Rise of HIV cases in N.S. prompts push for no-cost access to prevention meds

As a longtime harm reduction worker now working on a master's degree in counselling psychology, Andrew Thomas has spent a lot of time thinking about how to help people have safer sex.

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

If taken as prescribed, PrEP reduces the risk of getting HIV from sex by 99 per cent, and by at least 74 per cent for IV drug users, according to the U.S. Centers for Disease Control and Prevention.

But since the medication was officially approved for use in Canada in 2016, HIV cases in Nova Scotia have actually been trending upward — hitting a seven-year high of 33 in 2023. 

For Thomas, that's a sign the province isn't doing its job. He believes there wouldn't have been any new cases if Nova Scotia provided better access to the preventative drug. 

Nova Scotia remains one of a handful of provinces that don't offer PrEP for free to those in higher-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 accessing the drug through Pharmacare remains prohibitively expensive for many of the people most at risk of contracting HIV.

"Some people are covered with Pharmacare and they have a very low deductible, and that's fine," he said.

"And then there's just a middle group who don't have insurance through their work that can't really access it. The [Pharmacare] deductible is too high because they made too much money, but not enough money to pay for PrEP."

Thomas, who does not presently have private insurance, is in the latter category. When he went on PrEP using Nova Scotia's Family Pharmacare Plan in 2021 and 2022, he had a deductible of $827.07 and a maximum co-payment of $1,654.14, totalling $2,481.21. 

The province will cover the full cost of the drug only when the deductible and co-payment are both 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 markup — money that Thomas says many people don't have to spare, forcing them to choose between their health and paying their bills. 

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

Covering PrEP key to ending epidemic, says B.C. expert

In British Columbia, PrEP is fully covered for those in high-risk groups. Dr. Julio Montaner, the executive director and physician-in-chief at the B.C. Centre for Excellence in HIV/AIDS, has made ending the epidemic his life's work. 

He began his work in the 1980s, when an HIV diagnosis was akin to a death sentence.

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

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

"It's easy for you to say abstinence, be faithful and use condoms, but the ABCs, unfortunately, don't work so well," Montaner said.

"Biomedical interventions do work very well, and neglecting them is actually condemning people to becoming infected and suffering and to condemn society to pay a greater toll as a result."

He says covering PrEP universally for high-risk groups has proven to be highly effective in his province, especially combined with a strategy he helped pioneer known as Treatment as Prevention. 

A study completed by his team that was published in Lancet HIV earlier this year corroborated this, finding that making PrEP available to those at risk, on top of antiretroviral therapy for those who are positive, resulted in a notable decrease in new HIV cases in British Columbia.

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

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

NDP, Liberals support bill to offer universal PrEP access

In September, New Democrat MLA Lisa Lachance brought a bill to the House of Assembly that would give Nova Scotians universal access to PrEP.

"I think we wouldn't stand for this with another disease," said Lachance. 

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

"We have a miracle that we can actually address this," she said.

In an emailed statement, the Nova Scotia Liberals, who first added PrEP as an exception drug for Pharmacare while in power in 2018, said they support the bill introduced by the NDP.

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

"Our province should follow the example of other jurisdictions like Alberta and make PrEP available for 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 Department of Health and Wellness for comment before publication of this article and has yet to receive a response. 

In August, the province said it had no plans to expand coverage beyond Pharmacare, but that any future changes would consider feedback from stakeholders.

For Thomas, this push for wider 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 are able to rest easy knowing that they're protected," he said.