One year 40% HIV infection dropoff in London attributed to grey-market generic pre-exposure prophylaxis drugs


#1

Originally published at: http://boingboing.net/2017/01/09/one-year-40-hiv-infection-dro.html


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#2

But people are unwilling to choose between life-threatening infections, sexual pleasure and pharmaceutical patents

And, apparently, condoms.

If you’re in a committed relationship, and one of you is HIV+, that’s different.

But if you’re just screwing around (and there’s nothing wrong with that, as long as you and your fuck-buddy are cool with it, and either you’re single or your partner is also cool with it), use protection. It’s not just HIV, it’s hepatitis and syphilis and gonorrhea and chlamydia and herpes and crabs and genital warts and probably a bunch of others I’ve forgotten.

generic PREP drugs from India and Swaziland

Which just possibly need them more.


#3

You can complain about individual actions and counsel individual responsibility all you want (and the idea of not wearing a condom when having sex with a stranger is baffling to me personally), but a 40% drop in new infections is a real result.

As for the issue of taking drugs from countries that need them more, that’s jumping to a conclusion that the problem is about there being enough drugs for everyone. If they are selling them that cheap then I don’t think the problem is the drugs being expensive or difficult to produce, it’s more likely a problem of distribution, and people who are not able to get the drugs when they need them are likely suffering from an inability to pay, not a lack of capacity to supply.


#4

Agreed.

Maybe. But it’s not even mentioned by the post or by the article it’s linked to.

Swaziland has a population about one-seventh of London’s, but about seven times as many cases of HIV: HIV/AIDS is the cause of nearly half the deaths of those under five in Swaziland. The median annual wage in London is something like US$50,000: in Swaziland, it’s about US$800.

It seems reasonable to raise the possibility that Londoners buying Swazi anti-HIV drugs could be reducing the supply (or inflating the price) in Swaziland, and to seek reassurance that in fact that’s not the case.


#5

I certainly didn’t mean to say there was no problem with availability of these drugs in Swaziland - a country I know next to nothing about but which has a serious HIV crisis. What I meant was that if drugs being made in Swaziland that are desperately needed there are instead being sold to brits, it feels like that’s probably isn’t because drugs can’t be produced for the people of Swaziland, but because no one is interested in doing so.

If the median wage is $800 and the drugs cost $50 a month then they are probably unobtainable to the majority of the population. But then $500 a month is too expensive for many people in the UK. There are companies that are only willing to produce drugs at a certain profit margin and governments that want to let the system work by itself instead of saying “We should probably get involved.” I guess I just don’t want to blame brits for doing what they can to protect themselves and their families in a system that leaves that entirely to individuals to do. On the other hand, you never said you did blame them for that, you just pointed out that we should consider the plight of others as well, which I totally agree with.

Maybe it turns out some companies are producing these drugs, selling them to foreigners at a very high margin, and using that to keep themselves afloat so they can produce drugs for people who need to them locally at a locally affordable price. :musical_note:Wouldn’t it be nice…:musical_note:


#6

But what do they sell for in their country of origin? $40/month is a month’s salary in some places so I’ll bet whoever is selling them for $40 in the UK was selling them for $5 at home.

“Grey market” can cover a lot of ways something gets from “A” to “B” and not all of them are legal.


#7

Unfortunately, people… don’t do this, even if they’ve been told to for years. I use condoms. You use condoms. Great. But, it makes not only moral but financial sense for PrEP to be freely available. So why isn’t it?


#8

That’s what I addressed in my last paragraph. I don’t know what the situation is. Maybe they are selling them for $50 to brits and $5 locally. Maybe they are selling them for $50 to brits and they just aren’t available locally. Lots of other possibilities too.


#9

It certainly could be true that there is a surplus of these drugs, that this surplus is being sold at a premium to Westerners, and that premium is in turn used to subsidise the local pricey, in which case I will happily shut up, pack up my soap box and toddle off home with a smile on my face.


#10

40% Drop Off? Make that stuff legal and free, kinda like all medicine should be.


#11

Aside from the ethical discussion concerning reduced availability in other locations due to Northerners buying the drug off a market not originally intended to be used by them, I have a problem with the reporting by @doctorow and The New Scientists, here.

