Urgency as Incentive: The Future & PrEP

The UK-based movement in favour of pre-exposure prophylaxis (PrEP) has come face to face with an unreasonable hurdle.

That is to say, activists must now approach selective regulatory policy that rises to meet their feet just as change can occur. England’s National Health Service (NHS) has poured concrete around the base and built the hurdle higher, making it impossible to jump over bureaucratic stop-gaps and once again reinforcing the government’s inflexibility. Dare we recall thirty years of slow improvements to HIV medicine, the NHS’s announcement reminds us that health is afforded, first, to those who ‘need it most’.

The most are more often a few, as the privatised American health system exemplifies. Who are the most in relation to HIV in England? What is the government’s capacity to ensure the health and well-being of its citizens, especially as new statistics reveal a tremendous increase in mental health distress, indebted, in part, to working conditions and social stressors that tamper with one’s access to health itself?

For England, the most are those already HIV positive. The NHS can undertake effective treatment once the virus has been transmitted. Before that, you better use a condom.

Established safer-sex initiatives are crucial for deterring the transmission of HIV, but nothing is more crucial than to add new tools to the toolbox. Tools approved by a swath of esteemed medical clinicians and supported by MPs across the nation should not be ignored. We must speak out against the injustice of unhealthy regulation.

The law comes up to meet our feet as we stride toward greener pastures. Our greener pastures are a future where HIV transmissions have shrunk to an infinitesimal statistic. The focus on finding a cure, post-exposure prophylaxis, and HIV-positive regulatory medicine(s) is fine and well, but these measures are not enough. The present is not a viable future. Only if we add to regulatory reasoning effective prevention can we then uncover a future that, now, seems lost in the mire of soaring transmissions.

PrEP does not yet symbolise our overdue (and forthcoming) reactionary tactics. At the moment, the little blue pill represents everything bound up in the tenants of HIV’s history. The pill is a reflection of people living with AIDS and HIV (PLWA, PLWH). The pill gestures at the lives we can save in the wake of those who are lost. The pill is a simple tactic; it is the fundamental freedom of a free society, imparted by a government that can and should care passionately about the health of its citizens. The pill represents anger (our anger), because those at risk are not afforded the same preemptive measures otherwise given to patients of cancer and leukemia and irritable bowel syndrome.

PrEP is a blue pill turned red in anguish. Our future, according to the press release, is limited to the efficacy of funding a preventative medicine that could potentially displace ‘other “candidate” treatments and interventions’, as if equal share, over urgency, were the most provocative justification for dropping PrEP from funding on a national scale.

In other words: Where is the urgency? We must ask this of ourselves and resignify PrEP as a reactionary measure against bureaucracy.

This is the process of community building, which activists like Greg Owen and David Stuart continue to engender and employ. As Simon Watney once wrote, we must be cautious to conflate the differences within our queer communities as the wholeness that binds us. Which is to say, perhaps we have no essential ‘sexual’ community or biological binds to connect us, but we have validity in the anger that brings our bodies together. Today, the anger that binds us is the urgency of transmission. That urgency is:

  1. Five men testing positive each day in London.
  2. HIV organisations taking significant blows to their funding, laying off critical educational and administrative staff, and closing spaces in key ‘risk areas’ of the city.
  3. Living with constant anxiety because condoms are difficult, uncomfortable, or forgotten in practice.
  4. Being unable to visit a sexual health clinic because the wait is too long.
  5. Not knowing your status.

Acknowledgement of our urgencies is already undertaken in the medical and charity core. Ian Green, Matthew Hodson, Mags Portman, Michael Brady, Deborah Gold — the voices of reason, the experts — reiterate statistics and demand medical freedom(s) based on dizzying increases in HIV transmission. Their work compels war cries for PrEP. But how can we face an impossible hurdle if even the voice(s) of reason fail to establish the ‘necessary’ level of urgency?

PrEP is not a panacea, but it is an effective solution in the grab bag of measures. We need to turn to PrEP, because it is a ‘future-logic’: that is, a medical technology that signifies the future of health, the future of community, and the future (as Nikolas Rose might say) of life itself. What other purpose does cutting-edge medicine contain if not to allow society to burgeon in such an aggressive way that we can now live twenty to forty years beyond the life expectancy of the nineteenth century?

We can incentivize our urgency as a means to employ PrEP as a preventative measure and re-establish the future. In other words, we must compound our urgency to remain HIV negative, to cut down transmission rates, and to demand greater access to sensible, sensitive, and proven medicines, situating these demands as a promissory note that says the future resumes here.

It is the urgency of transmission that is our incentive. More than the urgency charities and medical practitioners place on statistics and numbers (though those are at the core of our anger), what I want to impress, even briefly, is that our urgency needs to derive from the knowledge that our future stops here when we fail to fight for our health and the health of others. Our future evaporates the moment we feign interest in community health. Believing our own safer-sex practices and drug use exist outside of communities at risk is dangerous at best and intentionally malicious at worst.

Only through our urgency for better health, for community, and for a future beyond HIV, does PrEP become more than simply an expense. Through multiple urgencies, through the enactment of a liveable future beyond HIV, PrEP embodies the core value of human lives — HIV-positive and HIV-negative lives in tandem — all working together for greater health, and less bureaucracy.

(Chase M. Ledin, 2016)

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