British Columbia, a province known for innovative research in HIV/AIDS prevention and treatment, is now lagging. A cure for HIV may not be here, but an effective tool for significantly reducing the number of new transmissions is—and it’s time for B.C. to step up.
Pre-exposure prophylaxis, or PrEP, is medication for people who are at elevated risk for contracting HIV. PrEP prevents the virus from taking hold in the body— it’s a once-a-day pill used by gay men around the world. But in B.C., it’s out of reach for far too many.
Clinical trials and real-world settings have shown that PrEP lowers HIV rates significantly in places like London and San Francisco. The evidence shows that PrEP works.
HIV is still a reality for many gay men in British Columbia. Gay, bisexual, and other men who have sex with men (including trans and two-spirit men) make up more than 50 percent of new infections. This statistic has remained consistent for over a decade but the number of young men (aged 20 to 24) diagnosed with HIV has nearly doubled from 2012 to 2014. New infections among ethnic minority men have also increased over the past decade, now representing over a third of all cases. Young guys, Indigenous men, and men of colour are less likely to have access to PrEP.
Currently, the onus is on gay men to ask their doctors for a prescription for PrEP, which some doctors are unwilling to prescribe. Whether this is because they aren’t well-versed on the latest prevention technologies or are unwilling to acknowledge the reality that gay men need this medication, it places gay men in the unenviable position of having to seek out a new doctor for care. And if you’re not out to your doctor, forget it.
Studies have shown that as many as 80 percent of gay men would consider using PrEP if the costs weren’t prohibitive. So-called early adopters of PrEP have gone to great lengths to get access to this prevention tool, including setting up U.S. postal boxes, ordering generic pills from Asia or Africa, and then driving across the border to collect them.
While the patchwork system may be working for some, it leaves many behind, often the most marginalized in our communities. We’re calling on the provincial government to act—now.
When asked about PrEP in an interview with Xtra in January, Premier John Horgan said “Give people the medical devices that they need to protect themselves, and you’re going to reduce costs over time”. Horgan recognized that funding PrEP would be a cost-effective tool for preventing HIV.
We couldn’t agree more. A province committed to treating HIV should also commit to preventing it.
Horgan and Health Minister Adrian Dix need only look to the leadership of provinces like Quebec and Ontario, both of which now publicly fund PrEP. Progressive cities like New York City and San Francisco also make PrEP available free of charge to vulnerable populations.
Here in B.C., the financial burden is placed on individuals—and with a price tag of anywhere from $500 to $1,000 per month—only those who can afford it can access PrEP. Some private insurance providers cover it, but some plans refuse to cover PrEP. Recent estimates tell us that treating HIV costs taxpayers about $1.3 million per infection. Not only is this an issue of equity and social justice, but preventing HIV transmission by providing PrEP is the fiscally responsible thing to do.
British Columbia is committed to the elimination of HIV and AIDS. Funding pre-exposure prophylaxis for those who choose to use it will bring us one step closer to that goal.
We call on British Columbia’s new government to step up for HIV prevention and gay men’s health. We deserve access to HIV prevention strategies that work.
Premier Horgan and Health Minister Dix—we have a once in a lifetime opportunity in front of us. It’s time to act. It’s time for PrEP.
Jody Jollimore is the Managing Director of the Community-Based Research Centre for Gay Men’s Health, a national gay men’s health organization. This article first appeared in the Georgia Straight on October 30, 2017.