PrEP, a pill that protects against HIV still not free here

PrEP, a pill that protects against HIV still not free here

Pre-exposure prophylaxis (PrEP or PprE) is an antiviral that considerably reduces the risk of HIV infection. While this little pill saves lives and is free in France and Vancouver, it is not fully reimbursed by the Régie de l’assurance maladie du Québec. Although its use is growing, its cost can be a hindrance for some people.

The Public Health Agency of Canada (PHAC), which tracks the use of PrEP in the population, notes that the number of people taking it increased fourfold between 2016 and 2020. Over this same period, it has increased by 1800% among 18-24 year olds. In 2020, 35% of people who use it were between 25 and 35 years old.

An “extremely important” tool

This treatment has “incredible efficacy”, few side effects, and it is an indispensable tool against HIV, according to the doctor, general manager and founder of the Clinique l’Actuel, Dr Réjean Thomas.

PrEP is our HIV vaccine, it’s as simple as that […] we still don’t have a treatment, we still don’t have a vaccine, so it’s an extremely important tool.

Dr. Réjean Thomas, CEO and founder of Clinique l’Actuel

Among his clientele, it is mainly men who have sex with other men (MSM) between 30 and 40 years old who consult for this. However, anyone can access PrEP.

“We have a cohort of nearly 4,000 patients on PrEP since 2014, we have not had a case of [patient infecté par le] HIV”, explains Dr. Réjean.

PrEP is taken as a medicine made up of antivirals (anti-HIV). It can be taken daily for more sexually active people. It can also be taken on demand, at least two hours before a risky report. Two doses follow 24 hours later over two days. This treatment targets HIV-negative people and its effectiveness rate exceeds 90%.

It differs from post-exposure prophylaxis (PEP), which is taken after having recently been exposed to HIV. The effectiveness of PEP is more than 80%.

When will PrEP be free?

The relative cost of PrEP in Quebec is nearly $90 per month when the drug is covered by the Régie de l’Assurance Maladie du Québec (RAMQ). It goes up to more than $200 for people without any insurance, such as refugees and people without status.

I still don’t understand why it’s not free. […] About 15% of our clientele stop PrEP for financial reasons.

Dr. Réjean Thomas, CEO and founder of Clinique l’Actuel

According to him, the pandemic has also played a role in the abandonment of PrEP among some. It has become a financial burden for people who have lost their jobs or their insurance.

“During the pandemic, 29% (of our clients) stopped taking PrEP […] We still had cases of infection among these people,” he said.

“Young people often have their parents’ insurance, so they won’t take PrEP,” explains Dr. Thomas. Also, “there are (private) insurances that if people are on PrEP, they stop insuring the client.”

The Ministry of Health and Social Services (MSSS) recognizes that it is a “highly effective strategy for reducing the risk of HIV transmission”. He explains, however, that “there are currently no plans to reimburse 100% of the price” of PrEP.

“If we want to achieve the objectives of the World Health Organization (to fight against HIV) we must have better access to PrEP, otherwise we will not succeed,” explains Dr. Thomas. He adds that this must be accompanied by free access to Tritherapy.

If politicians did simple mathematical calculations, they would see that it is to the benefit of the health system to offer PrEP to all those who are at risk […] even from a financial point of view, and it is easily justified even more from a human point of view.

Dr. Cécile Tremblay, microbiologist, infectiologist and professor at the University of Montreal

Optimize treatment

New molecules and the implantation of new medications are under study. The arrival of long-acting drugs to be taken every two months or every six months is hoped for.

Two current research issues are the implementation and observance of treatments. This is explained by the microbiologist and infectiologist at the CHUM and full professor in the department of microbiology, infectiology and immunology at the University of Montreal, Cécile Tremblay.

She conducted a cost-effectiveness study on a cohort of MSM at high risk of being infected. The results showed that stopping PrEP was associated with money and mental health.

“We saw that the most socially unstable people were those most at risk of stopping taking PrEP or even having difficulty accessing it,” she says. The more we intervene at the government level to support these very vulnerable populations, the more we will contribute to preventing the spread of the disease”.

To obtain PrEP, it is necessary to see a doctor. Regular monitoring is also required. In Montreal, various clinics deliver PrEP. This is the case of the clinic l’Actuel, la Licorne, SIDEP+ or the clinic of the Latin Quarter.

From July 29 to August 2, the International AIDS Conference (AIDS 2022) takes place in Montreal. The latest scientific knowledge will be presented and various topics will be discussed such as vaccines, the Aboriginal response to HIV or even health innovation.

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