Finally some discussion on PrEP in Ireland

newacc2015

I went to the GMHS for a regular check up. I was handed a survey and asked if I wanted to fill it. It about 30 questions such as Age, sexual preference, condom use, what I use PrEP, what I would pay for it monthly etc.

Although it said on the survey there was no real discussions on introducing PrEP in Ireland and no funding has been made available yet. Either the GMHS or HSE wanted to gauge interest on making PrEP available. The cost will be a massive barrier to its introduction. But it will be off patient in the EU in a few years.

There is massive discussions on PrEP in the US. But its completely ignored in Ireland. We obviously have lower rates than the US for HIV. But there is still a sizeable amount of high risk individuals who never use condoms despite being told to(this will never change, so there is no point discussing this). PrEP is an excellent HIV prevention strategy for these people.

bob50

Hi Just reading your note about PrEP availbility in Ireland

I really do hope the HSE offer this preventantive drug here I was reading that the NHS in England were sizing up offering this £5000 stg per anaum per patient as against treating someone who was HIV+

As you say Prep is cominng off patent soon so it should make the drug cheaper

No matter what people say about using a condom there are too many people still having sex without a condom

bodice ripper

Sounds like a dreadful idea. Another excuse to not use a condom. What about hep? What about another novel, fatal infection?

L1011

bodice ripper wrote: »

Sounds like a dreadful idea. Another excuse to not use a condom. What about hep? What about another novel, fatal infection?

Its primarily intended for people who have already long since decided they're not going to use condoms.

Hep A and B are vaccinatable against, Hep C is not often sexually transmitted and is now approaching 99% curability for the common varients in this part of the world.

The biggest concerns as goes other infections are antibiotic resistant strains of other STIs, many of which can be transmitted even with perfect condom use.

bodice ripper

Well, so long as they have already decided. I'd like to use a roll eyes, but I can't.

L1011

bodice ripper wrote: »

Well, so long as they have already decided. I'd like to use a roll eyes, but I can't.

Its quite hard to force people to use condoms. If there's something with can provide a risk reduction that they will actually use its well worth investigating. I don't think the current cost is justifiable on a social insurance system but if it falls as expected with patent expiry that changes things.

bodice ripper

You think people who won't use condoms during sex will take a pill everyday?

L1011

bodice ripper wrote: »

You think people who won't use condoms during sex will take a pill everyday?

Lots of people do in the US.

If someone has (for whatever reasons, I'm not intending to discuss this as I don't what their reasons are in the first place) decided to do or not do one thing there is no direct relationship to them making other decisions.

bodice ripper

That's just silly.

L1011

bodice ripper wrote: »

That's just silly.

What is?

Assuming that two completely different things do not have a correlation is not silly, if that's what you're suggesting.

newacc2015

bodice ripper wrote: »

Sounds like a dreadful idea. Another excuse to not use a condom. What about hep? What about another novel, fatal infection?

Ugh?! We have been telling people to use condoms for the last 30 years. Do we still have huge new infections every year? Has telling people to use a condom worked? No, not at all.

There is just some people who will never a condom. One pill a day will probably stop them eventually getting HIV. Its new solution to a problem that will never go away. NYC believes PrEP might finally bring NYC infections close to zero. Every gay man should have vaccines for Hep A & Hep B anyway

When you hear your female friends talking about being on the pill. Do you roll your eyes and tell them to "use a condom"? I dont see how its unacceptable for men not to prevent themselves from getting HIV with pill and its fine for women to use a pill to stop them getting pregnant

It's the strain that PrEP puts on the health service that is the worry. It is a good idea in theory but on a macro level, it's encouraging risky sexual behaviour and just not an appropriate use of HSE funds at the moment.

Let me put it this way. It would be like putting everybody on co-amoxiclav to stop them getting chest infections. What will happen is that there will be increased resistance to the meds and eventually they will stop working and we are back to the horrors of the 80s.

L1011

Deleted User wrote: »

Let me put it this way. It would be like putting everybody on co-amoxiclav to stop them getting chest infections. What will happen is that there will be increased resistance to the meds and eventually they will stop working and we are back to the horrors of the 80s.

Anti-[retro]virals do not have the same extreme tendency to resistance development as antibiotics; though - although it does happen. Seems to be quite a problem with the flu at this stage

If that had been a serious concern it would never have been approved, as its not like we have many other different ARVs - although off-label use would likely have continued in the US as happened before FDA approval

HSE simply cannot afford it as the pricing stands, unless they get a major price deal.

newacc2015

Deleted User wrote: »

It's the strain that PrEP puts on the health service that is the worry. It is a good idea in theory but on a macro level, it's encouraging risky sexual behaviour and just not an appropriate use of HSE funds at the moment.

Let me put it this way. It would be like putting everybody on co-amoxiclav to stop them getting chest infections. What will happen is that there will be increased resistance to the meds and eventually they will stop working and we are back to the horrors of the 80s.

How is it risky if it there is doctors in NYC, LA and San Francisco with hundreds of gay patients on PrEP who havent had a single gay patient contract HIV? If you are on PrEP you have to get tested for STIs every 3 months. Most gay men dont get tested at all. Studies of users of PrEP havent shown an increase in "risky behaviour" or an increase in number of sexual partners. PrEP will be off patent in a few years, so it will be super cheap for the HSE to buy

Let me put PrEP this way. There is hundreds of men in Ireland who refuse to use condoms. They will eventually catch HIV. We should keep telling them to use condoms, that they wont use and hope they dont eventually catch HIV. Which they probably.

You dont have the best understanding of HIV meds or PrEP IMO. If knew anything solid about PrEP you would know you get constantly screened to make sure you dont have HIV to prevent resistance to the drugs. Read a few studies on it and see if you still think its a waste

suicide_circus

Who pays for the drugs?

newacc2015

suicide_circus wrote: »

Who pays for the drugs?

I imagine it would be like any other prescription. The HSE pays the majority and the individual pays the usual amount up to the drug prescription limit. Although I cant imagine being the ideal amount of uptake if its €120 a month.

The price will be a lot cheaper when its generic

jimdublin15

newacc2015 wrote: »

I imagine it would be like any other prescription. The HSE pays the majority and the individual pays the usual amount up to the drug prescription limit. Although I cant imagine being the ideal amount of uptake if its €120 a month.

The price will be a lot cheaper when its generic

It could be cheaper when it becomes generic & if we also consider following the French and use the Ipergay prep method it has shown to yield the same high level of effectiveness and prevention but costs less in terms of medication resources as they take a few days at a time rather than taking the medication daily as they tend to do in the USA or have done in the recent UK Trials.

A few Truvada pills to gain an additional layer of HIV Prevention in high risks groups is going to be way cheaper than having to treat them in the long run.

In Ipergay, gay men and other men and transgender women who have sex with men, and were at high risk of HIV infection, were asked to take two Truvada pills one day to two hours before they anticipated having sex. If they actually did have sex, then they were to take another pill 24 hours after having sex and a fourth pill 48 hours after it. The period of taking PrEP would thus cover two to three days. If they continued having sex, they were told to continue taking PrEP until 48 hours after their last experience.

Ipergay studies:
HIV pre-exposure prophylaxis (PrEP)

http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/

November 2015 - France approves PrEP:
http://www.aidsmap.com/France-approves-PrEP/page/3016707/