Is withholding PrEP worth St Joseph?

Happy Election Year!

It’s opened with Keith Rowley’s Cabinet’s reshuffle, facilitating patronage the PNM will likely need to win.

In charge of social services is a woman who’s made campaign-platform jabs about abortion and homosexuality. Left in charge of health is a man who flouts WHO HIV guidelines and politicises public health.

Neither physician nor epidemiologist, he just thumbed his nose flagrantly at international and regional authorities’ reminders that providing antiretroviral treatment to populations at substantial risk for contracting the virus is an international public health standard for HIV prevention, endorsed collectively by Caribbean health ministers just this September.

Over three years he’s repeatedly made clear he intends to violate this standard, withholding government funding for PrEP, because of personal beliefs about morality and the political value of TT taxpayers at highest risk for HIV infection.

I’ve welcomed the ensuing local and international discourse. I’m returning to PrEP for several reasons.

I don’t expect much from political parties. The UNC in its first term passed legislation creating access to court orders for protection for domestic violence, which limits an eligible member of a household to someone related by blood, adoption or marriage – tailored to deny protection to same-sex partners.

Talk about badmind! In their Partnership term, they passed child-protection legislation decriminalising uncoerced sexual exploration between minors close in age. Except if they’re of the same sex! So outrageous every independent senator voted against it.

It’s one thing when government officials are neglectful, or pursue misguided, bigoted public policy. It’s another when ministers then trumpet that badmind to those harmed.

Our health minister’s told me, over and over, he’d rather I get a terminal illness than spend money to help me prevent it. Terrence Deyalsingh’s supercilious and spiteful scornfulness has hit a raw nerve, stoked deep memories of stigma. At least the UNC didn’t rub salt and say Betty Goaty!

What do I – and others – do with that rage?

He’s MP for one of the five most marginal constituencies, three of which his party lost last election, winning his by barely 1,600 votes. Thousands more people with HIV and LGBTI people vote. Maybe we decide which policies our next government pursues by organising and campaigning hard on our issues in constituencies like St Joseph, where the election’s actually won.

Another reason for circling back to PrEP is who’s said nothing. No local public health doctor or official.

I offered some this column; no takers. Voices President Weekes appointed to the Senate representing the medical profession haven’t said a word. Those in charge of national HIV policy, who know better, are muzzled. Or badmind themselves – like those who ejected me from the NACC’s launch. I’d hoped they’d correct misinformation circulating about PrEP, some well-meaning.

PrEP isn’t the name of a drug. HIV “pre-exposure prophylaxis” (PrEP) is when people who don’t have HIV take medications effective at treating HIV to prevent becoming infected (“prophylaxis”) if they are exposed (“pre-exposure”) to it. Truvada and Descovy, pills that combine tenofovir and emtricitabine, are used in PrEP regimens. Tenofovir and emtricitabine are well-tested among gay men, and ample information available about managing side effects.

In TT, you cannot get PrEP at a pharmacy with a prescription.

PrEP isn’t just for gay men, sex workers, or others we don’t value. Anyone exposed can get HIV; but not everyone is at equal risk of exposure or, when exposed, of infection. Targeting HIV prevention to groups at highest risk for infection is, logically, the most efficient way to end an HIV epidemic.

These include women who can’t get a male partner to use condoms consistently, or would provoke violence trying to. Wives suspecting a husband is less than faithful. Sexually active people with disabilities, or those at risk for sexual abuse. People with addictions and struggling with recovery from substance use.

Partners of people who know they have HIV living in eternal fear of condoms breaking; PrEP is also for people with HIV trying to conceive, preventing their child being born with the virus. HIV rates are so much higher in young gay men’s sexual networks that a single mistake or accident carries enormous risk for HIV infection. And people who simply have a lot of sex who, by sheer odds, will slip up once too often.

PrEP protects people who are vulnerable, and those who make human mistakes. It’s a more effective prevention method than condom use only.

Government won’t pay $50,000 a year for PrEP. At a US pharmacy, PrEP could cost an uninsured person US$1,000-$2,000 month. But HIV drugs are substantially discounted for developing-country governments. In Barbados, where PrEP is running, one physician estimates it costs US$10 a month – less than two per cent of that $50,000 figure.

But I wonder how important is the political cost of PrEP.

To Keith Rowley.

Worth risking the St Joseph seat?