As the number of HIV cases increases, NS politicians and advocates are pushing for free access to prevention drugs

Andrew Thomas has been working in harm reduction for many years and is now working on a master’s degree in counseling psychology. He has spent a lot of time thinking about how he can help people have safer sex.

But he’s frustrated because PrEP (pre-exposure prophylaxis), a prescription drug that dramatically reduces the chance of HIV infection, isn’t fully covered for many of the people who need it most — including himself.

According to the U.S. Centers for Disease Control and Prevention, when taken as prescribed, PrEP reduces the risk of acquiring HIV through sex by 99 percent, and by at least 74 percent for intravenous drug users.

But since the drug was officially approved for use in Canada in 2016, In fact, HIV cases in Nova Scotia are on an upward trend – reaching a seven-year high of 33 in 2023.

For Thomas, this is a sign that the province is not doing its job. He believes there would have been no new cases if Nova Scotia had provided better access to the preventive drug.

Nova Scotia remains one of the few provinces that does not offer PrEP for free to people in at-risk groups, including men who have sex with men, IV drug users and transgender women.

PrEP is covered by many private insurance plans and is listed as an exception drug in Nova Scotia’s Pharmacare program, but Thomas says access to the drug through Pharmacare remains unaffordable for many of the people most at risk of contracting HIV.

“Some people are insured with Pharmacare and have very low deductibles, and that’s fine,” he said.

“And then there is only a middle group that does not have insurance through their work and cannot actually access it. The (Pharmacare) deductible is too high because they made too much money, but not enough money to pay for PrEP.”

Thomas, who currently has no private insurance, falls into the latter category. When he took PrEP with Nova Scotia’s Family Pharmacare Plan in 2021 and 2022, he had a deductible of $827.07 and a maximum copayment of $1,654.14, which totaled $2,481.21.

The province will only reimburse the full cost of the medicine if the deductible and co-payment have both been paid in full.

For those not on Pharmacare, the price of emtricitabine/tenofovir (the only generic version of PrEP on the market) would be more than $2,800 per year before any drugstore surcharges – money that Thomas says many people won’t miss, leaving they are forced to choose between their health and paying their bills.

Although he previously paid some of the cost for the drug out of pocket, Thomas said he can no longer afford to use PrEP.

Treating PrEP is key to ending epidemic, says BC expert

In British Columbia, PrEP is fully covered for people in high-risk groups. Dr. Julio Montaner, executive director and chief physician of the BC Center for Excellence in HIV/AIDS, has made ending the epidemic his life’s work.

He started his work in the 1980s, when an HIV diagnosis seemed like a death sentence.

By 1996, Montaner had played a crucial role in the development of antiretroviral therapy, a treatment that turned the virus into a manageable condition that allowed people to live long and fruitful lives after their diagnosis.

He says it is inexcusable in 2024 that HIV cases continue to rise in some provinces, including Nova Scotia, now that resources are available to end the epidemic.

“It’s easy for you to say abstinence, be faithful and use condoms, but unfortunately the ABCs don’t work very well,” Montaner said.

“Biomedical interventions work very well, and if you neglect them you are essentially condemning people to infection and suffering, and condemning society to pay a greater price as a result.”

He says universal PrEP treatment for at-risk groups in his province has proven highly effective, especially when combined with a strategy he helped pioneer known as Treatment as Prevention.

A study completed by his team which was published earlier this year in Lancet HIV confirmed this and found that making PrEP available to people at risk, in addition to antiretroviral therapy for those who are positive, resulted in a notable decrease in the number of new HIV cases in British Columbia.

As Montaner explains, if someone is HIV-positive and receives antiretroviral therapy, it is common for the amount of HIV in their blood to decrease to the point where they have an undetectable viral load, thus preventing the spread of the virus through sexual activity .

Treating PrEP also makes economic sense, he said, because preventing new HIV infections is much cheaper than treating people with HIV for the rest of their lives.

NDP, Liberals back bill to offer universal PrEP access

In September, New Democrat MLA Lisa Lachance brought a bill to the House of Representatives that would give Nova Scotians universal access to PrEP. But it still needs a second reading.

“I don’t think we would be able to sustain this with any other disease,” Lachance said.

Lachance lived through the height of the AIDS crisis, but says some of the stigma associated with HIV still lingers, especially because many of those affected come from marginalized groups.

“It’s a miracle that we can actually address this,” she said.

In an emailed statement, the Nova Scotia Liberals said, which PrEP was first added as an exception drug for Pharmacare while in power in 2018, they said they supported the NDP bill.

“We know that access to PrEP is an important part of protecting Nova Scotians and saving healthcare resources,” the party said.

“Our province must follow the lead of other jurisdictions like Alberta and make PrEP available to Nova Scotians at no cost.”

Better coverage has long been advocated by the Health Equity Alliance of Nova Scotia, the organization formerly known as the AIDS Coalition of Nova Scotia.

CBC News reached out to the province’s Ministry of Health and Wellness for comment before publishing this article and has not yet received a response.

In August, the province said it had no plans to expand coverage beyond Pharmacare, but that was not the case Any future changes will take into account stakeholder feedback.

For Thomas, this push for broader access to PrEP isn’t just about economics or public health outcomes.

Being able to take PrEP would give him and others peace of mind: the ability to have sex without fear.

“People can rest easy knowing they are protected,” he said.