Generic PrEP available from December 4th

Ten of Swords

Teva Pharmaceuticals have said their generic version of PrEP will be available in Ireland from Monday December 4th. The cost is not subsidized by the HSE and a monthly prescription will cost €90~€100 which is about a 70% cost reduction. Historically Truvada cost approximately €400 for a 30 day course.

Considering HIV infection rates are at an all time high, particularly among gay and bisexual men, this will hopefully be a step in the right direction to reducing the number of cases.

Hopefully in the future some kind of scheme or cost subsidy can target some high risk categories but I think that's a good result today.

Irish Times

The Journal

Annasopra

Great news for those who can afford it. We still need it even cheaper again though.

Tenigate

The cost seems more than reasonable, particularly given that it's tax deductible.

My fear of people taking prep is it may result in the rise in other stis like Chlamydia, gonorrhea, genital warts, herpes, Syphilis due to unsafe sex while on prep... Some viruses aren't curable, and bacterial infections are becoming antibiotic resistant.

The other risk is a carefree attitude towards hiv just because we're told so many people do prep and use condoms... but many people don't and i believe infection numbers are rising or at least aren't falling. It's fine saying "hiv isnt a big deal, it's only a pill like a vitamin pill and the inconvenience of a blood test".

Finally there are short and perhaps long term side effects of using prep. I can only compare it to using an antimalarial prophylactic. For a short term need it's fine. Long-term and you're better off avoiding mosquitos.

JackTaylorFan

Tenigate wrote: »

The other risk is a carefree attitude towards hiv just because we're told so many people do prep and use condoms... but many people don't and i believe infection numbers are rising or at least aren't falling. It's fine saying "hiv isnt a big deal, it's only a pill like a vitamin pill and the inconvenience of a blood test".

Kinda have to agree with the above https://www.irishtimes.com/news/ireland/irish-news/record-numbers-of-people-diagnosed-with-hiv-1.3079987

http://www.pinknews.co.uk/2017/12/01/hiv-cases-in-northern-ireland-have-reached-an-all-time-high/

The drive to remove the stigma attached to HIV while well intended, seems like it's leading to a more laissez-faire attitude in young people today. Yes, it's not a death sentence anymore, in the first world, thanks to today's medications - but it is still a devastating diagnosis, and a life altering condition.

Annasopra

Tenigate wrote: »

The cost seems more than reasonable, particularly given that it's tax deductible.
.

It's reasonable if you are able to afford it. So its not reasonable for people living in poverty or on low wages.

Goodshape

Could anyone do a short "dummy's guide" to PrEP?

Some questions I have anyway –

Can it be taken 'as needed' or is it something you're either taking all the time or not at all?

Possible negative short and long term effects?



Whatever about having a care-free attitude towards sex, it would be nice not to be overly paranoid about HIV _all the time_.

Annasopra

Some good info in all these links (although a little outdated now)

http://actupdublin.com/prep/

http://www.hivireland.ie/hiv/prevention/prep/

http://www.thejournal.ie/anti-hiv-medication-in-ireland-prep-3446022-Jun2017/

http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

Ten of Swords

This American site (a collaboration of several charities and public health bodies in San Francisco) seems to have the most comprehensive guide online, several other guides seem to cite this one.

http://men.prepfacts.org/the-questions/

Goodshape

To summarise then


Can it be taken 'as needed' or is it something you're either taking all the time or not at all?

It can be taken as a tablet once a day for full cover.

It can also be taken 'on demand', which is two tablets two to 24 hours before sex, one tablet 24 hours after sex and a further tablet 48 hours after sex.

http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis#dose


Possible negative short and long term effects?

"About one in 10 people experience mild side effects like upset stomach, headaches or tiredness when they start PrEP. These effects usually last only a few days or weeks. A very small number of people experience kidney problems, which clear up when they stop using PrEP."

http://actupdublin.com/prep/


And all those sites suggest it is very effective against HIV when taken as directed.

Annasopra

Tenigate wrote: »

The cost seems more than reasonable, particularly given that it's tax deductible.

My fear of people taking prep is it may result in the rise in other stis like Chlamydia, gonorrhea, genital warts, herpes, Syphilis due to unsafe sex while on prep... Some viruses aren't curable, and bacterial infections are becoming antibiotic resistant.