It is, sadly, very normal to speak of a XX % drop or increase in something.
Percent of what? A total figure? Or of a long-term mean? The median number? How is this estimated or calculated? Is this a effect size in a model, or a proportion? And what does the figure mean, in context of more information?

Seriously, if I haven’t overlooked it somehow, then what is missing here is the information which is needed to understand the implications. Not giving it is potentially misleading, at best. And at worst, it is going to manipulate us into believing something which might not be backed up by the facts and the stats.

Please, Cory: if you find such seemingly great news again, run it through your internal quality-check. If you need advice what questions to ask, I think #sciencetwitter would gladly help to create a quality check-list for sciency news coverage.

Thank you.


#12

This hurts my head. I want fewer HIV infections, but I don’t see why taxpayers should have to pay close to £5k/year to support people who want to indulge in crazy risks when condoms cost very little. I have to think that there are other ways to spend that money.


#13

Yeah, another way to spend that money would be to spend it on a tiny fraction of the cost of treating the people who become infected. If you want to be pragmatic about dollar spending, funding the drug is objectively the right answer.

The number comes from a large clinic in London that had an 40% drop in the number of new patients in 2016 compared to 2015. That clinic accounts for one in nine HIV diagnoses in the UK to give you a sense of scale. After that clinic made it’s announcement, another large clinic said it saw a 50% drop. Both clinics report that bacterial STIs have had no change, and that the number of tests they’ve performed has gone up.

The article linked doesn’t have in depth information but it does have quotations from people who can be reasonably assumed to have the expertise to assess whether the infection rate drop is significant and whether it is actually caused by the drug. If you want to read an article that tells you what is going on with an assessment of why, the article is a good one. Cory’s assessment that a 40% drop is an “eye-popping” figure is reasonable.


#14

The drugs wouldn’t cost nearly as much if it weren’t for inhumane drug patent laws. That’s why the imported generics are so cheap. There’s no excuse for private drug companies to get such a huge markup on drug sales when so much of their research money came from public funding.

But even at full price it would cost less to pay for the PrEP drugs than HIV treatment.


#15

I understand the argument and agree that it’s the best use of the money. My head hurting comes from the idea that at least some of the people on PrEP have just said “fuck it” up until this point and for the sake of public health we need to spend £5k per year to limit the damage.


#16

People are going to do stupid, risky things, regardless of whether or not we give them extra protection to make those things slightly less stupid and slightly less risky.

And some of those stupid, risky things are going to have consequences for other people, because those people are being lied to about what stupid, risky things their partner is doing.

Additionally, a 40% year-over-year drop of new infections? That seems like a (very) early indication of a trend towards local eradication.

You’re never going to be able to stop the stupid. But you can, at least, limit the fallout.


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#17

Yeah. Whenever the edges get rubbed off my misanthropy I’m reminded in new ways why people are sacks of shit.


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#18

Yeah, I get it. You’d think the people just wouldn’t fucking drive drunk, right? You know, you don’t want to die, you don’t want to wreck your car, you might even not want to kill other people.

There is a knife’s edge - on one side you have a compassionate recognition of human flaws and on the other you have misanthropy. I flip back and forth, but, “People generally seem to have their shit together” is not an option.

If only. It’s a huge number, but I’d say for something like this it’s more like an early indication of a trend towards a 70%-90% drop. Have you seen those condom stats where they are only like low 90% effective? Turns out most people don’t use things right or don’t use them consistently. A PrEP study showed it to be 100% effective for those who adhered to it, but overall people say it’s 90% effective, and no everyone will use it.

I mean, we’re talking about cost and whatnot, but basically if there was a pill everyone could take, that was handed out for free by pharmacists and corner stores that was like, “If you take this every day you won’t get cancer, but on any day you miss it your odds of getting cancer are normal” the cancer rate would only drop 95%.


#19

I’m not an epidemiologist or virologist, but if you can get to that point, doesn’t herd immunity start to kick in?


#20

I would guess that herd immunity doesn’t play as large a role with a virus like HIV which hangs around, active, for a longer time than most viruses (if i remember correctly).