Handing out preventive HIV pills cheaper than treatment for life

The main proponent of an HIV-awareness pressure group is insisting that dispensing the preventive HIV pill PrEP on the government formulary, is cheaper than treating HIV patients for life.

Lawyer and PrEPing Malta activist Mark Josef Rapa is lobbying for the introduction of a preventive HIV pill on Malta’s national formulary. PrEP – a pre-exposure prophylaxis pill – is known to be a very effective preventive HIV treatment, yet although its introduction was proposed in the government’s LGBTIQ Action Plan 2018-2019, there was no further dialogue on the issue.

But Superintendent of Public Health Charmaine Gauci confirmed that PrEP is being considered as a solution, as part of the government’s HIV strategy and preventive treatment.

“PrEP is not on the national formulary but clinicians at the Genitorurinary clinic issue prescriptions where indicated. We are working on an HIV strategy as well and preventive treatment is being looked into. Preventive treatment will look into PrEP and treating HIV cases so they won’t be infectious,” Gauci told MaltaToday.

A health ministry spokesperson pointed out the need for PrEP to be ingested daily to be highly effective in preventing HIV. “PrEP is much less effective when it is not taken consistently [but] studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.”

According to the spokesperson, PrEP is available from some community pharmacies at a cost of around €43 for a monthly supply.

Rapa told MaltaToday that though it is not exactly the branded PrEP that is available in a handful of pharmacies, the generic unbranded pills are still as effective.

The Emtricitabine Disoproxil has been available since May 2019 in 13 pharmacies across Malta for the price of €56.70 per box, which includes 30 tablets.

“We have long argued that the price tag creates a barrier for several people who would benefit from using PrEP. PrEP should be made available on the national formulary not only because it is a matter of public health but because it is cost effective… prevention is better – and cheaper – than cure,” Rapa said.

Rapa heavily criticised a recent Times of Malta article which quoted an interviewee who said that there was a direct correlation between HIV diagnoses in gay men and chemsex parties.

Chemsex parties involve drug-fuelled sex which can last for days, the article reads, and is linked to an increase in HIV cases among gay men.

“Let’s be clear. Our issue is not with the experience of the person interviewed but with the write-up… two thumbs down for the reporting. It relied exclusively on the experience of one individual… and MGRM, we were told via correspondence with the NGO, were misquoted.

“Scientific and medical-related articles should be based on facts. Anything else can fuel stigma and discrimination. HIV is already a heavily-stigmatised field. For long, people have been uncomfortable to get tested for HIV and other STIs,” Rapa said.

In the various countries that it has been introduced, PrEP has led to a significant decrease in new HIV diagnoses. The most recent data comes from the Australian Sexual Health and HIV ASHM Conference (September 2019) where it’s been reported that in Australia there has been a drop of 13.5% in HIV diagnoses in 2018 alone.

In New Zealand, where PrEP is subsidised, the new HIV infections in gay and bisexual men dropped by 39% between 2016 and 2018. In Malta, on the other hand, the number of new HIV diagnoses are on the rise by over 50% since 2017 according to a 2018 World Health Organisation report.

In Malta, PrEP is only dispensed against a prescription by specialists, Rapa said. One can obtain such a prescription from the GU clinic. Even when purchased online, the medication will get stuck at Customs unless one presents a prescription for the medication.

Rapa even criticised the government for including PrEP as part of a series of proposals within the LGBTIQ Action Plan 2018-2022, claiming that such an HIV treatment merits its own action and that lumping it amongst a series of proposals would banish it to concealment.

“The government recently missed another opportunity when it launched a tender for the supply of antiretroviral drugs without any mention of PrEP. The combination of the two drugs found in PrEP is also found in ARVs,” Rapa said.

He added that comparing and competing against the availability of treatment for other diseases should never be on the agenda of any advocacy or lobby group and that such a methodology is ineffective and counterproductive.

“It is a trap set by governments and tabloids to avoid a mature discussion. The availability of generics on the market makes PrEP cheaper for the government to purchase… making PrEP available remains cheaper than treating someone for HIV for life,” Rapa said.

UNAIDS says that, globally, 36.9 million adults are living with HIV, more than half (18.6 million) of them being women over 15 years of age and 1.8 million of whom are children.

In Malta, Mrabat Pharmacy, St Paul’s Pharmacy, Tarxien Pharmacy, St Mary’s Pharmacy in Attard, St James Pharmacy in Sliema, Stella Maris Pharmacy in Sliema, Remedies on Manwel Dimech Street in Sliema, Regal Pharmacy in Msida, Regional Pharmacy in Msida, Milia’s Pharmacy in Birgu and Zurrieq, Castle Pharmacy in Gozo and Anici Pharmacy in Qormi all supply unbranded PrEP against a prescription.