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Nova Scotia government adds HIV prevention drug to pharmacare program

HALIFAX — The Nova Scotia government said Friday that it will add a drug that helps prevent HIV to the provincial pharmacare program, though some activists are still calling on the province to provide universal funding.

Pre-exposure prophylaxis — often referred to as PrEP — can be taken daily by people who are at a high-risk for HIV infection, like men who have sex with men or people who inject drugs.

The announcement comes days after health officials reported a significant increase in the number of new HIV infections in the province so far this year.

But Dr. Robert Strang, Nova Scotia's chief medical officer of health, said it's been in the works for months.

"We certainly recognize that this is a first step in increasing access and removing financial barriers to PrEP, that there are still many financial and other barriers that remain," said Strang Friday.

Strang says the eligibility criteria will be based on national guidelines and recommendations from the Canadian Drug Expert Committee. The amount of coverage provided would be based on which pharmacare program patients fall under and what their income is.

"We know that affordability of medications is a substantive issue across this country and that's why there is a national conversation about a national approach to pharmacare coverage," said Strang.

"I think we need to acknowledge that there are many groups out there who do have challenges with affording medication and we have to look at all those and do the best we can with the resources we have available."

Without coverage, the medication can cost around $400 a month in Nova Scotia.

Strang said PrEP is covered in many third-party drug plans, and around two thirds of Nova Scotians are covered under such plans.

The announcement was met with mixed reactions from a Nova Scotia AIDS researcher and activist, who said much work is left to be done.

"The reality of this measure is, in public health outcomes in the coming months, it will have very little impact on HIV cases," said Matthew Numer, assistant professor in the School of Health and Human Performance at Dalhousie University in Halifax.

"We need universal access to PrEP in order to really put our effort toward curbing this epidemic."

British Columbia, Quebec and Saskatchewan publicly fund PrEP, and the drug is also subsidized by some Ontario drug plans.

Numer, who is also chairman of the PrEP Action Committee in Nova Scotia, said increased PrEP availability in San Francisco led to a nearly 50 per cent decrease in diagnosed HIV cases in the California city since 2012.

Strang estimates adding PrEP to the provincial health care plan would cost around $300,000 a year, though Numer said publicly funding the medication would ultimately cost the province less.

According to the Canadian AIDS Society, each new HIV infection costs $1.3 million over the course of the individual's lifetime in health care, reduced productivity and other factors.

In the first six months of 2018, the province recorded approximately 16 new cases of HIV — a number usually seen over the course of a year.

Numer said that could mean 16 diagnosed cases in 2018 so far will end up costing the province $20.8 million.

"(Covering PrEP) not only makes social justice sense, but it makes economic sense for the health care system," said Numer.

He added that access to the medication is an important issue for him as a gay man and a user of PrEP.

"I've had friends, lovers, people that I've known contract HIV, and until you experience that I don't think you really know what it's like," he said. "It's life-changing for people."

The AIDS Coalition of Nova Scotia said they were encouraged by Friday's announcement, though it would like to see greater access for the medication.

Chris Aucoin, the group's health co-ordinator, said the province needs to address groups less likely to seek pharmacare, including homeless people, drug users and sex workers.

"Some of the most at-risk groups are people who have limited means and limited capacity to go through red tape to get access to things like pharmacare," said Aucoin.

"Just saying it's now covered isn't the solution that we're looking for. It needs to be simpler. Access needs to be easier than that."

About 75,000 people in Canada have HIV, according to the Canadian AIDS Society. The Public Health Agency of Canada said there were 2,344 new HIV infections in Canada in 2016, an 11.6 per cent increase from 2015.

Alex Cooke, The Canadian Press

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