEP is worth all the hassle and you will just use a condom. For that reason PrEP users will tend to be men who have a lot of sex, often with a large number of different partners.
Some of the more deluded publicity has even talked of being a “fabulous slut” or “Truvada whore.” Something that we’re sure didn’t go down well with the NHS.
Most gay men are using PrEP so they can have bareback sex. You really have to have a bit of an unhealthy obsession with it to jump over all the hurdles to get the drug and put up with the inconvenience.
Anal sex without a condom is one of the most effective ways to pass on sexually transmitted infections (STIs). Once you start barebacking, you end up associating mainly with gay men who are high risk for all STIs. Men who often have personality and mental health issues which help to explain their reckless behaviour and lack of respect for themselves and others.
There’s even a greater risk of an STI from oral sex because of where that cock may have been without a condom in previous hours, days and weeks.
So the sexual behaviour associated with PrEP is connected with a much higher rate of all STIs (except HIV). And while some of those STIs will be detected during the three-monthly PrEP check up, others will require more urgent treatment. Often an STI will mean several trips to the clinic. And there’s no sex until the infection is cured.
Who has time to take four half days off work every year just so they can get PrEP to have raw sex? Then extra visits due to STIs, most of which wouldn’t have been caught in the first place if using condoms and meeting likeminded gay men who also use them.
No doubt some men have discovered that bareback sex on PrEP isn’t the “sex without fear” that the (ill)health unprofessionals of the gay community and the media led them to believe. They may have dropped out and gone back to using the simple, cheap and safe condom which has no side-effects.
The gay men who went on the Trial will tend to have been the most enthusiastic about PrEP. Yet in Wales 45% dropped out.
Will the same be true when we see the figures for England? If so it will mean that the PrEPsters were unable to get and keep more than about 5,000 gay men on the Trial in the whole of England. We estimate there are 1.65m adult gay men in England based on us being 3% of the population.
This tells you how little demand there is in the UK. How many really want PrEP and everything that goes with it.
This is why the NHS Trial was every PrEP fanatic’s worst nightmare and caused temper tantrums. They know that hard statistics produced by the Trial will very likely undermine their rhetoric and huge lies.
We have said all along that there is a place for PrEP as an intervention for a small number of hopeless gay men who can’t get their lives together and look after themselves. Men whose extreme sexual activities are a danger to themselves and others.
The availability of PrEP must be balanced alongside the undesirable effects it could have if encouraged and provided more widely. That could lead to less condom use and more STIs, at a time when antibiotic resistant diseases are becoming a great concern. Abuse of PrEP and lack of monitoring could also cause more gay men to be infected with drug resistant variations of HIV.
In being cautious and refusing to give in, in the face of abuse and hysterical claims of homophobia, the NHS has done things exactly right so far.