The other risk is a carefree attitude towards hiv just because we're told so many people do prep and use condoms... but many people don't and i believe infection numbers are rising or at least aren't falling. It's fine saying "hiv isnt a big deal, it's only a pill like a vitamin pill and the inconvenience of a blood test".

Finally there are short and perhaps long term side effects of using prep. I can only compare it to using an antimalarial prophylactic. For a short term need it's fine. Long-term and you're better off avoiding mosquitos.

Some interesting observations and opinions. I wonder how you arrived at them? Is there a particular notable rise in other states of other STIs? Where are you getting information on the side effects?

Tenigate

Joeytheparrot wrote: »

Some interesting observations and opinions. I wonder how you arrived at them? Is there a particular notable rise in other states of other STIs? Where are you getting information on the side effects?

Sorry just opinions i formed through discussion and reading. I didn't note the sources of the info, other than to know I'm not interested in it.
Sti's in general are reaching epidemic levels. I know a pill isn't going to fix that.

JackTaylorFan

Joeytheparrot wrote: »

Some interesting observations and opinions. I wonder how you arrived at them? Is there a particular notable rise in other states of other STIs? Where are you getting information on the side effects?

The rising number of cases of STIs is a genuine concern across the board - gay , straight or other.

PrEP protects specifically against HIV, which seems to be the only concern for some men engaging in otherwise unsafe sex, it does not protect against any other STIs - a lot of which are quite worryingly becoming entirely resistant to antibiotics. Last time I read untreatable "super gonorrhea" has now been reported in over 50 countries worldwide.


https://www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns

Annasopra

JackTaylorFan wrote: »

The rising number of cases of STIs is a genuine concern across the board - gay , straight or other.

Of course. I wondered aloud if there was data suggesting that using prep directly leads to higher STI rates of other STIs

JackTaylorFan

Joeytheparrot wrote: »

Of course. I wondered aloud if there was data suggesting that using prep directly leads to higher STI rates of other STIs

I think it's dangerous to deny that there is a link between otherwise unprotected sex and PrEP use - at best it's a naive viewpoint.

Even this article from Poz.com references these concerns https://www.poz.com/article/prep-fails-third-man-time-hiv-drug-resistance-blame

So we’ll have to acknowledge that. It also doesn’t protect against STDs. So we think it’s clever to combine different prevention methods—PrEP being one of them, condoms and other risk-reducing behaviors being other ones.”

Annasopra

JackTaylorFan wrote: »

I think it's dangerous to deny that there is a link between otherwise unprotected sex and PrEP use - at best it's a naive viewpoint.

Even this article from Poz.com references these concerns https://www.poz.com/article/prep-fails-third-man-time-hiv-drug-resistance-blame

Where did I deny anything?

JackTaylorFan

Joeytheparrot wrote: »

Where did I deny anything?

Perhaps you weren't. Your previous comments read like you were dismissing the concerns though.

Annasopra

JackTaylorFan wrote: »

Perhaps you weren't. Your previous comments read like you were dismissing the concerns though.

I wasnt dismissing anything either. I was asking for more information and elaboration of opinion.

I am puzzled though at this perception that asking a question or two is denial and/or dismissal. It's not like I said - "No you're wrong because you have nothing to back your point up".

JackTaylorFan

Joeytheparrot wrote: »

I wasnt dismissing anything either. I was asking for more information and elaboration of opinion.

I am puzzled though at this perception that asking a question or two is denial and/or dismissal. It's not like I said - "No you're wrong because you have nothing to back your point up".

Fair enough.

JupiterKid

It’s great that this is finally available in Ireland now, although the price does seem a bit steep.

But my concern would be that it may give some gay guys license to have regular bareback, unprotected sex. And although HIV is (thankfully) no longer a death sentence, it is still not something good to have and there is still a major stigma against poz men.

thereality

I don't know what the obsession with PrEP and barebacking is about. If you don't agree with people barebacking, use a condom. Others should be so concerned about what others are doing in the bedroom. If someone wants to bareback, they are likely to do it with or without PrEP. At least with PrEP, they won't contracting HIV. If they do bareback on PrEP, they will have to go to their local GUM for a full regular screening to get another prescription. We should be delighted with the fact people, that are potentially exposing themselves to HIV are getting effective protection against. I seriously doubt everyone here disagreeing with PrEP is strolling up to the GMHS every 3 months

I know it is lovely to tell gay men to just use condoms and not introduce PrEP. But lets get real. Pushing condoms as the only effective way to reduce HIV is failing and will continue to fail. HIV among Irish born MSM has flat lined since 2003. Despite all the headlines of record numbers contracting HIV in Ireland, that is mainly just Latin Americans contracting it. Actually a fair of that is them registering for HIV services in Ireland.

