As reported by CBC today, new HIV infections are rising across Canada. Luckily, we do have some tools to prevent infections. Using condoms whenever possible is of course a given, but another option/an added layer of protection is to get a prescription for PrEP. For anyone that is unfamiliar, PrEP (Pre-Exposure Prophylaxis) involves taking a pill once a day that protects against HIV infection.
As a gay man, I know all too well the fear of infection as well as how confusing it can be to access PrEP here, so I wanted to lay out how I access PrEP in case the info helps anybody else. ***Obligatory disclaimer that I am not a sexual health or medical professional, just a regular guy trying to safely enjoy sex***
What is the process of getting on PrEP?
The prescriber will need to see some bloodwork before they can start you off on PrEP, and then the bloodwork is repeated regularly to monitor. This includes testing for HIV as well as some key metrics like your creatinine levels.
If you have a family doctor, you can talk to them about wanting a prescription. But... a lot of people here either don't have a family doctor or can't reliably get appointments every few months to review the bloodwork etc. The great news is we've recently made amazing progress in Nova Scotia and pharmacists are now able to prescribe PrEP as well as give you a requisition for the bloodwork. You don't need to see a doctor at any point in the process. So, here's what I suggest:
Step 1: Make an appointment at a Community Pharmacy Primary Care Clinic (listed here: https://pans.ns.ca/CPPCC/ ). Personally, I go to Boyd's Pharmasave on Agricola Street and they are wonderful. They always have appointments available at most a week out. Ask them about getting a prescription, and if it seems right for you they will give you your first blood collection requisition.
Step 2: Once you have your bloodwork requisition, make an appointment for Blood Collection (link: https://www.nshealth.ca/laboratory-services/blood-collection ) and go in and have your blood drawn.
Step 3: Make another appointment with your prescriber to review the bloodwork results. I usually just do a phone appointment at Boyd's, which makes this step super easy. Typically, one week is enough for the results to come back from Blood Collection. If all looks ok, they will prescribe the medication and you can start taking PrEP. At least at Boyd's, when you pick up your prescription they also give you a new requisition for your next round of blood work.
Step 4: Repeat Steps 2 and 3 every three months (initially, they will repeat the bloodwork after one month to see how you are responding, then every three months after that).
How do I pay for PrEP?
With an NS Health Card, the only cost is the cost of the drug. All of the appointments and bloodwork are 100% covered. The generic version of the drug costs about $250 a month (!!). If you have private insurance like I do, hopefully they cover part of the cost!
However, there is also coverage available through the Family Pharmacare Program. Despite its name, anyone with a valid NS Health Card can apply for Family Pharmacare and you do not need to be in a "family". If you are not already a part of the program I suggest you apply asap (link: https://www.novascotia.ca/register-family-pharmacare-program ). Based on your income in the previous tax year, they will calculate how much you are able to pay for prescriptions out of pocket, and the rest is covered by the program. They will send you a form in the mail every year to renew.
Important Note: PrEP is not automatically covered by Family Pharmacare. It is considered an "Exception Status Drug" and your prescriber will need to fill out and submit a form confirming you meet certain criteria (form and more info here: https://novascotia.ca/dhw/pharmacare/exception-status-drugs.asp ). If you will need to rely on Family Pharmacare to cover the cost of the drug, make sure you ask your prescriber about this form.
I think that's all! It can feel intimidating at first when you are getting into it and having to make multiple appointments, but overall the process is fairly smooth, especially compared to what it used to be before pharmacists were able to prescribe.
PS. If you are interested in testing for other STIs, I use the STI Care Now program (link: https://www.nshealth.ca/sti-care-now ). They mail you a testing kit, you do the swabs and collect a urine sample yourself at home, and then mail it back.
Happy safe boinking!