NHS Scotland is to fund a drug that could reduce the chance of people contracting HIV whilst engaging in high-risk sexual activities.
The Scottish Medicines Consortium (SMC), which reviews newly licenced medicines, this week announced that it has accepted Pre-Exposure Prophylaxis (PrEP) "for routine use by NHS Scotland".
Last year the NHS England said it would go ahead with clinical trials for PrEP after losing a legal battle.
But critics say the drug is ineffective, expensive and encourages dangerous behaviour.
Ineffective
Pre-Exposure Prophylaxis (PrEP) is a course of pills that tries to reduce the chance of people who do not already have HIV from catching the disease.
The pills contain two antiretroviral drugs which disable the HIV virus before it infects the body. Taking the pills every day has been shown to reduce the risk of contracting HIV by up to 86%.
But a Cochrane review found that in previous clinical trials the most at risk group (men who have sex with men) did not take the pills consistently. Overall, results from four trials showed a reduction in the risk of acquiring HIV infection of only 51%.
This raises serious questions about how effective the drug will be in practice.
High-risk behaviour
Men who have sex with men are at a very high risk of catching HIV. In the UK, 1 in 20 men who engage in homosexual sex has HIV. The ratio is 1 in 8 in London.
Among heterosexuals, only 1 in 500 has the virus.
Having anal sex, particularly with multiple partners, also greatly increases the risk of contracting many other sexually transmitted diseases such as syphilis, gonorrhoea, chlamydia and viruses such as Hepatitis A and B.
Dr Peter Saunders, Chief Executive of the Christian Medical Fellowship describes PrEP as "a harm reduction strategy aimed at lessening the damage that people addicted to high-risk sexual behaviours are doing to themselves", and compares the treatment to "giving clean needles to drug addicts".
Expensive
Around 1,900 people are expected to be given PrEP on the NHS in Scotland, with an annual cost of up to £5,000 per person.
NHS England did not want to fund PrEP because of its huge cost to the taxpayer. It would cost up to £20m a year to give the drug to everyone who might potentially benefit.
Because of the decision to fund PrEP trials in England, several treatments will now not be considered by the NHS, including adult stem cell transplants for leukaemia patients.
'Special privilege'
Andrea Williams said: "This is an irresponsible use of resources by NHS Scotland which gives special privilege to those who engage in dangerous sexual behaviour. These drugs are not a prevention strategy but rather a safety net for promiscuity and risk taking.
"We ought to be addressing the real cause and caring for those who have the HIV virus, instead of providing licence for the activity which is most responsible for its transmission.
"The safest and most fulfilling sex is had between a husband and his wife in a committed, excluslive, life-long marriage relationship."
Related links:
NHS told to fund preventive HIV treatment
NHS to spend £10m on clinical trials for HIV prevention drug
High Court rules in favour of NHS providing 'HIV prevention drug' but big questions remain (Christian Medical Fellowship)