Barriers to HIV prevention drug in N.B. 'mind-boggling'

Every year, Rob Swan makes the two-hour trip from Harvey Station to Moncton's infectious disease clinic.

He travels to the clinic to be prescribed pre-exposure prophylaxis, also known as PrEP. The medication prevents someone who is HIV-negative from contracting HIV if they come into contact with the virus through sex or intravenous drug use.

Swan is gay and says PrEP is a well-known drug that is "quite prevalent" in his community because it keeps people safe. He believes PrEP should be more accessible and better known to everyone.

"Not too many heterosexual people know about it," he said. "Why it's not being promoted by doctors to people that are sexually active, whether they be straight, gay, whatever — to me it's mind-boggling."

'One infection is too many'

Charles Furlotte, an assistant professor in the school of social work at St. Thomas University, said ideally PrEP would be available through Public Health, free of charge.

He is an advocate for equity in health care, and has conducted several research studies focused on people who are living and aging with HIV. 

"New Brunswick is trailing behind our provincial and national counterparts in terms of facilitating access to PrEP — particularly for people who lack a private insurance," he said.

According to Adam Bowie, a spokesperson for the Department of Health, a total of 13 cases of HIV were reported to Public Health in New Brunswick in 2021.

"Between 2011 and 2021 there was a total of 122 cases of HIV reported, averaging roughly 11 cases per year," Bowie said in a written statement.

Bowie went on to say that, "At this time, PrEP is not universally covered in New Brunswick."

While 13 cases in the past year may not sound like a lot to some, Furlotte argues "one infection is too many."

"Especially in the era of pre-exposure prophylaxis," he said. "Thirteen infections in a given year is quite high for this particular area."

Lack of family doctors big barrier

A one-month supply of a generic PrEP drug costs about $250. Furlotte said without health insurance, or paying to join the New Brunswick Drug Plan, it is prohibitive for many.

"There are a lot of barriers," Furlotte said. "First of all you need a healthcare practitioner who's knowledgeable and also culturally competent in working with communities that are impacted by HIV — of which we do not have a whole lot in New Brunswick."

While access is often difficult, Furlotte said there are local sexual health clinics in the province providing PrEP, as well as infectious disease physicians in Moncton, Fredericton and Saint John who will "facilitate access for their patients."

Since his visit to the Moncton infectious disease clinic in June, Swan's family doctor has closed his practice. Swan no longer has a physician to refer him to the clinic and he worries he will have trouble getting a prescription next year.

He said that is the reality for many in New Brunswick, but any excuse not to provide PrEP, "is a stupid excuse — plain and simple."

Swan said requiring patients to travel all the way to Moncton for something that should be available close to home makes no sense.

"Somebody in Edmundston might have to come all the way down here to get it. It's kind of stupid and redundant."

Jacqueline Gahagan, associate vice-president of research at Mount Saint Vincent University in Halifax, said there is a lot of "disparity" across Canada when it comes to accessing PrEP.

"There's been a push for quite some time for a national formulary that would actually say, wherever you live in Canada, these are covered by government," Gahagan said.

But even if Ottawa were to set that standard for PrEP, it's still up to provincial governments to do it.

"It could be that smaller provinces, New Brunswick for example … may say, 'No, we can't afford that. Here's our envelope of funding that we get from the feds and this is not where we're going to spend our money.'"

Without the political will to make sexual health a priority, Gahagan said many people are left without the power "to make decisions about their sexual health."

For Furlotte, it all points to the importance of making PrEP and other harm prevention drugs more accessible.

"An ounce of prevention is worth a pound of cure," he said. "There is no cure for HIV. So prevention is really our only option, which is why it has been such a game changer to prevent new infections across the country."

According to the Public Health Agency of Canada, there were 2,122 HIV diagnoses reported in 2019. Nearly 40 per cent of cases were in gay, bisexual and other men who have sex with men, 28 per cent were in heterosexual people, and 21 per cent of cases were in people who inject drugs.