Some provinces offer free preventive HIV drug coverage. Quebec should join, say advocates

The shipping container turned STI and HIV testing clinic, known at the Zone Rose, has reopened for its second season in the heart of Montreal's Gay Village.

But although the site's popularity is growing, the executive director of the organization behind it, RÉZO, says something is still missing: free access to HIV preventive medication pre-exposure prophylaxis, or PrEP. 

Alexandre Dumont Blais says he wants to see Montreal join other jurisdictions in offering the medication for free, especially as the rate of HIV diagnosis is on the rise across the country. In 2022, HIV cases in Montreal jumped 120 per cent, according to the city's public health agency. 

The pill is a medication taken by those who are HIV-negative but at risk of exposure to HIV.

"In a housing crisis, in an inflation situation, sometimes people who are at risk do not take PrEP because of a budget question," said Dumont Blais.

"The new statistics remind the importance of checking what strategies we have on the table and where we can put more energy to increase these strategies."

People covered under Quebec's public health insurance plan, RAMQ, or by a private insurer can pay between $70 and $100 per month if they take the medication every day. However, uninsured individuals can see that amount climb to $250, said Dumont Blais. 

Lack of awareness among doctors an issue

HIV specialist and physician Dr. Réjean Thomas adds that access to private coverage doesn't always mean someone is going to feel comfortable enough to resort to the family plan and submit a claim for PrEP.

Aside from the price tag, Thomas, who is also the president and co-founder of the medical clinic l'Actuel, says there are other barriers to access that have driven people from as far as Chicoutimi, Que., to the Montreal clinic to obtain the pill.

Of the "thousands" of patients registered with the clinic who are on PrEP, 50 per cent have a family doctor that has refused to prescribe the medication simply out of ignorance, if not discomfort, said Thomas.

"It's not very well known in the medical community. It's not very well known among pharmacists or just generally outside the gay community," he said. 

"The issue of talking sex with [a] family doctor is a real issue.… It's still a subject that's difficult in 2024."

For Dumont Blais, the solution lies in the creation of a provincewide program offering the pill for free, at least to vulnerable members of the population such as those who are newly arrived to the country. 

Provinces such as Alberta, British Columbia and Saskatchewan offer the medication for free under their provincial health insurance for at-risk individuals. Further to the east, Ontario offers it to people 24 and under who aren't already covered by a private insurance plan, a move replicated by Manitoba just recently.

Thomas says it's a matter of priorities; someone who contracts HIV can undergo treatment for decades which ultimately comes at a greater cost to society than a co-ordinated provincial prevention campaign. 

"It's always better to prevent than to cure — you cannot cure AIDS," said Thomas.

In a statement to CBC News, a spokesperson for the Quebec Health Ministry emphasized that Quebec was the first province to authorize PrEP and that the drug's been covered under RAMQ since the beginning. Plus, Quebec pharmacists can prescribe the pill, widening its accessibility. 

"There are no plans to reimburse 100 per cent of the costs for medication against HIV," wrote ministry communications director Francis Martel. 

He added there are generic versions of the drug that are also available at a lower cost.