July 11, 2018: 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.
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.
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.”