Most of us know the Oscar-winning film Dallas Buyers Club was based on a true story of a man importing HIV drugs. It turns out the movie also inspired another true story here in Canada.
Alex Smith launched the site Davie Buyers Club back in 2016 anonymously—and for good reason. Smith's site offers up-to-date information for gay and bisexual Canadian men on how to import generic FDA-approved pre-exposure prophylaxis, or PrEP, from foreign pharmacies in Asia via the United States. PrEP is a once-a-day pill proven to prevent the transmission of HIV by up to 99 percent with adherence but can cost $1,000 per month for the original brand, Truvada. Imported generics go for about $45 per month and several have been approved by Health Canada, yet it's prohibited to import generic PrEP or any other medication into the country by mail or courier. It is legal, however, to bring a 90-day supply across the US border in person with a valid prescription—a process Smith has clearly outlined on his site because those same importation laws don't exist down south.
Smith works as a registered nurse by day, and he didn't want the regulatory body that governs his profession to confuse the information provided on his site as being the recommendation by a healthcare provider that Canadians should cross the US border to pick-up drugs purchased through the internet from places like India and Thailand. He was also concerned that they wouldn't believe that he maintained a boundary between his advocacy in his personal life and his professional responsibilities. It might've led to disciplinary action or, worse, him losing his job. It was easier to remain anonymous.
After running the site for over a year, he contacted me because he's finally decided to "come out" about what he's been up to. His identity was going to be revealed anyway because he was continuing his education and included this experience on his application, but he also believes strongly in this option and stands by the work he's done. He's received such overwhelming support and acceptance that he's not worried.
"Just the sheer number of people that have been helped by it, I don't think that they could say that it was a negative or unprofessional thing to do and I also think because of that sort of mainstream healthcare buy-in that there would be, you know, some powerful people who would come to my defense if it came to that."
When we first started to talk, I was surprised to learn that Smith was actually not on PrEP himself. What's more surprising is that he's not gay or bisexual either, despite the name Davie Buyers Club referencing Vancouver's gay district. Which raises the question: Why would some straight dude living in Calgary care so much about PrEP that he'd be willing to put his career on the line?
Despite the fact that PrEP could've theoretically prevented most of the 2,570 new HIV diagnoses in Canada in 2014 (research has shown its effectiveness since 2012, so it could've prevented much more), it's a difficult drug to access in this country because of its high cost. With exception to Quebec, the only other way to get it without paying the hefty fee is through third-party health insurance. Even though some generics have been approved in Canada, they're still $250 per month at the very least in Ontario ($750 at most), which isn't affordable for many.
Prior to launching the site, Smith had been working at a community based HIV/STI testing clinic for men who have sex with men (MSM) in Vancouver. During his tenure, he was asked many questions about PrEP by his patients. "We had conversations about their risk and about PrEP and many of these men were, you know, pleading with me for access to PrEP. But [because of] the lack of a public program or the right insurance policy I was sort of powerless to help them with that request," he told me from his Calgary home.
"I recalled one young man in particular who was diagnosed with HIV within six months of having this conversation with me. So seeing that PrEP would've been an effective option for him, it would've been an acceptable option for him, but because it was not available he seroconverted." Seroconversion is the period in when one develops HIV antibodies after being infected.
Smith was troubled by this particular incident and others like it, so he began thinking of creative ways to help similar patients in an effort to curb infections in Vancouver and the rest of Canada, and ease his "moral distress," as he described it. He remembers seeing a presentation on how one can import generics for a fraction of the cost so he did a lot of research on the safety and efficacy of those drugs, which were FDA approved, and had a couple of friends do trial runs to the US. Since he couldn't share this information with his patients at the clinic (it was a line he always drew for himself), he created the site instead hoping that his high risk clients would find their way to it. Not only does he update the website regularly and answer questions, but in some cases he'll track shipments for people who are having issues with their order.
This method requires crossing the border every three months so it's not the most ideal way to get access. That said, since launching the site last year, he's helped approximately 200 people access generic PrEP, many of whom are in metro Vancouver. He's also had about half a dozen former patients reach out with questions or seeking assistance in accessing generics—patients he'd had conversations about PrEP with when he worked at the clinic in Vancouver.
Smith's site has also been promoted by major MSM health organizations, such as the Health Initiative for Men (HIM) in Vancouver. He's worked with the Gay Men's Sexual Health Alliance (GMSH) in Toronto too who emulated the importation model outlined on his site to spread the word.
"Healthcare providers are, I think, very grateful to have an option for their clients because a lot of them, like me, were distressed that, you know, they were identifying and talking to clients who could benefit from PrEP but they had no options for them. So now, although it's not the perfect option, there is an option and I think providers are happy to have something."
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