More education about the risks would be money better spent. A person going out and having unprotected sex knowing they can just take a pill will lead to yet another drain on the NHS, and I don't think this is a good road to go down.

Another view of mine is that we seem to be reaching (hopefully) the home straight on curing this bastard disease so I would again, spend the money on more research.

Just my 2 Cents. 

Agreed. 

They should aggressively push pre-exposure drugs like Truvada, etc. in the HIV high-risk populations. Its proven to be up to 90-99% effective in preventing the acquisition of the virus if taken correctly. The problem is that is can be very expensive unless you have high-end insurance. If taken without insurance, it can cost about $14k a year. 

PrEP works!

Any sexually active gay male, not in a monogamous relationship, should be on it. Organizations opposing it, on the assumption it will lead to an increase in unprotected sex, need to pull their heads out of the sand. It's happening already and the infection rate amongst young gay men is rising.

Every time I meet a twenty-something, HIV positive kid, my heart breaks. My generation was decimated, anyone not doing everything in their power to prevent a repeat is heartless.

Honestly curious, not trying to start a fight: what's the rationale for not using condoms? (edit: I meant, as provided by kids in their 20s today. I've heard lack of use is more common but I don't really understand what's different now)

Edit: Never mind, that was stupid. Truvada site's definition is as follows:

 

 

• Uninfected individuals at high risk for sexually acquired HIV-1 infections include:
  • individuals with HIV-1 infected partner(s)
  • individuals who engage in sexual activity in a high prevalence area or social network and have one or more of the following: inconsistent or no condom use, diagnosis of sexually transmitted infections (STIs), exchange of sex for commodities (money, food, shelter, drugs), use of illicit drugs or alcohol dependence, incarceration, and/or sexual partners of unknown HIV status with any of the above risk factors.

A lot of members of the above groups have low condom compliance anyway.

If we're switching to single-payer in the US, there'll need to be cost assessments. Are there any publicly available for the high-risk population? I assume the marketing company presented something?

1 in 13 doesn't sound very promising to me

condoms do more, work better,cost less, and don't require any more forethought than putting one in your wallet

A little self-discipline can keep you healthy. We KNOW that program works.

PrEP is a tough one for me because there is no question that it underlines the inequities of American healthcare more than anything else I've ever come across. More than cancer, more than anything. Imagine a woman asking her insurance company for a drug that would reduce her risk of HIV because she could not rely on her partners to not use condoms.

... What I'd be interested to know, in the US, is where the money comes from, and the assumptions about prescriptions. Because the "high risk" patients, as described above, don't necessarily match the people who actually qualify for employer healthcare plans. It depends on how the numbers shake out, and what they're expecting to make off Medicaid, which is notoriously difficult for patients to use.

I'm not a fan of rushing to medicate people.  I think that we are too quick to use medication to solve our problems without thought to the long-term risks associated with their use.  Have an issue? We've got a pill to solve it!

By the way, why draw the line there?  Why not make standards for other medications/behaviors?

Why not have doctors encourage birth control to their female patients as soon as they menstruate?  It is clearly cheaper than pregnancy and no one likes the idea of teen pregnancy or abortions anyways.

Why not immediately issue statins / beta blockers / ACE inhibitors to everyone over 40 or with a BMI over 25?  After all, so many people develop high cholesterol and heart surgeries are really fucking expensive.

According to the Centers for Disease Control and Prevention, in 2010 suicides accounted for 6 in 10 firearm deaths in the United States.  Now, I know you'll respond and say "ban guns" but that is a constitutional issue and not a medical issue.  So, my response would of course be... Why not evaluate and medicate everyone for depression that owns or has access to a firearm?

Personally, when the US Task Force on Prevention raised the recommendations for mammograms from 40 to 50 a few years ago I wondered what the fuck they were thinking.  There is clear evidence that women are dying from breast cancer in their 30s and 40s and to raise the age where doctors will recommend a mammogram just exacerbates the problem.

I'm not wholly opposed to PrEP, but I think condom use is more effective.

 

 

There is clear evidence that women are dying from breast cancer in their 30s and 40s and to raise the age where doctors will recommend a mammogram just exacerbates the problem.

Did you read the early-prevention results? I think this may have been linked. Early and frequent mammograms were found to increase detection rate, but didn't make as much of a dent in mortality rate as they should have done. One explanation was that some number of tumors resolve on their own, and the treatment that cascaded from detection of more tumors, without reference to type, brought its own mortality risks with it. 

