- Opinion: Time For Tim Houston Government To Cover High Cost Of A Daily Blue Pill That Prevents HIV/AIDS
Opinion
By Andrew Macdonald
This past week, politicians of all stripes in the NS Legislature honoured a handful of members from the gay, lesbian, bi and transgendered community. But, what’s the point of honouring gay rights in the House, when the Tim Houston government can make an anti-HIV blue pill free under MSI – that would do more than this week’s political platitudes in the Legislature?
As World AIDS Day arrives Dec. 1st, I am hoping, but not optimistic the Houston government will make this anti-HIV pill universally covered.
Two years into their government mandate and there is no talk of making this wonder drug which prevents the spread of HIV universally covered by MSI. That is sad.
I was in grade 8 when HIV/AIDS first popped up in the news headlines in 1982.
Back then in cities like Toronto and New York, it was originally called GRID. That stood for gay-related immune deficiency because originally it was contracted by gay men. Today HIV knows no such boundary; gay and straight folk can catch it.
Since the early 1980s in Nova Scotia, 800 residents of the province have contracted HIV. In 2018 alone, 25 Nova Scotians contracted the disease.
It’s almost a year since the 2022nd World Aids Day (Dec. 1). A year ago, Nova Scotia Health Minister Michelle Thompson raised a red ribbon at the Legislature. According to her own department in that news release, there were some jarring statistics:
- There are an average of 15 to 20 new HIV cases in Nova Scotia each year; by the end of August in 2022, Public Health had reported more than 20 new HIV cases
- 950 cases of HIV have been diagnosed in Nova Scotia from 1983 (when reporting began) to the end of 2021; this does not include people who were first diagnosed outside the province
- Nova Scotians can access HIV testing through primary care providers, including family doctors, nurse practitioners, walk-in clinics and Virtual Care NS
Thompson is a politician who impresses me. She is a trained nurse, and a nursing home administrator, and enjoys a lot of admiration and respect in her riding of Antigonish. She is the second health minister from Antigonish. Former MLA Randy Delorey was Liberal health minister under Stephen McNeil.
Thompson is also caring. When my 21-year-old nephew in her riding died tragically in April 2022, she attended his funeral and made a personal call to the parents of Mark Andrew MacGillivray.
So, I can testify Thompson is a very caring politico, a real people person.
But, where Thompson fails is in having spent the last two years in office without doing the right thing immediately, and putting the daily pill that prevents HIV under MSI coverage, so that the high cost of this wonder drug is universally covered.
I have spent a lifetime avoiding contracting HIV and am disease-free, but a former lover, Blair, who was not yet 40, died from the disease in 2007, and I have lost other close friends to the disease, including road builder Owen Chisholm in 1999 -a brother of John ‘Nova’ Chisholm.
Getting a regular HIV blood test is a nerve-wracking experience. Even though I have been tested for decades, each time I get a new test, there is anxiety and deep concern. Each test is nerve-racking. I had my last test this week and it too came back negative. it is a stressful test, although in practicality the only blood tests I really need to fear are diabetes and the impact of my daily cholesterol pill…And those tests came back fine and dandy.
With modern cocktail drugs, HIV illness can now be managed and treated, but not cured.
But in Canada since 2016, a prescription drug that actually prevents contracting HIV has been on the market.
Other provinces in Canada offer universal coverage for free, including here in the Maritimes where tiny Prince Edward Island offers universal coverage of this anti-HIV pill — a daily blue pill.
In recent years, Manulife Insurance began to offer life insurance to folk who have HIV. The giant insurer a couple of years ago said HIV is now a manageable disease, and that someone in their 20s who contracts the disease can expect to live into their senior years because drugs have been invented to fight the disease.
And, now there is a new one-a-day pill, PrEp (pre-exposure prophylaxis), that will actually prevent someone from getting HIV.
I never thought in my lifetime— I am nearly 56 now — that medicine would be discovered to prevent someone from getting HIV.
A modern-day invention, this Pre-Ep once-a-day blue pill prevents HIV from spreading. It costs more than $250 a month and is not covered by MSI. (Istock image).
