In the United Kingdom, the high prevalence of HIV infections is a significant public health problem. In 2013, there were 107,800 people living with HIV infection in the UK, of which 43,500 were men who have sex with men (MSM). (Public Health England, 2014, 4) If taken prophylactically, a new antiretroviral drug, Truvada, has been shown to be highly effective to protect HIV-negative people who engage in high-risk behaviour, such as having unprotected sexual intercourse or multiple sex partners. (Aidsmap, 2015, 3) However, whether the NHS should cover Truvada in the UK remains a highly controversial matter because of two reasons: 1) the role of personal responsibility for the behaviour of MSM is used as a justification for denying Truvada coverage
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In doing so, this dissertation pursues to include considerations of fairness related to personal responsibility for people’s own health-related choices. This project is interesting and relevant given that the NHS has not yet decided on a policy for this matter. The NHS is currently drafting a policy on whether Truvada should be provided and to whom, which will then be evaluated in terms of clinical efficacy, safety, cost-effectiveness and affordability. Also, the wider think tank and policy research community including Nesta, The Health Foundation and the IPPR released reports in which they emphasise a need for a paradigm switch where people are the co-producers of their own health. This presupposes a degree of responsibility of the citizens for their own health. My contribution to the current decision-making exists in the moral analysis of the role of personal responsibility for high-risk behaviour in health policy, specifically in the case of MSM in relation to HIV infection. Other groups that are at risk of getting infected with HIV are beyond the scope of this dissertation. The focus of this dissertation is MSM since this group is considered to be at highest risk and therefore needs to be prioritised in the provision of Truvada as pre-exposure …show more content…
Part I covers the background of the HIV epidemic in the UK and contextualises the ethical tension concerning the coverage of the Truvada medication in the broader philosophical debate and within the values of the NHS. Part II assesses two normative frameworks of health responsibilities. Firstly, I consider one retrospective view of responsibility, the Forfeiture View, the theoretical framework that uses personal responsibility as a justification to deny coverage of Truvada. Secondly, I assess the prospective liberal egalitarian approach, endorsed by Cappelen and Norheim. This view takes into consideration both the notions of fairness and responsibility in priority setting in health care as well as the incentive-based objections set forth by the Forfeiture View and critics of Truvada. Consequently, I argue against both views that the denial of coverage of Truvada or the introduction of co-payments for their own health care through the justification of personal responsibility for HIV protection is rendered unfair and immoral on the following grounds: 1) the HIV-related stigmatisation, 2) giving MSM equal health opportunities, 3) fairness and relational equality. I then argue in favour of a universal Truvada coverage whilst making people involved and engaged in their own health, which is compatible with the recent NHS developments and the wider think tank community. Lastly, I trace the policy implications of the normative analysis by
In doing so, this dissertation pursues to include considerations of fairness related to personal responsibility for people’s own health-related choices. This project is interesting and relevant given that the NHS has not yet decided on a policy for this matter. The NHS is currently drafting a policy on whether Truvada should be provided and to whom, which will then be evaluated in terms of clinical efficacy, safety, cost-effectiveness and affordability. Also, the wider think tank and policy research community including Nesta, The Health Foundation and the IPPR released reports in which they emphasise a need for a paradigm switch where people are the co-producers of their own health. This presupposes a degree of responsibility of the citizens for their own health. My contribution to the current decision-making exists in the moral analysis of the role of personal responsibility for high-risk behaviour in health policy, specifically in the case of MSM in relation to HIV infection. Other groups that are at risk of getting infected with HIV are beyond the scope of this dissertation. The focus of this dissertation is MSM since this group is considered to be at highest risk and therefore needs to be prioritised in the provision of Truvada as pre-exposure …show more content…
Part I covers the background of the HIV epidemic in the UK and contextualises the ethical tension concerning the coverage of the Truvada medication in the broader philosophical debate and within the values of the NHS. Part II assesses two normative frameworks of health responsibilities. Firstly, I consider one retrospective view of responsibility, the Forfeiture View, the theoretical framework that uses personal responsibility as a justification to deny coverage of Truvada. Secondly, I assess the prospective liberal egalitarian approach, endorsed by Cappelen and Norheim. This view takes into consideration both the notions of fairness and responsibility in priority setting in health care as well as the incentive-based objections set forth by the Forfeiture View and critics of Truvada. Consequently, I argue against both views that the denial of coverage of Truvada or the introduction of co-payments for their own health care through the justification of personal responsibility for HIV protection is rendered unfair and immoral on the following grounds: 1) the HIV-related stigmatisation, 2) giving MSM equal health opportunities, 3) fairness and relational equality. I then argue in favour of a universal Truvada coverage whilst making people involved and engaged in their own health, which is compatible with the recent NHS developments and the wider think tank community. Lastly, I trace the policy implications of the normative analysis by