After Years of Foot-Dragging: A Meager PrEP Decision with No Ambition

Yes­ter­day, Dutch Min­is­ter of Health, Wel­fare and Sport Bruno Bru­ins announced his plan to pro­vide PrEP for the next five years to a group of gay men at high risk of HIV. In a sense, his announce­ment comes as a response to a mem­o­ran­dum from the Health Coun­cil of the Nether­lands which advised him three months ago to take urgent action on this top­ic.

The min­is­ter claims to attach great impor­tance to med­ical super­vi­sion as pro­posed by the Health Coun­cil. There­fore, he wants five to sev­en Munic­i­pal Health Ser­vices (GGD) regions to admin­is­ter PrEP and pro­vide accom­pa­ny­ing quar­ter­ly med­ical check­ups for PrEP users. “When select­ing the regions, we will ensure that they are well-dis­trib­uted through­out the coun­try, so that major cities are cov­ered in any case,” says Bru­ins in his let­ter to the Dutch House of Rep­re­sen­ta­tives.

No Involvement from GPs

Min­is­ter Bru­ins sees no need to involve gen­er­al prac­ti­tion­ers (GPs) in PrEP care. PrEP­nu has always tak­en the posi­tion that GPs should in fact play a key role in super­vis­ing patients who use PrEP as an inte­gral com­po­nent of their sex­u­al health. The many indi­vid­u­als cur­rent­ly receiv­ing this treat­ment from their GPs can no longer count on reim­burse­ment for their med­i­cines in the future. They too must go to the GGD.

Personal Responsibility

Min­is­ter Bru­ins recog­nis­es the pub­lic health inter­est in intro­duc­ing PrEP but says this ‘does not change my opin­ion that pre­vent­ing HIV infec­tion is also a per­son­al respon­si­bil­i­ty. As an expres­sion of this per­son­al respon­si­bil­i­ty, the user will be asked to pay their own con­tri­bu­tion of up to 25 per­cent and must also take part in med­ical mon­i­tor­ing.” This per­son­al con­tri­bu­tion is expect­ed to cost PrEP users around 12 euros per month.

Mixed Reactions

Bruin’s pol­i­cy plan was met with fair­ly mixed reac­tions, rang­ing from mild­ly enthu­si­as­tic to dis­ap­point­ed and crit­i­cal.

Good news! Start­ing now there’s a plan,” was the excit­ed reac­tion on Twit­ter from Marc van der Valk, chair­man of the Dutch Asso­ci­a­tion of HIV-Treat­ing Physi­cians. How­ev­er, this inter­pre­ta­tion is unfor­tu­nate­ly far from the truth.

Louise van Deth, direc­tor of the Aids­fonds and Soa Aids Ned­er­land also announced she was “espe­cial­ly glad […] that a min­is­te­r­i­al deci­sion has final­ly been made.” How­ev­er, she says, “To me, the minister’s deci­sion still lacks the urgency to put this into action quick­ly. He expects for PrEP to start being admin­is­tered next year.” Accord­ing to van Deth, there is no rea­son what­so­ev­er to wait so long.

Pieter Brokx, direc­tor of the Dutch Asso­ci­a­tion of Peo­ple Liv­ing with HIV, agrees with the activists and is deeply crit­i­cal of the minister’s let­ter: “We know bet­ter than any­one how impor­tant acces­si­ble HIV pre­ven­tion is. With the bar­ri­ers that this pol­i­cy response throws in place, we bid farewell to the prag­mat­ic, effec­tive Dutch way in which we’ve tack­led the HIV epi­dem­ic over the past decades and we will nev­er reach our shared goal of zero new HIV infec­tions in 2021.”

Poz&Proud, one of the first groups in the Nether­lands to advo­cate PrEP, finds that the pol­i­cy plan gen­er­al­ly looks sus­pi­cious­ly like “a redo of the AMPrEP study in a larg­er set­ting. Nor­mal­iza­tion of PrEP seems to be nowhere in sight in this plan. Appar­ent­ly, it’s still a top­ic that has to be han­dled with kid gloves,” says the inter­est group for HIV-pos­i­tive gay men.

Dr. Lin­da Duits, who has gained recog­ni­tion as a promi­nent PrEP activist in recent years, is relieved that an end has final­ly come to the delay tac­tics used by this and the pre­vi­ous gov­ern­ment. “It is good that PrEP is now more afford­able, but there are still bar­ri­ers that must be over­come.” Accord­ing to Duits, “It is par­tic­u­lar­ly con­cern­ing that the government’s deci­sion was pri­mar­i­ly reached as a means of sav­ing costs. The peo­ple this impacts are always referred to in such neg­a­tive terms: as poten­tial cost items instead of full-fledged cit­i­zens who are tak­ing care of their sex­u­al health.”

Last updated 14/07/2018