The PrEPpers are OUT

This is not about Preppers. They are in their bunkers rotating their stock of freeze-dried beef-jerky, beans, bottled water and shot-gun shells in anticipation of RightToBearArmsageddon. It must be a real drag having to eat at-sell-by beans every day rather than go off to McDs like the neighbours and get fat eating burgers and shakes. otoh it's a REAL DRAG if the nukes start flyin' and you're unable to take out the Zombies because you've run out of ammo. What Preppers need is an anxiety cost-benefit analysis:

• Is it worth spending a chunk of your disposable income on your ammo insurance against an uncertain future?
• Should you start paying into a pension fund in your 20s? 
• Is it worth popping vitamin-C even if the evidence tells you it doesn't much affect your susceptibility to the common cold rhinovirus?

Did someone mention viruses? Is it worth taking prophylactic anti-retrovirals as a hedge against an HIV infection which will blow up into AIDS, uncontrollable Candida infection, Karposi's sarcoma and a grim and early death? Dau.I and her pals from @RadQueersResist think so, as does ActUpDublin. And they were out in front of the Dáil on Friday to tell it like it is to Simon Harris our youthful Minister of Health. It's only a month since they were on the same side celebrating the 2:1 vote in the Pro-Choice Referendum.

I left Boston in the Fall of 1983. For the next several years I got letters from my pal P written while sitting at the hospital beds of a succession of her friends as they died by inches assaulted by a truly wild and bizarre collection of infectious diseases. Those diseases were the consequence of HIV infection. The thing about HIV is that it prefers to reproduce in T-cells and destroying them as the reproductive cycle completes. Without T-cells the immune system is stymied in its fight against other bacteria, fungi and viruses. It was the stuff of horror seeing fit young men, P's pals, turned into cadavers before her eyes. Then along came anti-retroviral therapy ART. It was like a miracle! These drugs didn't do away with the HIV virus but they slowed t'bugger down, so that it was unable to reproduce as quickly. That meant that T-cells could hold their own against the slings and arrows of outrageous pathogenesis. The young men could leave hospital on their own feet rather than feet-first in a box.  The first ARTs were nucleoside reverse transcriptase inhibitors aka NRTIs or nukes. There are now at least 10 NRTIs on the market not to mention 2) non-NRTIs, 3) protease inhibitors, 4) entry inhibitors and 5 integrase inhibitors all of which intervene and disrupt different stages of the HIV lief-cycle. Scientific studies have shown better efficacy if you bundle drugs together and combination cARTs were born.

One of the earliest cARTs to market was a drug called Truvada, patented and manufactured by Gilead Sciences which celebrated its 30th corporate birthday last July.  Truvada combines two NRTIs Tenofovir & Emtricitabine [prev on bonkers names for drugs] and was highly successful and presumably profitable for Gilead. As the patent came due to expire, other companies moved in to develop identikit generic medicines and get a piece of the action. Developing a generic drug has a whole set of manufacturing and licencing conditions different from, but almost as onerous as, creating and marketing the original.

Here's another issue to throw into the equation. If you only go to the doctor when you notice the symptoms of HIV/AIDS, then you've probably left it too late. If your T-cell count is down enough to open the gates to peculiar opportunistic infections, then you already have a lot of HIV particles coursing through your system. Best to minimise your exposure to HIV in the first place. 0) Don't share needles. 1) Don't have sex! 2) If you're a gay man don't have sex with men MSM. 3) If you must have sex then use a condom. 4) Even if you use a condom, use PrEP: pre-exposure prophylaxis, of, say, Truvada (or its generic equivalent). If you embrace Case 4 and you take your medicine every day then you can reduce your chance of getting HIV-infected by 90%.

Last 1st December, to mark World AIDS Day 2017, Teva Pharmaceuticals launched their yellow-pack version of Truvada especially at the PrEP market. Our Taoiseach Leo Varadkar was delighed:

It's potentially lucrative: the cohort of young gay men are expected to spend €4 a day (€1440/yr) for the next 30-40 years. The Gilead branded product is about 3x the price.  That's not insanely expensive if you're on a pensionable salary and buying a couple of lattes a day already. Sure beats getting AIDS, that's for sure. But Varadkar's delight wasn't so great that he instructed the government to pick up the tab by allowing it to be paid for by the GSM medical card or the drug-payment scheme. If you live below the poverty line because you live in the ghetto and/or are an IV drug user, then you're not going to have €30 a week to spare for the blue pill. It is for these poor, dispossessed, HIV-susceptible people that RadQueersResist are fighting. Well, not fighting, or even on the barricades yet, but shouting loudly outside the Dáil in the hope that Health Minister Simon Harris will get off the fence and start the ball rolling on the cost-effectiveness analysis that has to be gone through before yet another drug is added to the allowable costs of the HSE.  Hello! Mr Harris: this problem is not going to go away, young people are not going to shop having sex: HIV is here to stay. Every week you delay effective prophylaxis against HIV/AIDS there are another 10 HIV positive diagnoses. Those chaps are going to have sex and the infection cycle will crank up a notch. It's like Ebola, if you don't act quickly, you have an epidemic which is out of control and then, well, everybody dies.