The lowdown on the pill that's helping prevent HIV before it starts

In the last 30 years, the HIV pandemic has claimed the lives of more than 35 million people.  Now, thanks to global efforts to reduce deaths and prevent new infections, it seems like an HIV-free future might come sooner than anyone expected. In 2014, UNAIDS embarked on a strategy to eradicate HIV by 2030, an achievement that seems almost unthinkable twenty years ago, when deaths from the virus were at their peak.

One of the most exciting developments in the fight against HIV is pre-exposure prophylaxis, aka PrEP for short.  Approved by Health Canada in 2016, PrEP isn't a new invention, but an innovative approach to preventing the spread of the virus using existing medication. Simply put, PrEP is the daily use of the anti-HIV drug Truvada by people who don't yet have the virus. And it's incredibly effective: if used consistently and as directed, studies show it can reduce the risk of HIV transmission by between 85% and 92%.

This is an especially big deal for men who have unprotected sex with men, one of the groups at the highest risk of contracting HIV in North America. But for millions of gay and bisexual men, PrEP is more than just a medical solution. Len Tooley, a Counsellor and Public Health Research Coordinator and a PrEP user, says the drug marks the end of a dark chapter in gay and bisexual history, in which sex could mean a death sentence.

For that reason, the emergence of PrEP marks an exciting time for Toronto's gay community, says Len, and not for the reasons you might think. He sees the medication as spurring a new kind of activism to improve access to the drug: "It's a great cultural moment. For so long it was 'we have condoms, just use them and deal with it.' Now [gay and bisexual men] are finding their voices: they're engaged and excited again."

There's a lot to think about when you're deciding whether PrEP is right for you, but here are a few facts to help you get started.

How much does it cost?

PrEP isn't exactly cheap, without insurance coverage it costs anywhere from $750 per month for the generic version to about $1000 per month for Truvada. That being said some insurance plans and provincial drug plans are now starting to cover PrEP.  In Quebec, for example, PrEP is covered under the Régie de l'Assurance Maladie, and in BC Truvada is administered for free by the BC Centre for Excellence in HIV/AIDS, a research institute in Vancouver.  In Ontario, though, while the Trillium Drug Program covers the cost of Truvada for treatment of HIV, it doesn't cover it for prophylactic use, meaning many Ontarians who want to use PrEP have to pay for it out of pocket. (*Since this article was first published the Ontario Health Ministry has started covering PrEP. Generic versions for as low as $450 have also become available.)

What are the risks?

Like a lot of medications, Truvada has potential side effects like headaches and stomach upset, although they are usually only temporary. There's also the chance that PrEP will negatively affect the health of your kidneys, liver and bones, effects that should be monitored by your doctor while taking the drug.

And https://www.thestar.com/news/gta/2016/06/12/hiv-prevention-drug-truvada-fails-for-toronto-man.htmlPrEP is not completely failsafe, even when used properly. Just last year a Toronto man who had been taking it as prescribed was diagnosed with HIV. That's why doctors recommend people on PrEP continue to use condoms, not just to prevent HIV, but also to protect against the many other infections like hepatitis, gonorrhea, HPV and chlamydia.

Where can you get it?

Because being on PrEP means regularly checking in with your doctor, it's important to find a physician who is familiar with it and feels comfortable with the necessary follow up.  If you think you are at risk of HIV infection and decide to go on PrEP, you will need to have an initial appointment for screening and blood work (including an HIV test) done, and then you will have to be seen every three or so months for follow-up appointments, lab work and to renew your prescription.

Where can you find out more?

Given that it was only approved last year, finding a physician who's comfortable prescribing it can be challenging.  One good thing to do is to have as many facts as you can before you go to see someone. Start by connecting with your local sexual health clinic, or if you feel comfortable, your family doctor.  There is also a lot of great information online from organizations like CATIE and AIDS Committee of Toronto.

Miranda Elliott has a Masters in epidemiology and works in public health.