Thursday, May 26, 2005

Immediate treatment of people who may have contracted HIV could be doing more harm than good, researchers claim

I was drawn to that subhead, "Immediate treatment of people who may have contracted HIV could be doing more harm than good, researchers claim."

Instead of some distressing news about the ineffectiveness of early treatment of infected persons, we learn that the drugs may not prevent those treated from behaving irresponsibly, and that they cost the UK's National Health Service money. It may as well be an article about how leg casts may do more harm than good because they allow skydivers to jump again.

The taxpayers shouldn't be on the hook for medical treatments. But a physician should no more concern himself with the future sex habits of an HIV-infected homosexual than he should the jump plans of a skydiver. HIV transmission requires that two persons engage in risky behavior, except when rape occurs, and voluntary sexual behavior should be no business of medicine or the state. People have just as much right to infect themselves with HIV as they do to commit suicide, and the responsibility to cope with the physical and economic consequences, lamentable though they may be. (And there is nothing wrong with charitably helping ill people.)

Beware physicians who define treatment as doing harm or good in a way that doesn't pertain to the person being treated. That is medicine in service to "society" and the State, not to the individual.

BBC News
25 May 2005

Concerns over early HIV treatment
Immediate treatment of people who may have contracted HIV could be doing more harm than good, researchers claim.

The treatment, known as PEPSE, can reduce the chance of infection if taken within 72 hours of potential exposure.

But sexual health experts from London's Mortimer Market Centre warn knowledge treatment is available could increase risky behaviour and HIV transmission.

...The researchers, led by Dr John Richens, write in the journal: "We are concerned that there is pressure to make PEPSE available for homosexual men regardless of cost and without proper consideration of possible negative consequences on service delivery and HIV transmission.

"We believe that there is a distinct danger that the promotion of PEPSE could reinforce rising trends in risky sexual behaviour and might add to, rather than lessen HIV transmission."

Dr Martin Fisher, an HIV/Aids consultant at Brighton and Sussex University Hospitals NHS Trust, said it was true there was not a robust evidence base for the policy.

But he said concerns that PEPSE treatment would lead to complacency and risky sexual behaviour had not been borne out by the data which was available.

He said: "In the two studies that have examined behaviour after individuals have taken PEPSE, the opposite appears to occur.

He added that, while PEPSE could cost up to £1,000 per patient, it was still significantly cheaper than providing treatment for HIV infection, which costs up to £1m.

Dr Fisher also said PEPSE is given to healthcare workers after occupational exposure, where the absolute risk is lower than that of risky sex between gay men.

And Will Nutland, of the Terrence Higgins Trust, said: "There is no firm research foundation on which to base the argument that increasing the availability of PEPSE will lead to an increase in sexual risk taking."

He added: "Ensuring that key at-risk communities know that PEPSE is available, and that it is not a morning after pill, is an important strand in the UK's HIV prevention strategy.

"Additional funding should be made available to key sexual health centres to provide PEPSE under strict prescribing criteria".


At 10:59 AM, Blogger Mira de Vries said...



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