The increased popularity of HIV prevention system PrEP on hookup apps seems like good news for gay men and for Canada's healthcare system. But the trend is highlighting a bit of a hitch: the potentially life-saving drug program is still not approved by Health Canada.
Truvada, the revolutionary drug used in the PrEP system, is sanctioned as an effective way to treat people who are already HIV-positive. Yet the drug has also proven itself as a hugely successful way to prevent transmission, prompting doctors to prescribe it as "pre-exposure prophylaxis", aka PrEP, to people who are at risk of getting HIV. Canada's federal government, however, has yet to officially recognize this very important other purpose.
But gay men have taken note and are passing the message along. On hookup apps like Grindr and Scruff, users are mentioning PrEP under their sexual preferences or even directly within their profile names. Erstwhile Grindr user Dan Snow says it's sparking a conversation, albeit one that leads to a disappointing realization for Canadians.
"It's definitely planted the seed for me to ask my doctor," says Snow, a Toronto-based digital strategist. "But my understanding is that it's hella expensive."
That's because without Health Canada's stamp of approval, PrEP can be prohibitively pricey.
Sean Hosein, editor at HIV resource website CATIE.ca, says that in most of the country, a month's supply of the daily-dose drug can cost more than $1,000. "Every province and territory has a list of drugs they subsidize," he explains. "The Quebec government does subsidize the use of Truvada, but not the rest of Canada." La belle province's universal drug insurance plan means that insurers cannot refuse coverage of the PrEP system and so the drug is much more affordable, sometimes even free.
Since preventing HIV is not the drug's approved mandate, prescribing Truvada within the PrEP system counts as off-label use. "Because it's approved for treatment, many insurance companies can reimburse patients," Hosein says. "But some HIV negative people are saying their insurance companies stop paying once they find out the drug is being used for prevention." Snow's doctor also warned him that insurers who find out about off-label use can request a reimbursement for any amount they've covered.
"Unless you have private insurance that's willing to pay for this, or you're someone who is wealthy, most people who want or need Truvada are not getting it," Hosein says. "Point is, access to Truvada is limited."
Yet making the PrEP system available to all is more important than ever.
Snow says that for young people, HIV awareness seems to be lacking. "We're the generation that's just far enough removed from the AIDS epidemic that we've forgotten that it's still a thing." he says. And while HIV rates have remained relatively stable since 2008, "they are increasing at larger rates among men who have sex with men and yes, younger people are getting infected more," says Hosein.
According to 2011 data from the Public Health Agency of Canada, men who have sex with men are 71 times more likely than straight men to get HIV.
Hookup apps are often criticized for encouraging promiscuity, and some reports claim they're actually contributing to the hike in STI and HIV rates. Conscious of the applications' outreach powers, the companies have responded by giving PrEP more visibility within their platforms.
Last year, Grindr administrators joined forces with PrEP makers to raise awareness through in-app messaging. And last month, Scruff added PrEP to its Safety Practices drop-down menu to encourage disclosure.
Snow says subscribers have also taken it upon themselves to spread the word, and even noted one user—a healthcare worker—offering to educate men on the topic: "Using [Grindr] to get sex and as an educational tool? That's two birds!"
Hosein says this type of information-sharing is a positive step. "As news about Truvada's power in protecting people gets out, more and more people will ask about it," Hosein says. "It shows that gay men, when tools are available, are willing to use them to prevent from getting HIV, and that's a good thing."
Until PrEP is greenlit by the federal government, however, the awareness campaign can lead to frustration. Health Canada spokesperson Sean Upton says it's up to the drug company to make the first step. "The decision to seek market authorization for an expanded indication rests with the manufacturer and requires the manufacturer to submit an application to Health Canada," he told VICE. A representative from Truvada manufacturer Gilead confirmed the company had filed the necessary submission in August. Considering the standard Health Canada review period is about 300 days, this means PrEP won't be fully sanctioned until late 2016.
In the meantime, Snow says he'd like to see Gilead make their product more affordable. "The conversation will be the catalyst for change," he says. "It makes sense for the drug company to lower their price and increase their share of market, if the demand is there."
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Correction: A previous version of this article stated the price of PrEP in Quebec was $25. The drug's price's can actually vary from person to person.