On Thursday night, Gabriel Enxuga asked a panel of AIDS/HIV experts a question he said is on a lot of people’s minds: When will PrEP be covered under provincial care?
No one could give him a definitive answer.
Enxuga cares because he used to take PrEP, a preventative medication for HIV. He relied on it for protection that condoms often fail to provide. But he can’t afford to take it anymore.
Pre-exposure prophylaxis (also known as PrEP) has been around since 2004. It has only seen use in Canada for the past two years.
It comes in the form of a daily pill, much like allergy medication or birth control, that people can take if it’s likely they’ll have high-risk sex.
Enxuga said PrEP didn’t just provide him with protection from HIV, it took away the anxiety associated with sexual activity.
“It just brings you that peace of mind,” he said.
Chris Aucoin, gay men’s health co-ordinator with the AIDS Coalition of Nova Scotia, said access to PrEP depends on the person.
“There are some people who don’t have the resources to pay for it, and those people are waiting and hoping that the province will come forward and do something,” he said.
The drug is not yet covered by provincial health care. This forces people to pay out of pocket or navigate the red tape of getting it through a private plan, said Aucoin.
Costs for PrEP range from $250 (mail-order from Toronto) to $1,000 (local brand name) each month.
“Obviously one of the biggest access barriers is cost,” Enxuga said.
Enxuga was one of about 50 people who attended an information session about PrEP at the Halifax Central Library on Wednesday night. It was hosted by the AIDS Coalition of Nova Scotia.
Aucoin, who was a panellist at the event, said no one knows exactly when provincial coverage might happen.
Working toward provincial coverage
Although Health Canada approved PrEP in February 2016, Canadian guidelines only became available in a report published by the Canadian Medical Association Journal last November.
The report recommends considering PrEP for people in high-risk communities. Two of the most at-risk groups are gay men, who make up over half of newly diagnosed HIV cases in Canada, and Indigenous people.
Aucoin is part of the Nova Scotia PrEP Working Group, a team currently working with the province to get PrEP on the provincial formulary, a list of drugs that can be covered by the province. Aucoin said that will be the first step for getting the drug into public coverage.
Tracy Barron, a spokesperson for the provincial Department of Health and Wellness, confirmed that options for provincial coverage of PrEP are being developed.
“This is a prevention therapy, so we are working with local infectious disease experts to better understand who the medication is appropriate for, anticipated uptake and the types of supports prescribing primary care providers would need,” said Barron in an email.
However, she was unable to provide a timeline for when the drug might be added to the formulary.
“It’s painfully slow from our perspective, but the fact that they are talking to us at all is progress,” said Aucoin at the library information session.
‘An ounce of prevention’
Aucoin said major urban centres that have had access to PrEP for a few years are seeing drastic reductions in new HIV infections.
“There is lots of talk about how PrEP, along with treatment-as-prevention, are the best tools we have. Those two things combined could possibly eliminate new HIV infections within the next decade,” said Aucoin.
But only if they are made available to the high risk populations, he added.
“In this case, an ounce of prevention is worth a pound of cure,” said the panel moderator, Renee Masching, who is also the director of research and policy for the Canadian Aboriginal AIDS Network.
Enxuga thinks it’s important that accessibility to the drug improves sooner rather than later.
“People who are at highest risk tend to be people who might not have drug coverage,” he said.
“I think having it covered would have huge impacts. Personally, it would make it affordable for me but it would increase the access level — we’re looking at whole populations.”
PrEP is already covered publicly in Quebec, Ontario and British Columbia.
“The door has been opened, but don’t expect it to happen overnight,” said Aucoin. “There is still a lot of work that needs to be done.”