My ever-so-friendly grocery store druggist had not heard of this pill when I asked about it in 2018. That year my pharmacist did not stock it, so new is this wonder drug.
Health Canada approved the use of PrEp in Canada in 2016, but as with any new drug, it is expensive. In fact, without health plan coverage, the pill costs $250 for a month’s supply. But that is down from just a couple of years ago when a month’s 30 doses cost a whopping $1,300.
Even with my own health plan, the extra premium would be $55 dollars a month, or over $600 a year.
In Nova Scotia’s 2021 election campaign, both the Liberals under Iain Rankin and the Gary Burrill-led NDP promised to make this drug free or provide universal coverage under MSI.
In neighbouring PEI, the anti-HIV drug is free for those on the Island who want it, as it is in several other provinces, including British Columbia.
But, Tim Houston’s health minister, Michelle Thompson, could not commit to making the wonder drug free in this province when she spoke to my reporter, Avery Mullen last fall.
In an interview at the Tory annual general meeting in October 2022, she told Mullen that making the wonder drug free is under review, but there is no sign she will place it under MSI universal coverage.
Avery asked if there is any movement to expand universal coverage, beyond the coverage in the province’s Pharmacare program.
“So part of my mandate letter (from Premier Houston) was to review the formulary, which includes Pharmacare,” said Thompson. “I certainly have heard from advocates within the communities (mainly the gay community) affected, and it is something that is important. I would say that at every budgetary year, we review what we’re able to (do). We will continue to review PrEp and our ability to provide that.”
In a follow-up question, Mullen asked if there are budgetary restraints to making it free for at-risk communities.
“There are a lot of demands on the publicly funded system for a lot of things (prescriptions), and we continue to review what we’re able to provide, and certainly, Pharmacare is one of the avenues to provide that for Nova Scotians and outside that we would have to look at what our opportunities are through the budget,” Thompson replied.
The first political party in Nova Scotia to call for this anti-HIV wonder drug to be placed under MSI and thus made universally covered was the NDP in 2018 when MLA Tammy Martin called on the Liberal government of the day to make it free.
Some provinces, including British Columbia where there is a large gay population, do offer PrEp to high-risk groups for free, as does Alberta and Saskatchewan. PEI also moved in recent years to make it free.
In Nova Scotia, former Health Minister Randy Delorey in 2018 moved to put the drug into the province’s Pharmacare program, but he did not move to make it free, despite its success in preventing HIV infection.
The wonder drug has been available in the United States since 2012, and a two-year study of 600 gay men in San Francisco who took PrEp found not one contracted HIV during the study.
The NDP’s Tammy Martin, who used to represent Cape Breton Centre told The Notebook in 2018, that if a pill was invented to eliminate diabetes or cancer, the provincial government would quickly make it available at no charge.
She argues, I think rightly, that since PrEp prevents someone from contracting HIV, the government should make this drug available free under the province’s Pharmacare program, especially since many gay millennials — 20-somethings — don’t have health plans and can’t afford the out of pocket monthly bill of $250.
Health Minister Delorey acknowledged World AIDS Day during a ceremony at Province House in 2018, but instead of announcing universal coverage in PrEp, he only offered platitudes. That is not good enough.
This past week, Thompson also participated in a ceremony Dec. 1 on World Aids Day, but again, just political platitudes, and not a word about putting the anti-HIV pill under MSI universal coverage.
Michelle Thompson, PC Health minister, should make free and place under MSI universal coverage a costly daily blue pill that prevents HIV/AIDs from spreading. (The Notebook/Avery Mullen photo).
It’s a bit too much to raise a Red Ribbon flag at Province House and offer talk without making this anti-HIV drug free for all who want it.
Here is the official statement from Minister Thompson during the 2022 WorlD AIDS Day At the NS Leg:
A red ribbon flag is flying at Province House to mark World AIDS Day today, December 1. The theme of this year’s event, chosen by the United Nations, is Equalize.
We have come a long way in addressing HIV/AIDS but there is still a lot of work to be done to end the inequities and stigma. People who are stigmatized face inequalities and discrimination that delay much-needed healthcare services for prevention, diagnosis and treatment. We cannot allow this to happen in Nova Scotia.
