'It's so overdue': Advocates relieved Manitoba now covering HIV prevention drug after years of pressure

Sexual and community health experts are relieved the Manitoba government has agreed to cover the cost of a drug that prevents HIV after years of reluctance to do so.

Manitoba was the only province or territory in Canada that wasn't already covering pre-exposure prophylaxis, commonly known as PrEP, before the government announced Friday that the drug has been added to the provincial formulary.

"It's so overdue," said Rusty Souleymanov, an assistant professor in the faculty of social work at the University of Manitoba. "The fact that we were remaining the only province ... it was really unacceptable."

PrEP reduces the risk of contracting HIV from sex by 99 per cent, according to the Centre for Disease Control.

Souleymanov is director of Village Lab at the U of M and co-authored a report earlier this year called The Manitoba Two-Spirit, Gay, Bisexual, and Queer Men's Health Study.

One of the recommendations from that report was that the Manitoba government cover PrEP for 2SGBQ+ men.

Souleymanov and others surveyed 365 Manitobans from those communities. One of the largest barriers to getting PrEP was cost: about 59 per cent of respondents said they couldn't afford it.

Without provincial funding or private insurance, the drug runs between $200 and $300 a month. Some anti-retroviral drugs used to treat HIV are covered and cost over $1,000 a month.

Other barriers also surfaced in the research.

Over 80 per cent reported a clear understanding of what PrEP is. That wasn't a huge surprise because gay and bisexual men have been "bombarded with info on HIV prevention," said Souleymanov.

But roughly 20 per cent didn't know much or anything about the drug. That's an issue, because gay and bisexual men, as well as Indigenous people and some other communities of colour, are over represented in the HIV epidemic, said Souleymanov.

"Now that PrEP is covered, that doesn't mean that the fight is over," he said. "We still have work remaining to do in terms of improving knowledge."

Stigma in health care

Some of those efforts to improve knowledge will have to be targeted at health-care professionals.

More than two-thirds of respondents experienced some form of discrimination in health-care settings in the previous two years.

Souleymanov said some reported their doctors had little or no knowledge of PrEP. Others experienced stigma when they asked for the prescription.

"There are lots of opportunities for doctors to have their own discomfort and bias get in the way of them becoming prescribers, and that's a barrier," said Jared Star, co-executive director of the Sexuality Education Resource Centre of Manitoba (SERC).

Star said it's important the province put resources behind educating primary care providers.

He said it's been a frustrating few years trying to persuade provincial officials to listen to the science on how effective PrEP is at curtailing a public health issue like HIV. It's also more cost effective than treating people once they have HIV, said Star.

"From a community perspective, it's a hard question to answer … 'Why wouldn't you cover this to improve the quality of our lives?'" he said. "It sends a message that the health of marginalized communities who are at risk of acquiring HIV is less important. And so this is a really big step forward."

'We're quite relieved'

Nine Circles was one of the organizations leading the charge.

As recently as last month, the health and social services agency was circulating a petition urging the government to cover PrEP.

"We're quite relieved," said executive director Mike Payne. "We've been working on this ... for a long time."

Payne said the coverage comes at a good time. The pandemic led to reductions in uptake of safer sex supplies, testing for sexually transmitted infections, educational resources and other preventive tools.

At the same time, crystal meth use spiked. And in Winnipeg, the use of injection drugs, including meth, has been a significant driver of HIV spread in recent years.

That's another reason covering PrEP now holds promise, said Payne. Emerging evidence from the CDC suggests the pill reduces the risk of getting HIV by 74 per cent among those who inject drugs.

The latest figures on HIV numbers in the province are from 2018 due in part to pandemic delays. The Public Health Agency of Canada estimated that year that there were 1,900 people in Manitoba living with HIV.

The provincial government says there were 107 new diagnoses in 2018, 119 in 2019, and 116 in 2020. As of September, about 100 new cases were identified in Manitoba this year.

Payne expects those figures to jump as a result of pandemic-related barriers to resources and a rise in mental health and addictions issues.

"That's really a challenge that we will need to face," he said. "Having resources like PrEP… having more tools in our tool kit [is] that much more important now because the complexity of the populations that we're working with is expanding."