The Chief Epidemiologist at the Directorate of Health has recommended the use of an anti-viral (Truvada) as a prevention for HIV.
PrEP is short for „Pre-Exposure Prophylaxis“ and by prescribing an anti-viral medication to people at risk of contracting the HIV virus Chief Epidemiologist Þórólfur Guðnason believes the spreading of HIV can be reduced further in Iceland.
„The Ministry of Welfare has received a request for allowing PrEP and asked for my comments as is protocol. In my report, I recommend allowing it but only if the usage is controlled,” Þórólfur explains.
PrEP is used as prevention for HIV infection; that is, individuals who consider themselves at risk of contracting the HIV virus, e.g. through sex, can take this medication before and after in order to prevent infection. “Research shows that this method is effective but we haven‘t had a general acceptance of this specific usage in Iceland so the Social Insurance Administration doesn‘t subsidize for it.”
The medication called Truvada comes in a tablet form and has been used in the treatment of HIV but can be used for preventive purposes as well. “This medication is already being used in Iceland in the treatment of HIV positive individuals and has recently received market authorization for preventative treatment. So I wasn’t actually recommending a new drug to be used but merely supporting its use for preventive purposes. The question is simply, who should pay for this new usage? If doctors prescribe it now to high risk, HIV negative individuals, the cost would fall upon the individuals themselves. It’s a so-called S-Category drug which means it can only be handed out in a hospital. My suggestion was to subsidize the cost for preventative usage with certain conditions: that the individuals get educated about sexually transmitted diseases other than HIV, and how to prevent becoming infected by them. Also, that PrEP has to be used correctly, for instance that individuals already being infected with HIV would not get the preventive treatment because that could make matters worse.”
„The Ministry of Welfare has received a request for allowing PrEP and asked for my comments as is protocol. In my report, I recommend allowing it but only if the usage is controlled.”
Þórólfur says that incorrect usage of PrEP could make matters worse so warns against buying the drug online and self-medicating. “If an individual uses PrEP when he or she has already contracted HIV, the virus might become resistant to the medication and that could damage further treatment. This is why I want to allow this specific usage but only under strict conditions and in a controlled environment. I know that people might be tempted to buy the drug online but if used incorrectly, PrEP can do more harm than good.”
But who would benefit from using PrEP in Iceland? “Anyone who practices in some way high risk sex, either with individuals that are HIV infected or are at risk of being infected without knowing for sure. This may also be spouses of HIV infected individuals, so it’s quite a broad group of people in all sorts of situations. If the Ministry accepts this usage then these people can ask Infectious Disease specialists at Landspitalinn hospital to prescribe the drug but they’ll have to receive education about the correct usage and about prevention of other sexually transmitted diseases.”
“I know that people might be tempted to buy the drug online but if used incorrectly, PrEP can do more harm than good.”
Do you have high hopes about stopping HIV spreading in Iceland, by taking up this preventative method? “I think this could work well along with other measures in reducing the spreading of HIV but my main concern now is other STDs. I feel people have become too complacent about them and not using the condom as much as they should so in the past few years we’ve seen syphilis and especially gonorrhoea on the rise, especially among men who have sex with men. This tells me that this particular group isn’t using the condom as much as before, possibly because they feel that the danger of becoming infected with HIV has dwindled so much, which it has. But these other STDs can still be very serious too and have grave consequences.”
Main photo: SAJ