EVERYONE feels a warm glow at the thought of helping sick people get better. Feelings about attempts to prevent people becoming sick in the first place, though, are rarely so straightforward.
That has always been so when it comes to HIV, given the controversies over handing out condoms or clean needles, or regulating the sex industry. With 30 million people infected worldwide 鈥� and the of a promising prototype vaccine 鈥� the need for prevention has never been greater.
The good news is that we may soon have a new strategy. If current trials prove its worth, as seems likely, people can slash their risk of catching HIV from sex or injecting drugs by taking one pill a day (see 鈥淪afer sex in a pill鈥�).
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Called pre-exposure prophylaxis, or PrEP, the best guess is that it could cut the infection rate by about two-thirds. The first trial isn鈥檛 due to finish until next year but this strategy will almost certainly trigger unease at best and, at worst, a convulsion of outrage.
The risk that prevention-in-a-pill could promote resistant viruses is real if users already have HIV, although regular testing would help avoid this. And who will pay? In countries with state healthcare, critics may demand that patients pay top-up charges for prophylaxis. Why should taxpayers finance people鈥檚 sex lives? The answer is that many countries already provide the same antivirals free as treatment. And because prevention is always better than cure 鈥� especially when a disease has no cure.
Most of the people at risk live in the developing world and so will only benefit from the pill if a richer country foots the bill. The money is certainly there. A considerable fraction of the $10 billion the west contributes annually to HIV aid has been spent on dubious strategies: until recently, one-third of US funds for prevention went on abstinence-until-marriage campaigns.
Those who see themselves as our moral guardians will recoil from a drug that facilitates more carefree sex. Spluttering outrage apart, there is a genuine problem here. While official advice is to use the drugs plus condoms, inevitably some users will leave the latex at home. Since the pill is by no means 100 per cent effective, this could spur the transmission of HIV.
This concern can only be addressed when the trials finish. Although the new strategy will be less effective than vaccination, it could still curb the daily toll of 7000 new infections. Perhaps the biggest question for those seeking new prevention strategies is this: why should a pill stir deeper disquiet than an injection.