In 2016, Health Canada approved the use of a highly effective drug to prevent HIV transmission. Clinical studies have shown that pre-exposure prophylaxis (PrEP) reduces HIV infection in HIV-negative people by 86%. Despite this, the number of newly diagnosed HIV cases in Canada has remained stable for a decade.
The results of the Engage study—a study focused on the sexual health of gay, bisexual and other men who have sex with men—demonstrate that more action needs to be taken to make PrEP accessible to people with Not needed anymore.
Data from the Engage study, collected from February 2017 to March 2020, show an increase in the use of PrEP in the three cities where the study was conducted (Toronto, Montreal and Vancouver), with a marked increase in Vancouver. Over the course of the study, drug use increased from 14.2% to 39.3% in Montreal; 21.4% to 31.4% in Toronto; and 21.7% to 59.5% in Vancouver. Yet data collected in 2020 shows that only half (52.1%) of people who meet the criteria for PrEP prescribing have used the drug in the past six months.
“We have a wealth of data supporting the effectiveness of PrEP as an HIV prevention strategy,” says public health physician David Moore, one of the principal investigators leading the Engage study. “Now the priority is to reduce the barriers to access to PrEP, to ensure that the drug ends up in the hands of the people who are most at risk of contracting HIV. »
The cost of PrEP, which varies from province to province, is one of the major obstacles. In British Columbia, PrEP is fully paid for by the public health and drug insurance plan, people who use the drug have had to pay nothing since January 2018. British Columbia’s free program, a first in the Canada, has been accompanied by a major campaign to raise awareness of HIV and promote testing, as well as training for health professionals who work with gay, bisexual and other men who have sex with men. men. To date, there have been over 5,000 new PrEP users, 99% of whom are in this segment of the population.
In other provinces, drug costs vary. For example, in Quebec, the public drug insurance plan covers part of the cost, but patients must pay a sum of $95 per month to take PrEP continuously. In Ontario, people aged 25 and over who do not have private insurance must pay $250 per month. The much higher number of PrEP users in British Columbia suggests that full public drug plan coverage, combined with education and training of healthcare professionals, would ensure greater use of PrEP, thereby reducing the number of new HIV diagnoses.
To this end, the federal government must play its role, which is to fund community organizations. These organizations are often the first point of contact for gay, bisexual and other men who have sex with men who want to implement an HIV prevention strategy.
“We have the tools to prevent the transmission of HIV in Canada,” says Daniel Grace, a professor at the University of Toronto’s Dalla Lana School of Public Health. “We must now work to reduce multiple barriers, such as financial, social and structural barriers, so that all communities in Canada have equitable access to HIV prevention strategies and treatment. So we need a strong commitment from the federal and provincial governments to fund community organizations and make PrEP free for those who need it most. »