It's a one-size-fits-all problem. I have a friend at familial risk for a very aggressive type of BC, and she's in an early-detection program, and in her case, even a month's delay could make the difference.

Did you read the early-prevention results? I think this may have been linked. Early and frequent mammograms were found to increase detection rate, but didn't make as much of a dent in mortality rate as they should have done. One explanation was that some number of tumors resolve on their own, and the treatment that cascaded from detection of more tumors, without reference to type, brought its own mortality risks with it. 

It's a one-size-fits-all problem. I have a friend at familial risk for a very aggressive type of BC, and she's in an early-detection program, and in her case, even a month's delay could make the difference.

Yes, I did read the results and the underlying scientific basis for it.  Doctors are still making the mistake of classifying cancers solely based on where they are originally found and not based on the mutation that leads to the cancer/halt in cell death.  Breast cancer is not one disease but a group of diseases.  Medications are often targeted to a particular mutation and therefore will not treat all breast cancers.  All cancers, regardless of where they are found, can be caused by numerous different mutations.  Some mutations produce slow growing tumors, others more aggressive forms.  Some cancers are even highly affected by glucose consumption so one person with a low sugar diet might have a slow growth rate compared to another person that guzzles soda.  Depending on which group of statistics you use, on average 35-50K women between the ages of 30 and 49 will be diagnosed each year.  I realize that benign tumors and cysts are often found in the breast tissue and can lead to misdiagnosis, but that to me suggests we need to have better testing and not just put off the problem.  I'm sorry, I disagree with you that this is a one-size-fits-all problem.  Some women no matter when they are detected will die because of this faulty logic.  Until we start sequencing tumors and picking the appropriate medicine based on the mutation people will continue to die.

Finally, one of the main tenets of preventative medicine when it comes to cancer is that early testing, diagnosis and intervention will reduce death rates and costs associated with the treatment of metastatic cancers.  I support preventative medicine.  I think it is cost effective and will save people's lives.  I'm not willing to let a bunch of pricks in Washington tell me when I should get checked based on graphs and statistics that fail to see that real people fall below their graph and WILL DIE as a result of it.

By it being a one size fits all problem, I mean that you can't treat people at high risk and people at low risk the same. It doesn't make sense for me to get screened the same way as my friend, or for the same thing. 

I think we essentially agree on that point.

I can address the BC screening issue from personal experiance. My tumor was found very early, so early it required a special biopsy proceedure as it was so small. If i had not had previous mamo films to compare to, my ER+ tumor (the agressive sort) COULD have gone overlooked as normal changes due to aging instead of being agressively treated.

medication maybe one way to "control" the infection rate - but being blood tested and being informed will help a lot - when i get tested its not because of risky sex (condoms always a matter of course - not only keeping safe but maybe a little cleaner ) ... but because of the massive blood transfusion i had - thanks NHS ... all negative 

One thing the article makes clear is that there already is an existing population who aren't using condoms consistently, and who likely won't. Unfortunate as that is, it makes sense for NHS to provide them with preventive care. Harder to make the case here, where healthcare is rationed by class and race.

a follow on comment about this ...

http://www.dailymail.co.uk/debate/article-2973020/PLATELL-S-PEOPLE-pay-gays-unsafe-sex.html

(sorry about the rest of the article but i couldn't cut the rest off the link)

and boy what a stupid "reporter" she is .. cancer drug cut backs & HIV prevention are 2 completely different areas & what happens in one area of research wont effect another ... and its not just the gay community that has a problem with HIV & AIDS ... its well within the hetro community as well ... so working on preventative controls will help there as well

POne thing the article makes clear is that there already is an existing population who aren't using condoms consistently, and who likely won't. Unfortunate as that is, it makes sense for NHS to provide them with preventive care. Harder to make the case here, where healthcare is rationed by class and race.

the BBC link article is focused on Britain. We have a real problem in Britain where so many schools are allowed to operate outside government control in terms of what students are taught and how they're taught - that's left to the individual schools to decide and will reflect things like parents' wishes - which means they are not required to give sex education, including sexual health such as HIV prevention. Such schools will include religious schools, for example. It's tragic. Actually, I'd say it's criminal