Quebec refuses to make it free software a drug that is central to the prevention of aids

Étienne Paré

Saturday, February 10, 2018 08:00

UPDATE
Saturday, February 10, 2018 08:00

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Every day, when it is 13 h, the cell Alex* sounds. He then takes out a pill container from his pocket and swallows a small pellet blue. “It is the hour of my PrEP”, ” sliding-t-it before swallowing his mouthful of water.

Prophylaxis préexpositoire, commonly referred to as PrEP, allows him to have unprotected sex with guys with hiv, without fear of being infected by HIV.

“I sleep with lots of guys different. Often, I don’t know their state of health. Even when one puts on a condom, there is always the fear that it breaks down while it is done,” said Alex, openly bisexual and polyamoureux.

Men who have sex with men are still the group most at risk of contracting HIV. Prescribed in Québec since 2013, the PrEP is quickly becoming requested in gay settings.

“For many gay men, it is very interesting. We talk about 92 % efficiency. At the clinic, none of the 2000 patients under PrEP has been tested hiv positive for the past five years”, says Dr. Réjean Thomas, founder of the clinic The present, specializing in the treatment and prevention of STBBIS.

rejean thomas

Photo Le Journal de Montréal, Hugo Duchaine

Dr. Réjean Thomas

A reasonable price

“For $ 89 per month, it is worth it. It is still cheaper than if I still had to take the emergency treatment each time where I’m afraid to be infected,” says Alex, satisfied that the RAMQ covers most of the costs associated with it.

Except that, when the PrEP has been authorized, the State would assume 90 % of the cost. Since then, the price of the drug has dropped, as has been pointed out Alex on his last invoice.

However, it pays out always be $ 89 at the pharmacy counter. The prescription drug insurance pays more than 63 % of a monthly dose.

In other words, the government saves, but not the users of the PrEP. “If the government had continued to put the same amount, the medication would be free,” grumbles Alex.

No price reduction in sight

Alex has not taken a pill too; the gross cost of the PrEP has indeed declined.

As is often the case in the pharmaceutical industry, the arrival of a generic drug resulted in a drop in prices. Truvada, the first drug patented for use of PrEP, cost 830 $. Today, the Tenofovir is 242 $.

This is what pushed British Columbia to offer PrEP for free to people at risk of being exposed to HIV. In Quebec, by contrast, not matter for the moment, to follow suit.

“They have a completely different model from ours. In Quebec, the price of the PrEP is indexed according to the income of the person. If someone who is a recipient of social assistance wants to have access to PrEP, this will be free for him”, argues the spokesperson of the ministry of Health, Noémie Vanheuverzwijn.

Réjean Thomas is careful to criticize the prescription drug insurance plan. “Quebec was the first province to cover part of the cost of the PrEP. The government has always been supportive of the various initiatives to counter the AIDS virus. Private insurance companies also cover the PrEP”, is it to remind.

In the medium term, Quebec should, however, seriously considering the option of free education, not only for the PrEP, but also for all drugs that treat HIV, according to him. “As soon as there is a cost drug, it repels people who might need it. I have seen many patients in my office who have told me they stopped the PrEP because of the price.”

A visit to the doctor that disturbs

Almost all of the patients of Dr. Thomas are gay men, but he noted that more sex workers, who are another group at risk, come to prescribe PrEP to the clinic that he directs

What rejoice Réjean Thomas, but that leaves ice Sandra Wesley-Hartman, director of Stella, an organization that defends the rights of sex workers. “Those that require the Pers are not the ones that need it the most. Never a girl in a situation of vulnerability will not go to see her doctor to ask for the PrEP in the current context.”

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Sandra Wesley-Hartman

It is that every individual who is prescribed the PrEP must meet with his doctor every three months.

“We need to ensure a follow-up to see if it works. The PrEP does not protect against other STIS, so it requires a test each time. The PrEP helped a lot of people who had not seen a doctor for years to be followed”, welcomes Réjean Thomas

Sandra Wesley-Hartman, it, is, however, the things with another eye. “The health-care system is still discriminatory with regard to sex workers. For example, when a physician sees that you have children, it will always call the DYP. It has too much to lose to go to the doctor for three months.”

Moms in many cases, those who exercise the oldest profession in the world often do so part-time to round off the end of the month. “Many work in the hospitals. With the digitization of medical records, there is nothing confidential. Everything can be to know. It means that your boss can learn that you are a sex worker.”

If some are afraid to be laid off, for others, it is downright of Canada that they are afraid of being returned. “Many are migrant women. They do not have the same rights as canadian citizens. If a customs officer or a police officer finds a box of PrEP in her purse and that he suspects to be a sex worker, it may be sufficient to find himself in front of immigration and the risk of being deported,” said Sandra Wesley-Hartman.

The other side of the pill

An issue that is so far from being a priority, and that raises other, much more important for the group that Sandra Wesley-Hartman defends. The director-general of Stella admits that if the PrEP was covered 100% by the State, the more sex workers there would agree.

They would be better armed against aids, but it’s a safe bet that most regular customers are the would also be prescribed. “They do feel more obliged to wear the condom”, anticipates it. However, the PrEP does not protect against pregnancy, hepatitis and other STBBIS.

In short, the free the PrEP could eventually prove to be a double-edged knife, for sex workers the least.

*fictitious name