FILE PHOTO – A pharmacist pours Truvada pills back into the bottle in a United States pharmacy in 2010. Local advocates say that taking this drug regularly prior to exposure to HIV can dramatically reduce rates of infection.
Albertan health, citizen and government groups start to lay the groundwork for a new tactic to combat HIV rates, as the province continues to see rates of the disease increase.
So far in Canada, Ontario, Quebec and British Columbia have pledged public funding for HIV Pre-Exposure Prophylaxis (PrEP).
The treatment sees a person with a high risk of contracting the disease take HIV medication on a set schedule, often daily.
When adequate doses of these drugs — like Truvada, which the Canadian government approved for human use in 2016 — exist in a patient’s system, it helps prevent the virus from multiplying in his or her body, reducing the risk of infection.
PrEP has a high rate of efficacy when combined with other safe-sex protocols and regular checkups with the doctor who prescribed it proponents say.
They further note PrEP’s success in other jurisdictions, including San Francisco; New South Wales, Australia; and London, England.
“I was initially skeptical when the concept of PrEP was first put out there. I’ve been working in the field since 1998, and all we see is continuing rises in STIs,” said Ameeta Singh, clinical professor, division of infectious diseases with the University of Alberta.
“I have become convinced from now overwhelming data that HIV PrEP is the single most important advancement in the area of HIV prevention since the condom, if used properly and if there is wide uptake.”
That said, according to a written response the Government of Alberta sent to the Examiner, PrEP is not 100-per-cent effective, does not protect against other STIs, and should not replace other safe sex practices.
The province saw 280 new cases of HIV reported in 2016, an increase from 6.8 to 9.1 people per 100,000 among men the year prior, said an STI report sent out by Alberta Health Services last fall.
That said, the rate of diagnoses in women during the same time period decreased from 4.2 to four for every 100,000 people.
According to Singh, some populations in Alberta are more vulnerable to HIV infection than others, including men who have sex with men and Indigenous peoples.
Currently, AHS works with health-care providers, community groups and other stakeholders to create a set of guidelines and best practices for PrEP in Alberta as it rolls out. This working group has the exceedingly lengthy monicker Alberta Health Services Sexually Transmitted and Blood Borne Infection Operational Strategy and Action Plan Pre-exposure/Post-Exposure Prophylaxis Working Group, and the exceedingly long acronym AHS STBBI OSAP PrEP/PEP Working Group.
The province is currently looking at the different aspects of implementing PrEP, including potential cost to patients and the public, a written response from the government said.
At the same time, the working group’s informal deadline for suggestions is the end of March, though it is unlikely it will have many suggestions about PrEP implementation. While it seems the province may give public funds to it, a dollar amount is still up in the air, said Singh, who is also co-chair of the working group.
“We’re also hoping to develop more implementation guidelines, but of course we’re not really able to work on any details of that, because we’re not sure how PrEP will be funded in Alberta,” she said.
“Currently, the only individuals who are on PrEP are either those who have private insurance, or those who are willing to purchase the drug themselves.”
Barriers to Entry
Currently, some barriers keep potential patients from accessing PrEP, said Brook Biggins, founder of the Edmonton Men’s Health Collective.
The local GBTQ organization — also a member of the working group — opened a survey asking members of the communities it serves to provide their perspectives on the treatment.
The survey found that respondents had a high level of knowledge on the topic, and many of them met Canadian government-made criteria for eligibility.
“However, we found there were not a lot of people taking PrEP at the time,” Biggins said.
“Many of the people who attempted to access it found various barriers.”
While, currently, most health-care providers — like family doctors — can prescribe PrEP, many will not, due in part of a lack of understanding of how it works.
Biggins would like to see this system continue, rather than having infectious disease specialists be the only entry way into the treatment, but also wants there to be more knowledge amongst doctors regarding PrEP.
As it stands, Truvada costs around $1,000 a month, and is not covered by public health care. “For many vulnerable people, paying that’s just not possible,” he said.
That said, Canada has recently allowed generic, cheaper forms of Truvada, which can ease the cost for both individuals and the public health-care system.
By Doug Johnson