Fight against HIV/AIDS | An effective drug, but not always accessible

A 120% increase in new HIV infections in Montreal is prompting Public Health to launch an awareness campaign. However, PrEP can prevent HIV infection. But what is PrEP?

Who can take “PrEP”?

Pre-exposure prophylaxis (PrEP) is a medication composed of antivirals (anti-HIV) intended for HIV-negative people.

It can prevent up to 97% of HIV infections if exposed¹.

PrEP can be used daily by the most sexually active people. It can also be taken on demand. In this case, it must be taken at least two hours before risky intercourse. This is followed by two doses 24 hours later, over two days.

Although it is currently available as a prescription tablet, an injectable form is expected to be available soon.

The site maprep.org allows people who wish to do so to answer a questionnaire to find out if PrEP is a good option for them.².

Why a prevention campaign?

In 2022, Montreal recorded a significant increase of 120% in new HIV infections compared to the previous year, or 310 new cases of infection. Of these, 108 were in gay or bisexual men, compared to 80 in 2021 and 64 in 2020.

New Montreal cases in 2022 represent 74% of new cases in Quebec.

In addition, less than half of people eligible for PrEP do not take it. All of these factors have prompted the Montreal Regional Public Health Department (DRSP) to launch a prevention campaign across the island of Montreal this Thursday.

“We try to talk to people who don’t feel at risk for HIV,” explains Dr.^r Julian Gitelman, medical director of the Sexually Transmitted and Blood-Borne Infections Service at the DRSP in Montreal. “We hope that this will create conversations between friends or with your doctor to find out if you are eligible.”

The D^r Gitelman helped develop the campaign and hopes to raise awareness among people who may not feel they are affected.

“People don’t know that PrEP is very effective and if taken regularly or as prescribed, it prevents almost all transmission,” he says.

This campaign was developed in partnership with the HIV/AIDS Portal, REZO, GAP-VIES, ACCM, SIDEP+ and the Quartier Latin urban medical clinic.

Is PrEP accessible?

PrEP can be obtained from your family doctor, but also from a sexual health clinic.³.

However, several barriers limit its accessibility, starting with its cost. It costs an average of nearly $100 per month for a person covered by the RAMQ without private insurance.

For people who do not benefit from RAMQ, such as international students and temporary workers, its cost can then rise to $250 per month in the absence of private insurance.

“The biggest barrier to access is cost,” explains COCQ-Sida Executive Director Ken Monteith. “When someone has to choose between the various costs of living that have increased, buying an HIV prevention tool sometimes becomes the tool that will suffer.”

He points out that making PrEP free in England has helped increase its use and “drastically reduce” new infections.

“If we want to remove the barriers, we have to make this tool free,” explains Ken Monteith. [Mais] the government [québécois] does not answer us. […] It’s a shame, because we had better listening in the past with former governments.”

What do doctors think?

The President and CEO of the Clinique l’Actuel, Dr.^r Réjean Thomas sees thousands of people on PrEP in his establishment, the vast majority of whom are men who have sex with other men.

“The new infections we have are people who have never taken PrEP or people who stopped taking it and never started again,” says Dr.^r Thomas. [La PrEP] is much less known outside the LGBTQ2+ community.”

He deplores the ignorance and discomfort of many health professionals who refuse to prescribe this medication. Half of his patients who come for PrEP already have a family doctor.

“It’s not normal that PrEP isn’t taught to medical students,” he says. “We have people who come from Drummondville, Sherbrooke, it’s not normal that they don’t have access to PrEP in their region either.”

What does the government think?

For its part, the Ministry of Health and Social Services (MSSS) points out that Quebec was the first province to “make PrEP accessible” by allowing the RAMQ to cover part of the costs.

“There are currently no plans to reimburse 100% of the costs of HIV medications, as these are reimbursed in part by the General Drug Insurance Scheme,” adds the MSSS. “Economically vulnerable people, particularly those requiring social assistance, benefit from free medications.”

1. Consult a study published on PubMeb (in English)

2. Consult the questionnaire on the maprep.org website

3. Visit maprep.org