The Vanguardian, Issue #2: April 1999
If you are HIV-negative and you have been at risk for HIV infection within the past 72 hours, there are drugs which can reduce your chances of getting HIV.
Studies have shown that people who take anti-retroviral drugs after occupational exposure to HIV are less likely to get infected than those who don't take them. You have to start taking the drugs within 72 hours of the risk incident, and you have to stay on them for a month. This is called post-exposure prophylaxis, or PEP.
The drugs used are combinations of anti-retroviral medications, such as 3TC and d4T, which are usually prescribed only for people with HIV/AIDS. Unfortunately many people experience severe side effects from the drugs. Sometimes the side effects are bad enough to prevent people from working, and some choose to stop taking the drugs in order to avoid the side effects.
Under the current provincial guidelines, free post-exposure prophylaxis drugs are available only to people who may have been exposed to HIV at work, by accident, or through sexual assault.
People exposed to HIV through consensual sex or through injection drug use are not currently eligible for free post-exposure prophylaxis in BC or anywhere else in Canada. In such cases your doctor could prescribe these drugs for you, but you would have to pay for them yourself, at a cost of between $500 and $1000.
The San Francisco Department of Public Health recently changed their guidelines to make free PEP available to anyone who may have been exposed to HIV, regardless of the circumstances. Anyone who has unprotected sex or shares needles in San Francisco can now get PEP free of charge, provided they seek treatment within 72 hours of exposure.
There are no immediate plans to make similar changes to the guidelines in BC, but the potential cost of doing so is the subject of an abstract submitted to the Canadian Conference on HIV/AIDS Research, held in Victoria in May 1999.
Using data from the Vanguard Project and other studies, research associate Sophie Low-Beer addressed the question "What would it cost to provide post-exposure prophylaxis to gay and bisexual men who engage in high-risk sexual behaviour?" The cost of providing one month of PEP to gay and bisexual men at risk for HIV in the West End of Vancouver was estimated to be between $800,000 and $2,400,000 per year, depending on the number of times each person sought treatment.
The low end of this price range is about the same as what we currently spend in BC on PEP drugs to prevent HIV infection in people who have accidental or occupational risks. Expanding the criteria to include consensual sex among gay and bisexual men throughout the province would more than double the drug costs of the program. Nonetheless, this figure may represent only a fraction of what it would cost to provide ongoing anti-retroviral therapy to people who - without the preventative drugs - might otherwise become HIV-positive.
Watch for more debate on this controversial issue in the future.
The full text of Sophie Low-Beer's abstract is available on our web site, or by request.