Box Turtle Bulletin
News and commentary about the anti-gay lobby“Now you must raise your children up in a world where that union of man and box turtle is on the same legal footing as man and wife…”
News and commentary about the anti-gay lobbyNovember 28th, 2015
One of the fascinating things about the use of pre-exposure prophylaxis (PrEP) as a tool for preventing the spread of HIV is that, until this week, the United States alone has supported this measure and encouraged its use.
In the US, costs are covered by all insurers (it’s seen as a preventative measure which will result in lower costs in the long run). Some regions (though certainly not all) have established funds which can take care of those without insurance, and the CDC and other private and/or public health services have committed to finding a way to get anyone who wishes to be on PrEP to be able to acquire the medication. Finally, Gilead (the manufacturer of Truvada) has established programs to cover costs. For many in the US (though certainly not all), the out of pocket cost for being on PrEP is zero.
But if you live in Canada or the UK or Sweden, PrEP is not publically available. There are clinical trials and, should you be fortunate enough to be part of the trial, your costs are covered. But otherwise, the cost is born entirely by the patient. A Canadian told me recently that he pays about $1,200 per month for his Truvada prescription.
However, this week another nation has committed to this step in the prevention of HIV transmission. (AIDSMap)
In a historic move, France has become the first country outside the USA, and the first country with a centrally-organised, reimbursable health system, to approve no-expense pre-exposure prophylaxis (PrEP) for people who need it.
The French Minister of Health, Marisol Touraine, announced today that PrEP would be available from mid-December, and reimbursable through the French health system from the beginning of January.
In addition to the daily regimen procedure, France will also support incident based prevention (two pills two hours before sex and one pill each of the next two days).
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Nathaniel
December 1st, 2015
My impression of Europe is that they are typically ahead of the curve on health care. It is shocking to see they are so far behind on this.
Jim Burroway
December 1st, 2015
Nathaniel, I think in Europe, they are way ahead of the curve when it comes to *access* to health care. Because of that access, their strategies can be different. Where everyone has access to health care, treatment as prevention (TasP), where everyone who is HIV+ has access to medication to drive viral loads to undetectable levels, becomes a much more viable prevention strategy. It’s not an ideal strategy, but it make the case for PrEP somewhat less of an immediate concern.
In the U.S., where only about 30% of those who are HIV+ are on meds ( due to a combination of not knowing their status and not having reliable access to health care or costly meds), TasP is not at all viable, which is why it’s so rarely discussed when compared to PrEP. Unfortunately, access to PrEP is also problematic as well, a situation that is probably less likely to be repeated in France.
Timothy Kincaid
December 1st, 2015
Jim,
I think that the number is that 40% are on meds and 30% are virally suppressed (undetectable). Or maybe it’s 52% on meds. Or 37%.
Because the CDC delivers data slower than a snail at the turtle races, that is based on a 2014 report which is itself based on data collected in 2011.
With such rapid changes in technology and even in health care delivery, who knows if those percentages are within shouting distance of the current numbers.
It’s. All. So. Frustrating!!
Nathaniel
December 1st, 2015
Thanks for the info, guys.
Jim, that certainly makes sense. Easy access to health care would certainly translate to more regular testing, with quicker diagnosis and treatment. Still, it is better for someone to never become infected in the first place. TasP takes the decision making out of the hands of the currently-uninfected (aside from condom use, which is only one layer of not-100% protection), and relies on the already-infected to act responsibly (i.e. taking their meds to reduce viral load, and disclosing their status regardless of load). At least with PrEP, everybody has more options for how, and to what degree, they choose to protect themselves.
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