PrEP has been one of the main factors in reducing HIV rates by 40% in London in recent years. We can keep pretending condoms will eliminate HIV, despite decades of this policy failing. Or we can get real and see PrEP as a step in the right direction.

FYI I have feeling most of the people disagreeing with PrEP over bareback concerns would not tell their female friends to just use condoms and not the pill...

Annasopra

The HSE has produced an information booklet


http://www.hpsc.ie/publications/informationleafletsforthegeneralpublic/HIV%20PrEP%20in%20Ireland_English.pdf
http://www.hpsc.ie/publications/informationleafletsforthegeneralpublic/

Annasopra

thereality wrote: »

I don't know what the obsession with PrEP and barebacking is about. If you don't agree with people barebacking, use a condom. Others should be so concerned about what others are doing in the bedroom. If someone wants to bareback, they are likely to do it with or without PrEP. At least with PrEP, they won't contracting HIV. If they do bareback on PrEP, they will have to go to their local GUM for a full regular screening to get another prescription. We should be delighted with the fact people, that are potentially exposing themselves to HIV are getting effective protection against. I seriously doubt everyone here disagreeing with PrEP is strolling up to the GMHS every 3 months

I know it is lovely to tell gay men to just use condoms and not introduce PrEP. But lets get real. Pushing condoms as the only effective way to reduce HIV is failing and will continue to fail. HIV among Irish born MSM has flat lined since 2003. Despite all the headlines of record numbers contracting HIV in Ireland, that is mainly just Latin Americans contracting it. Actually a fair of that is them registering for HIV services in Ireland.

PrEP has been one of the main factors in reducing HIV rates by 40% in London in recent years. We can keep pretending condoms will eliminate HIV, despite decades of this policy failing. Or we can get real and see PrEP as a step in the right direction.

FYI I have feeling most of the people disagreeing with PrEP over bareback concerns would not tell their female friends to just use condoms and not the pill...

Have you got some proof of your assertion that HIV among Irish born people has been flatlining since 2003 and that the increases in HIV amongst MSM is mainly due to Latin American Men?

thereality

Joeytheparrot wrote: »

Have you got some proof of your assertion that HIV among Irish born people has been flatlining since 2003 and that the increases in HIV amongst MSM is mainly due to Latin American Men?

The HSPC monitors infectious diseases in Ireland. They keep track of everything from TB, the flu and STIs. It is not my assertion that HIV has been stable, it is the view of an independent body that collects data on HIV. According to their 2016 HIV report :

The rate of diagnosis among those born in Ireland has remained stable since 2003, ranging
from 3.4 to 4.2 per 100,000 population (see Figure 5).

Of the 508 new diagnoses, just over half (51%) were among men who have sex with men
(MSM). This was the largest number of diagnoses ever reported in MSM, who remain the
subgroup most affected by HIV in Ireland. Similar to what was seen overall, the proportion of
MSM previously diagnosed HIV positive before arrival in Ireland has been increasing and was
42% in 2016 compared to 16% in 2012. The majority of these men (87%) were born abroad,
with the highest number from Latin America. Similarly the numbers of new diagnoses in MSM
not previously diagnosed abroad dropped by 14% in 2016 compared to 2015.

www. hpsc. ie/a-z/hivstis/hivandaids/hivdataandreports/HIVIreland_2016.pdf (remove the spaces between the www. and hspc. ie to use the link correctly)

As much as people like to think HIV is soaring in Ireland due to younger people not using condoms and not remembering the AIDS crisis and thinking it is just a pill a day etc etc. HIV among Irish men has not really changed much in just over a decade.

Tenigate

A bit more empirical evidence but i was chatting to someone who only found out he had hiv because he applied for a job in healthcare in Ireland and tests like hiv and tb were mandatory.

Personally I'd like to see mandatory screening for illnesses like hiv from countries like Brazil. Many people would say that's discrimination or stigmatisation but if it stops the disease from spreading in Ireland i wouldn't particularly care too much.

Ten of Swords

A new online resource giving information about PrEP in Ireland has gone online recently, it is run by a group of Dublin based volunteers

https://www.getprep.online/

Good job guys!

