Obituary | One tablet, taken daily

Obituary: Mags Portman died on February 6th

The sexual-health pioneer and campaigner for access to PrEP was 44

THE YOUNG man Mags Portman had come to meet that day in 2015, in a wine bar near her clinic in the Mortimer Market Centre in London, was clearly nervous. He seemed lost; he was homeless and sofa-surfing. So in her bright Yorkshire way she came straight to the point: “What can I do?”

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Greg Owen was HIV-positive, for a start. But, like her, he was well aware of a treatment called PrEP (for Pre-Exposure Prophylaxis, with an anti-viral drug sold as Truvada), which could have prevented his now-incurable infection. It couldn’t be prescribed in Britain. So he had built a website so that others like him, men having sex with men and hoping to stay safe, could click through to get PrEP from pharmacies in Asia. But now traffic to the website was growing fast, he told her, and he wasn’t sure whether it was legal to skirt round the doctors like this. He needed backing from someone in the profession who was credible and visible.

And hey, he had come to the right person! Visible and credible was just what she was, with loads of confidence (even fairly stubborn at times). Petite she might be, but you couldn’t overlook her. And she knew as much about PrEP as anyone. Through her clinic she had helped conduct a study of 545 men at risk of HIV which had produced the fantastic conclusion, laid out in the PROUD report in 2015, that use of PrEP reduced the risk of infection by 86%. If Greg had taken one of those blue pills daily, he could have had sex with any male partner with almost no danger. It was high time Britain’s doctors got on board! “Leave it with me,” she said.

She then took off like a whirlwind. First stop was the General Medical Council, the governing body of doctors, which told her—hallelujah!—that clinicians had a responsibility to get the best treatment for their patients, even if it was not commissioned. With that under her belt, she started testing the generic pills coming in via the IwantPrEPnow website, to check there were no dummies and to quell her own professional doubts about safety. She got Greg and other activists to train doctors at Mortimer Market to recommend PrEP to gay men, and other clinics did the same. Between 2015 and 2016 the number of gay men diagnosed with HIV in England fell by a third. In London the number fell by 40%.

Meanwhile, she didn’t forget the visibility bit. She campaigned up and down the country for PrEP, which wasn’t difficult, since despite working in London she lived in Leeds with her husband and two little boys. So she could talk to the doctors in Westminster on Monday and the next day be hitting Blayds Bar in Lower Briggate. Copious cups of Yorkshire tea kept her going. She tweeted and retweeted the latest HIV news, paraded with placards and wore the “PrEP up your LIFET-shirt (great look with a flouncy pink mini-skirt and rainbow socks!). For HIV Testing Week she teamed her scarlet HIV ribbon with scarlet lipstick and a red stripe in her hair. She campaigned for HIV-testing points in saunas, bars, churches, pop-ups at festivals. Awareness was everything.

Still the NHS dragged its feet on PrEP. (How could it, her beloved NHS, her life? Come on!! Even cheap generics were too expensive for too many people.) In 2016, after 18 months’ mulling, NHS England said it would not fund PrEP except for a small group at highest risk. She was horrified. Even after losing a court challenge, it kept access low. There had to be a bit of moralising going on here: gay men shouldn’t be encouraged in a reckless lifestyle. They could use condoms, couldn’t they? Well, she’d retort, they often did, but not always; just as straight men often did, but not always.

Gay and straight love had to be seen in the same way. It was obvious. All through her 20-year medical career she helped out in sexual-health projects set up by gay men as if she was one of them. Perhaps because she had been an outsider as a child, she especially liked working with others who felt that way and in a field, genito-urinary medicine, where shame could reinforce pain. When she appealed for PrEP in the British Medical Journal, the interest she declared at the end was “a mutually supportive relationship” with men who loved, but were often scared of loving, other men. That sounded pretty defiant because, of course, she was still fighting.

And she was getting a bit tired, which wasn’t like her at all, what with cycling everywhere, sitting down only with knitting in her hands, and juggling the chaos and joy of the clinic with the chaos and joy of home. She had a cough, too, but it was probably something the boys had brought back from school. Then came the devastating diagnosis: she had mesothelioma, a rare cancer of the lung lining caused by asbestos. The prognosis was dreadful.

Determined to keep chirpy, she started a blog about her illness called “Not Doing Things by Half”. As it went along, she couldn’t help making comparisons with HIV—though this time as a flailing patient, rather than a know-it-all doctor. Unlike HIV, “Mr Meso” didn’t inspire much research; but like HIV, there was no cure and no NHS funding of treatments that might do some good. How she hated having to go private! It upset all her principles, that care ought to be about love, respect and kindness, not about money.

By a real irony, her illness too had been preventible. She’d contracted it, she was sure, from working in a hospital in south Lanarkshire which was full of asbestos. Here was a new and urgent cause, then: to check all hospital buildings for the stuff, and to teach staff about the dangers. Awareness was everything. Where there was no cure, save lives by prevention! That was still worth repeating and repeating, as long as her fading lungs would let her.

This article appeared in the Obituary section of the print edition under the headline "One tablet, taken daily"

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