ACCESS DENIED

On a scale of irresponsible, irrational and just dumb things to do,
shooting up with dirty needles and having unprotected anal sex are
hard to beat. And yet people do both those things even though
information is widely disseminated about HIV and how it is
transmitted. Why people knowingly put themselves -- and others -- at
risk is an enigma of human behaviour, but it is not restricted to HIV.

Think of smoking. Despite all the evidence that it dramatically
increases the chances of developing lung cancer, emphysema and heart
disease, 30 per cent of Canadians still puff away.

Think of teenage pregnancies. Again, despite sex-education classes
beginning in elementary schools, walk-in contraception clinics and all
sorts of evidence about the hardships, health risks and diminished
opportunities for both mother and baby, teenage pregnancies are
running at about 46 per 1,000 in Canada.

Think of sexually transmitted diseases. A 1997 Health Canada survey
reports that 27.7 per cent of men did not use a condom when having sex
with a non-regular partner. The rate for women was 28.1 per cent.

We do not deny treatment or social services to these people, on the
grounds that they should have known better. In fact, when it comes to
unwanted pregnancies, abortion and morning-after pills are options in
most parts of the country.

Yet, we seem to have a different standard when it comes to offering
morning-after pills to people who fear they may have become infected
with HIV. Sexual-assault victims and health-care workers exposed to
the virus are offered a powerful drug-combination therapy known as
post-exposure prophylaxis. Although long-term benefits of the drug
cocktail are not conclusive, some studies have shown a greatly reduced
risk of infection, if the month-long treatment is begun quickly.

But the same service is not routinely available to people at risk
because of bad choices or foolish behaviour. People who have deluded
themselves into thinking they are immune to obvious dangers, or thrown
caution aside for a momentary pleasure, or are unable to deny a habit
that has become an addiction must first persuade a doctor to prescribe
the prophylactic treatment and then have the money to pay for it
because pep drugs are not usually included in provincial drug plans.

This is two-tier medicine of the most pernicious sort. The pep therapy
should be available to everybody who needs it, under the same terms as
the morning-after pregnancy pill: Patients are given a prescription
along with a series of counselling sessions on practising safe sex and
using clean needles.

The cost of providing a month's worth of pep therapy is minuscule
compared to the ongoing costs of caring for patients with HIV or
full-blown AIDS. Nobody wants to encourage risky behaviour, but it is
not our place to judge who is entitled to treatment, especially when
dealing with such a dreadful disease.