Cllr Gary Powell is a councillor in Buckinghamshire
In his piece for ConservativeHome, Elliot Colburn, MP for Carshalton and Wallington, celebrated the grant of £11.1 million to local authorities to fund a roll-out of “PrEP” (“Pre-Exposure Prophylaxis”). The primary purpose of this drug is to reduce HIV transmission among people engaging in multiple-partner penetrative casual sex without wearing a condom. The manufacturers don their own reputational protection by asserting PrEP should only be used in conjunction with a condom; however, the demand for PrEP in the gay male community is fuelled by men who have unsafe sex with multiple casual sexual partners and who do not like using condoms. The whole point in them taking PrEP is to facilitate unprotected sex: these days called “barebacking”.
Colburn referred to this Government largesse with taxpayers’ money as a “huge breakthrough”, as “something every Conservative can be proud of”, as “PrEP on the NHS”, as a “thing we can celebrate” and as “another thing to be proud a Conservative government has achieved.” Well, I am one gay Conservative who is anything but proud of this politically-driven insanity.
In 1983, nine years before Colburn was born, I was already campaigning for gay rights, at a time when we really did lack them. As President of Oxford University Gay and Lesbian Society I had a particular responsibility to keep our members informed as the terrifying AIDS crisis was breaking. I lost dear friends to AIDS – all of whom became infected before the virus was identified and before there was any advice about using condoms for penetrative sex. As a lentivirus, HIV can sit around in the body for many years before causing illness, which meant that, for several years, many people had become infected, and were infecting others, unwittingly. At that time, HIV infection was a death sentence. Today, antiretroviral medications for life can provide a normal lifespan.
Knowledge about safer sex with condoms in the 1970s and early 1980s would have saved many lives. Condoms are very cheap and are available free at GUM clinics. They are a great and safe alternative to PrEP, dispensing with a long-term daily medication regime that somebody has to pay for, that requires regular clinical monitoring, and that carries long-term risks, including kidney damage and a loss of bone mineral density.
Colburn’s assertion that, “When taken correctly (PrEP) is nearly 100 per cent effective,” is dangerously misleading. The US Center for Disease Control (CDC) informs us that “PrEP reduces the risk of getting HIV from sex by about 99 per cent when taken consistently”. Unlike Colburn, I would not describe 99 per cent efficacy as “nearly 100 per cent effective” when there is a one per cent risk of contracting a potentially deadly virus that will put one on medication for life. If a million men who have sex with men (MSM) ended up on PrEP and took it consistently, exposing themselves to risk, a one per cent failure rate equates to 10,000 HIV infections. You wouldn’t tell someone, if there was a one per cent chance of being attacked by a shark in some waters, that swimming there was “almost 100 per cent” safe. Just as worrying is Colburn’s failure to acknowledge that, for people who inject drugs, PrEP affords a protection rate that may be as low as 74 per cent.
Although condoms can break or slip off, the largest study to date indicates a failure rate of less than one per cent for anal sex and less than two per cent for vaginal sex, so long as appropriate lubrication is used. (A caveat, however: previous studies have suggested higher failure rates.) If a condom does break, and the HIV status of the other person is positive or unknown, people can attend a GUM clinic or hospital A&E department for a 30-day course of Post-Exposure Prophylactic (PEP) (best within 24 hours, certainly within 72 hours). Neither condoms nor PEP are 100 per cent reliable, but in combination, they provide very good odds. Indeed, when a commitment to avoid anonymous sex with multiple strangers is added to the above, or even – perish the thought! – a commitment to a monogamous relationship with someone you love, then the odds of HIV infection will fall lower still.
The sexually transmitted infection (STI) statistics in the UK are skyrocketing, and not only among men who have sex with men. The MSM statistics, however, are particularly worrying, and the specific concern, in relation to PrEP, is gonorrhoea. The CDC informs us that “Gonorrhoea has progressively developed resistance to the antibiotic drugs prescribed to treat it.”
A 2016 study in the USA estimated that between 1.5 per cent and six per cent of its adult male population had sex with other men. I’m going to take the higher figure and assume six per cent of the adult male UK population are MSM (i.e. gay or bisexual, and sexually active with other men). A 2019 report on STIs by Public Health England revealed that, between 2018 and 2019, gonorrhoea cases among heterosexual men had increased by 17 per cent (from 13,036 to 15,253) and among MSM by 26 per cent (from 26,864 to 33,853). This same MSM group that is at high risk of HIV infection therefore also has a colossally higher number of gonorrhoea infections. Condoms are very effective at preventing gonorrhoea, and the figures clearly point to a worrying lack of condom use by a section of MSM.
The MSM raw infection numbers are alarming. MSM (remember: only around six per cent of the male adult population) had 33,853 gonorrhoea infections, while the whole male heterosexual population had 15,253 infections. If heterosexual males had been infected with gonorrhoea at the same rate as MSM, the UK adult male population would have had 564,216 infections. Just let that sink in.
Instead of championing PrEP as a milestone in LGBT+ activism, the Government would be wise to encourage people to limit their casual sexual partners and to commit to safer sex using condoms, with PEP for condom failure. If antibiotic prescriptions to treat gonorrhoea infections continue to climb, so will the risk of antibiotic-resistant gonorrhoea becoming a future global pandemic.