The documentary that goes out at 9pm on BBC2 tomorrow, The People vs The NHS, shows
how a disparate group of people from very different walks of life banded
together to force the English National Health Service to provide PrEP. That’s pre-exposure
prophylaxis, the pill that has contributed to significant falls in HIV
diagnoses in gay men.
The BBC’s press release gives something of a flavour of the
original brief: “Show how the NHS decides who gets the drugs.” It’s part of a
season of films set around the NHS’s 70th anniversary, and most of
the others are celebrations of what surveys still show is a widely valued
institution.
But there’s one thing a free-to-all health service must do
that will never be popular: ration drugs in the face of ever-expanding demand.
Director Mark Henderson could have taken a more conventional
tack and done a hard-hitting Panorama-style
investigative job on, say, the pain of the families of cancer patients denied meds
that allow them a precious few more months.
Instead he’s taken on a bigger challenge in the story of
PrEP: a more multifaceted tale that draws in the politics of sex and morality,
the clash and mix of counterculture and establishment, and some of the most
wildly different personalities ever to collaborate on a matter of medical
commissioning.
Initially Mark was going to tell it through the story of one
person – Greg Owen, gay son of a Belfast mom (who also cameos, wonderfully).
Greg, enraged that he had heard of PrEP just too late to avoid HIV, and determined
to stop it happening to mates, set up IWantPrEPNow,
despite being homeless and jobless at the time. There is an amusing
re-enactment of Greg and his compadre Alex Craddock putting together IWPN in a
blizzard of Post-its. This London Buyers’ Club (the original title of the
documentary) inadvertently created a health revolution by tunnelling an internet railroad between gay men in the west and the generic companies turning
out drugs for AIDS in India.
In the process he set off a new wave of HIV activism. Greg’s
story is still central to the programme. But, with an eye on the BBC brief, Mark
got interested in the other players in the PrEP story. He interviews the scientists
and older-generation HIV activists – including me – who, sensing PrEP would
work, set up the studies that proved it. He follows the tortuous trail of an
NHS that tried repeatedly to wriggle out of its obligation to handle this political
hot potato by claiming it couldn’t fund prevention. He interviews Deborah Gold
and Yusef Azad from the National AIDS Trust, which took them to court, and
follows them into the law courts to talk to the solicitor and barrister who
successfully fought the case, twice.
He even delves into the gay community’s own soul-searching
about PrEP by finding Andrew Pierce, a gay journalist who believes in the
“social contract” theory of gaydom – that in return for being allowed to exist,
gay men owe society their sexual good behaviour. Pierce’s pursed-mouth rectitude
is juxtaposed with Greg and his mates in a way that offers no commentary but
suggests whom you might prefer to spend an evening out with.
This is strength of the documentary. Henderson’s found a
different style for each interviewee that subtly brings out their
individuality. Greg is shot like a character from Queer as Folk, freewheeling
down Old Compton Street in his shorts and singlet. Dr Mags Portman, the medic
who first contacted Greg to set up medical monitoring for his PrEP buyers, is
long-shot in an empty café, suggesting the compassion of the doc who can’t save
all her patients. Activist Will Nutland of PrEPster, the head to Greg’s heart,
is shot in his book-lined sitting room, radiating radical wisdom. And
Javan Herberg, the barrister who fought the case, practically pops out of
the screen in extreme close-up to explain the minutiae of the law.
And me? Well, you be the judge. But I was left moved for the
second time in my life by a sense of pride at having played a role in something
important.
I think sometimes we UK HIV activists suffer from a vague
sense of inferiority at having had a relatively easy time of getting HIV
treatment from a benign establishment. We didn’t have to strew dead boyfriends’
ashes on the White House lawn or redden the streets of Paris. It was only when I watched the film Pride, which featured portrayals of many
friends, alive and dead, that I realised this had only happened because we’d
already bloodied our knuckles in the fight between queerdom and Thatcherism.
Now, faced with a harsher political time, and a cowed NHS
that would rather let gay men catch HIV than risk the wrath of the Daily Mail, we came together again,
illustrating an attractive aspect of English activism at its best: the banding
together of unlikely allies, from Vauxhall clubbers to Lords.
This creates a moment of confusion where a mention of health minister Jeremy Hunt worrying about the Mail
segues to Lord Hunt, a sympathetic peer and former Labour health minister. With
a few exceptions, a kind of outraged English reasonableness seems to animate
all contributors: “But this works. Why can’t we/they have it?”
It begins and ends on a note of hope, with Greg and I
recounting the separate moments when we heard that – to everyone’s astonishment
– HIV diagnoses had started to tumble in the London clinics. But the fight is
not over yet. Though I’ve heard that the PrEP IMPACT trial will be expanded to
12,000 places for gay men plus 1000 ringfenced for others, it’s still a capped
provision and everyone expects those places to go fast. We still don’t have the
open availability they have in France or Scotland, and other long sagas, such
as the fight for the anal cancer vaccine for boys, show that the NHS can ignore
the science if it sees it coming with a big bill.
And we need to take the fight abroad too. The US insurance-based
model doesn’t apply to the crumbling centralised health services of eastern
Europe, but the guys and gals are there, curious about this PrEP thing and wanting
it. The next step is to
take PrEP from UK to Ukraine and similar
countries, as I was reminded in Kiev last week. As with HIV treatment, PrEP is
both creating and riding a new wave of queer activism. Films like The People
vs the NHS will help to sustain it.
The People vs The NHS
is on BBC2 at 9pm on Wednesday 27th June – see https://www.bbc.co.uk/programmes/b0b8cdm4