PrEP stands for Pre-Exposure Prophylaxis, an anti-viral drug used to prevent HIV infection in individuals at high risk.

Icelanders get free PrEP in the fight against HIV

Icelandic Health Authorities have agreed to subsidize PrEP treatments in Iceland so those who practice high risk sex can now get free medication to prevent HIV infections. This could reduce the frequency of all sexually transmitted diseases in Iceland, says an expert.

Bryndsis Sigurdardottir, infectious disease specialist at Landspitalinn.

“I‘m very happy about this, I‘ve been following this project since 2012 when PrEP was accepted by the FDA (Food and Drug Administration in USA),“ says Bryndis Sigurdardottir, infectious disease specialist at Landspitalinn.

But what is PrEP, exactly? “It’s called Truvada on daily basis but it’s actually two types of HIV medication combined in one tablet. It’s been used for about 19 years, as part of a HIV treatment but never on its own until about a decade ago when scientists started wondering whether it was possible to prevent HIV infection with medication. The idea was that if you already had a HIV virus medication in your bloodstream, the actual virus wouldn’t be able to settle in the body. And that was indeed the case so health authorities in the US allowed Truvada to be used for that purpose but it was very controversial to begin with and a slow process for doctors, and men in risk of infection, to understand this treatment and start using it.”

“…people speak to a specialized nurse who assesses them for a PrEP treatment, carries out blood tests and informs them about the usage of the drug and the treatment.”

Bryndis explains that all US studies show that PrEP treatment works. “That is, a daily intake of this drug can reduce the risk of HIV infection by 90% or more – within the group at high risk of sexually acquired HIV infection. That’s people who practice anal sex, don’t use condoms and have multiple sexual partners. So, we hand-pick those who are eligible for PrEP treatment.”

The EMA (European Medicines Association) gave the green light on PrEP treatments in 2016 and since then, Bryndis and her colleagues have been keeping a close eye on developments in the neighbouring countries such as France, Scotland, Norway, Belgium and Portugal, but the NHS in England was a bit slower on the uptake.

“Which is surprising because the biggest study carried out on PrEP was conducted in Britain,” says Bryndis. She’s talking about the recent PROUD study which shows without a doubt that pre-exposure prophylaxis is highly protective. “However, British men simply found an alternative way of accessing Truvada and started PrEP treatment anyways, with the assistance of health staff. And the result was that last year, the frequency of HIV infections had gone down in London, and the explanation was that men were buying Truvada online and using PrEP.”

Therefore, Bryndis and her colleagues in Iceland began offering Icelandic men to assist them if they were purchasing Truvada online. They were able to get an assessment at the Infectious Disease Ward in Landspitalinn and be tested for HIV and other sexually transmitted diseases regularly even though they were buying the drug from abroad – as it wasn’t subsidized by Icelandic health authorities. Up until now, a handful of men in Iceland have taken advantage of their service but with a green light from the Icelandic Medicine Pricing and Reimbursement Committee, Truvada is now available to them for free so it is expected that more people will seek starting PrEP treatment in the nearest future.

“People can just call the clinic on 824 5857 between 8am and 4pm on weekdays and book an appointment. On their first visit they speak to a specialized nurse who assesses them for a PrEP treatment, carries out blood tests and informs them about the usage of the drug and the treatment. We don’t want people to use PrEP if there’s a risk of them recently having been infected by HIV already because Truvada only works as treatment if part of the so-called cocktail of HIV drugs. Truvada is taken once a day, just one tablet with food either in the morning or evening and the only real side effect is a bit of nausea for the first few days which then wears off.”

She says that even though Icelandic health authorities have been successful at detecting HIV infections and start treatments early, Icelandic men are not practicing very safe sex in general. “Those who have gone through our assessments are actually scoring very high, at high risk, so there are definitely many men here who are eligible for PrEP.”

That’s actually not so different from other Western countries, Bryndis explains. “Sadly, in Europe and the US where people have access to a good health care system, the one group where HIV infections have been going up in numbers are men who have sex with other men (MSM). In contrast, HIV infections have been going down in Africa and developing countries where men and women have been getting infected equally and been at equal risk, where there wasn’t much access to HIV medication some years ago. Thankfully, there’s been an enormous turn-around there in the last five years.”

But instead, people in Western countries have become less scared of HIV infections and are not as careful of practising safe sex, e.g. using condoms. “Unfortunately, in this particular group MSM, the number of HIV infections are growing. People aren’t using condoms as much but obviously, the condom also protects you from chlamydia, gonorrhoea and other STDs, and those cases have also been going up.”

“… it is more likely that the side effect of PrEP treatment is that the frequency of other STDs will go down – it totally makes sense if you think about it.”

Bryndis says that it’s harder to make people change their sexual behaviour than just help them find a way to prevent getting infected by HIV while practicing high risk sex. But isn’t it a concern that the usage of PrEP will simply make people stop using condoms altogether and increase the frequency of other sexually transmitted diseases?

“That’s a very good question and this was often used as argument when debating about whether or not we should allow PrEP treatments. But here’s my answer: I can cure chlamydia and gonorrhoea and what have you. I can’t cure HIV. And because those on PrEP are required to get tested every three months, those men who are getting other STDs will be detected sooner and treated right away. So it is more likely that the side effect of PrEP treatment is that the frequency of other STDs will go down – it totally makes sense if you think about it.

If you are a man who has sex with other men and you come in for a PrEP check-up every three months, you’re basically being monitored and treated for all STDs we possibly can. So, in my opinion, we’ll get an even better control of STDs by using PrEP.”

See also: “I was basically just tired of worrying all the time about getting infected.”

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