Goodshape

A lot of good and useful info there! Fair play.

what the hell!

Can I ask a stupid question- I asked my GP to enquire about it and he came back from the Pharmacist to me and said it was costing €600 a month. Am I missing something?

haro124

what the hell! wrote: »

Can I ask a stupid question- I asked my GP to enquire about it and he came back from the Pharmacist to me and said it was costing €600 a month. Am I missing something?

Maybe the pharmacy only has the branded version?

Tenigate

what the hell! wrote: »

Can I ask a stupid question- I asked my GP to enquire about it and he came back from the Pharmacist to me and said it was costing €600 a month. Am I missing something?

Shop around.

Annasopra

what the hell! wrote: »

Can I ask a stupid question- I asked my GP to enquire about it and he came back from the Pharmacist to me and said it was costing €600 a month. Am I missing something?

It should be around €100 per month.

https://gcn.ie/affordable-prep-made-available-irish-pharmacies/

thereality

what the hell! wrote: »

Can I ask a stupid question- I asked my GP to enquire about it and he came back from the Pharmacist to me and said it was costing €600 a month. Am I missing something?

I imagine that is the branded version from Gilead Sciences called Truvada. Meaghers pharmacy on Baggot St beside the GMHS is apparently charging €85 per month.

You are better off going to a local STI clinic in a hospital. With PrEP you will need a kidney function test and HIV test before you start. Then another HIV test after month one to ensure you are negative. You will need quarterly HIV / kidney function tests to ensure you are negative and your kidneys are ok. If you don't have a medical card, it will have cost you about €300 in GP fees in year 1.

Whereas the likes of the GMHS is free and can actually advise you where is selling generic truvada. I know a few people who went to their GP for advice on PrEP and they were useless.

what the hell!

thereality wrote: »

I imagine that is the branded version from Gilead Sciences called Truvada. Meaghers pharmacy on Baggot St beside the GMHS is apparently charging €85 per month.

You are better off going to a local STI clinic in a hospital. With PrEP you will need a kidney function test and HIV test before you start. Then another HIV test after month one to ensure you are negative. You will need quarterly HIV / kidney function tests to ensure you are negative and your kidneys are ok. If you don't have a medical card, it will have cost you about €300 in GP fees in year 1.

Whereas the likes of the GMHS is free and can actually advise you where is selling generic truvada. I know a few people who went to their GP for advice on PrEP and they were useless.

Ya thanks guys I popped into the local pharmacy today and they'll ring the wholesaler on Monday to find out the price of the generic one. Didn't realise I'd need to do the kidney test. Seems like the GPs aren't very up to date!

thereality

what the hell! wrote: »

Ya thanks guys I popped into the local pharmacy today and they'll ring the wholesaler on Monday to find out the price of the generic one. Didn't realise I'd need to do the kidney test. Seems like the GPs aren't very up to date!

The RRP of it is €100. Meaghers do it for about €85 a month. About 60 pharmacies in Ireland are stocking it(although most are in Dublin and Cork) Apparently South Terrace Pharmacy in Cork stock it

You absolutely have to do a kidney test to start and during it. PrEP was found to reduce kidney function in patients. I know from my last test, my kidney function has reduced marginally. But it is still in the safe range

I think you have to be tested for Hep A&B, as the medicine interacts with that too. You can get free vaccines for Hep A&B if you don't have it

Honeslty

adam88

If your getting this as prep will the pharmacist be under the illusion your poz.

I know I’ll prob get my head bitten off for this but unfortunately the stigma still exists

thereality

adam88 wrote: »

If your getting this as prep will the pharmacist be under the illusion your poz.

I know I’ll prob get my head bitten off for this but unfortunately the stigma still exists

Your pharmacist wont. AFAIK HIV meds are only dispensed from hospital pharmacies to keep the cost of it low and because there is a small demand for it ie there are only a few thousand on HIV meds. Even if all pharmacies stocked it, most HIV patients are on several drugs and not a simple two drug combo like Truvada

Ten of Swords

adam88 wrote: »

If your getting this as prep will the pharmacist be under the illusion your poz.

