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