The province is also recognizing HIV/AIDS Awareness Week, which ends today, and Indigenous AIDS Awareness Week, which starts today. These events honour people living with HIV/AIDS and those who have lost their lives to AIDS worldwide.
As you can see from Thompson’s statements there is not a single word of making the drug that prevents HIV free under MSI. The backdrop of recognizing Dec 1 as World HIV Day, is meaningless and just political showmanship. It would have been an opportune time for Thompson and the Tim Houston government to do the right thing and make the anti-HIV pill free for all who want or need it.
Premier Tim Houston’s Tory party has a ‘diversity committee’ which includes gay men. That is an enlightened step, but it is shallow if the HIV drug is still unattainable for residents Houston governs.
If you believe the Kinsey Scale that one in 10 is gay, then a city like Halifax with a population of 400,000 has 40,000 gay or lesbian citizens.
“This is a straightforward approach to dealing with a significant public health issue,” said Tammy Martin, then the NDP’s health critic in a 2018 chat. “Nova Scotia needs to do better when it comes to HIV prevention. There is an increase in new cases in our province and this medication could help reverse that trend.”
She says evidence from other jurisdictions that have implemented universal coverage shows a significant decline in new HIV diagnoses.
Universal PrEp coverage should cost about as much as the lifetime costs of a single HIV infection, Martin added, pointing to the $1.5 million lifetime costs of treating a Nova Scotian with HIV.
Martin agrees the pill is a wonder drug. “We’re being told it is 98 per cent effective, so why aren’t we providing this to the people who need it to prevent this disease? This is important to us as the NDP, it is important to the people we represent, and it is important to the people who need the drug—and we will push for this drug to be universally offered.”
Martin was another who did not think a drug to prevent HIV infection would be discovered in her lifetime, and asks, “As with any new drug if we can eliminate such a terrible, terrible disease why aren’t we doing that.”
Matthew Numer, Ph.D. associate professor & head, the Division of Health Promotion School of Health and Human Performance at Dalhousie University, said in 2018 the Liberal McNeil government had stopped taking his emails and calls on his very public advocacy that a relatively new anti-HIV drug be made universally available in Nova Scotia.
Although Health Canada approved the retail sale of the pill in this country in 2016, he says neither Premier McNeil nor Health and Wellness Minister Randy Delorey nor their bureaucrats responded to his campaign to make a daily pill, which can prevent HIV infection, free of charge.
“More provinces have come on board to offer universal access, including Alberta and Prince Edward Island bringing the total to six. We know from the example in British Columbia that government-funded PrEP programs can help people access this prevention tool and reduce HIV transmission,” he said
“The price of PrEP medications can vary based on negotiated agreements. The maximum cost of PrEP prescription for one person would be $150. If Nova Scotia covered the costs for 800 people, the total cost of prescription drugs would be $1.4 million. That’s assuming that the province could not negotiate a lower rate; other jurisdictions are paying as low as $60 month (which would be $576,000 for 800 people for one year),” says the Dal prof.
“In Nova Scotia, there were 32 new cases of HIV in 2018. Each new HIV infection costs our economy $1.3 million over the person’s lifespan; including health care ($250,000), reduced labour productivity ($670,000), and quality of life impact ($380,000).
“A single case of HIV potentially has greater financial impact than funding an entire PrEP program for the entire province for one year,” says Numer. “We know making PrEP universally available will prevent HIV transmission, improve public health, and reduce the financial impacts of HIV transmissions in our province,” he added.
Numer says he became an HIV researcher because he is gay and has lost friends to the disease.
“For each new case of HIV, we estimate a cost of $1.3 million lifetime costs…Last year, we doubled the number of cases, so we are looking at adding $20 million in healthcare costs over the course of these peoples’ lives,” he notes.
“Instead, we could cover the entire program for less than $1.5 million (if the drug was made free in NS) annually.
HIV- human immunodeficiency virus – is a virus that attacks the body’s immune system.
While other provinces provide the pill under universal medical care, in Nova Scotia the pill is not covered by MSI and for the vast majority of Nova Scotians, the pill is unattainable.
Only those privileged to have a health plan have the drug paid for. That includes Nova Scotia civil servants and MLAs.
