Dear Neighbors to the North, Do I think that PrEP should be reimbursed by the RIZIV (the Belgian public health insurance)? It’s a trick question, as most people know what I do professionally, and how the subject sometimes involves me. They try to figure out my position on the subject, knowing that I’m gay. This is perhaps a reason to expect an appropriate answer from me?
They are startled when I say that I believe that the general public health insurance should not reimburse this form of primary prevention. This response always leads to hard looks, certainly from gay friends who call me “harsh,” and a series of less kind words.
The reimbursement in the case of a potential condition that can be tackled preventative is an expression of complete contempt for those patients who are suffering from a serious illness for which prevention does not exist, or for patients who are at high risk genetically. These groups of patients often need a lot of medical attention as well as medication, in a budget that is already under tremendous pressure.
So no, I do not think the Belgian state should reimburse PrEP. And it doesn’t look like it will in the near future. The current reimbursement of PrEP for Belgian gays is in the context of clinical trials, not by the government. A gay friend of an acquaintance of mine claimed that the RIZIV was reimbursing it, and that every gay should do the same.
Do the same in particular means having sex without a condom, now PrEP is an option. On Facebook I sometimes see his posts (and from other PrEPpies) as a response to the discussion on PrEP. The suggestion of PrEP as a “license to unsafe fuck” is grotesque.
The falsehoods the gay community (especially those using it) send out on PrEP are criminal. PrEP protects – to a certain extent – only against an HIV infection. “To a certain extent” means that it is too early to conclude that PrEP is effective in stopping HIV infections.
Much of the results from research are downright optimistic, although validated scientific conclusions concerning PrEP still need to be made before one can describe it as the Valhalla for gay people.
Most of the people on PrEP remain oblivious if they continue to claim that they fool around without a condom. Their advertising of sex without a condom is plainly criminal. Those using PrEP and having sex without a condom still have an increased risk of a host of other sexually transmitted infections. They include potentially serious illnesses. When you tell this to a PrEPpie, you will usually get the answer that the medical world can usually solve this “with just a little pill.” True, but I also think that you should take “just a little pill” when you are HIV positive.
What I do support is reimbursement of PrEP in the context of additional private insurance comparable to car insurance. Those who drive a car, pay insurance. Those who don’t, don’t need car insurance. This might present the situation as a caricature, but let’s call a spade a spade. Those exhibiting expensive risk behavior should get private insurance. And that private insurance should reimburse PrEP.
Not only does the money for PrEP not have to come from public funds, it will make some gay men think and rethink when filling in a questionnaire on their risk behavior. Although I now also realize that it is too late to convince some. I’m curious to see whether everyone would be on PrEP if they had to pay for it out of their own pocket.
And if you are not convinced yet, I heard from a reliable government source that PrEPpies in Amsterdam are affected by sexually transmitted infections en masse. Some even with an STD variant that is resistant to every treatment possible. In Amsterdam hepatitis C is also on the rise.