PrEP can be taken as a preventative measure as well as a treatment, a pharmacist would know this so them drawing any solid conclusion seems unlikely. In any case they dispense medicines to people suffering from all sorts of illnesses and conditions every day of the week, what difference would it make? They won't discuss it with anyone else anyway

maxsmum

Hi all, I was reading about this in an issue of GCN (got it in the cinema, didn't realise was LGBT mag but really good reading!). As a very uneducated straight person who works in health service (but not with LGBT community) can someone answer a basic question for me. I know PREP or something like it used to be given out in A&E in case of an accident, probably still is. What I don't understand is why people are looking to be prescribed it on a regular basis... I must be missing the point - what does it do that condoms don't? And as people say above it doesn't have any effect on all the other STIs? Excuse my ignorance!

Gadgie

maxsmum wrote: »

What I don't understand is why people are looking to be prescribed it on a regular basis... I must be missing the point - what does it do that condoms don't? And as people say above it doesn't have any effect on all the other STIs? Excuse my ignorance!

It needs to be taken regularly to be effective. Some people may use it in addition to condoms, while some may use it as an alternative. But as you say, it doesn't offer protection against other STIs.

Annasopra

maxsmum wrote: »

Hi all, I was reading about this in an issue of GCN (got it in the cinema, didn't realise was LGBT mag but really good reading!). As a very uneducated straight person who works in health service (but not with LGBT community) can someone answer a basic question for me. I know PREP or something like it used to be given out in A&E in case of an accident, probably still is. What I don't understand is why people are looking to be prescribed it on a regular basis... I must be missing the point - what does it do that condoms don't? And as people say above it doesn't have any effect on all the other STIs? Excuse my ignorance!

There is a difference between PEP and PrEP

PEP is post exposure and is prescribed after a potential risk happened
PrEP is pre exposure and prescribed before a potential risk happens

I think HIV Ireland answers your other 2 questions quite well

http://www.hivireland.ie/hiv/prevention/prep/

Taking PrEP before and after being exposed to HIV means there is enough of the drug inside you to block HIV if it gets into your body – before HIV it has the chance to infect you.

PrEP does not prevent other STIs. Condoms, when used consistently and correctly, are the best way to prevent the transmission of HIV and other STIs.

maxsmum

Ok so...
PEP is for those who use condoms but may have an accident eg condom split or those who maybe didnt use a condom but at the time weren't aware of being exposed to HIV.
So PREP is for those who don't/won't use condoms?!
I'm trying not to sound too simplistic but have read it again and again!

Goodshape

maxsmum wrote: »

So PREP is for those who don't/won't use condoms?!
I'm trying not to sound too simplistic but have read it again and again!

Well, no. I'm not sure how better to phrase or than has already been done but maybe just read it again one more time

"PrEP does not prevent other STIs. Condoms, when used consistently and correctly, are the best way to prevent the transmission of HIV and other STIs."


PEP can be taken if you believe you may have been exposed to HIV.

PrEP can be taken to reduce, significantly, the chances of being infected in the first place.

Neither should be used *instead of* condoms and other safe sex practices.

thereality

maxsmum wrote: »

So PREP is for those who don't/won't use condoms?!

Would you say the pill is for women who just don't/won't use condoms?

People take PrEP for a variety of reasons. Some take PrEP as their partner is HIV+ (technically according to the PROUD study if you are HIV+ undetectable, the risk of giving HIV to your HIV - partner is close to zero). Some guys regularly use condoms, they just slip up the odd time. PrEP is far less harsh far than PEP now and again.

I personally think it is very harsh to say that PrEP is just won't use condoms. We don't see anything wrong with straight individuals never using condoms.

If people don't like condoms, why not let them take a daily pill and get tested 4 times a year. We don't sham straight people for not using condoms. Why can't it be the same for gay people?

maxsmum

thereality wrote: »

Would you say the pill is for women who just don't/won't use condoms?

People take PrEP for a variety of reasons. Some take PrEP as their partner is HIV+ (technically according to the PROUD study if you are HIV+ undetectable, the risk of giving HIV to your HIV - partner is close to zero). Some guys regularly use condoms, they just slip up the odd time. PrEP is far less harsh far than PEP now and again.

I personally think it is very harsh to say that PrEP is just won't use condoms. We don't see anything wrong with straight individuals never using condoms.

If people don't like condoms, why not let them take a daily pill and get tested 4 times a year. We don't sham straight people for not using condoms. Why can't it be the same for gay people?

Fair point when you compare it with the pill. I think I get it now. The way I read the article was that the LGBT community are outraged that PREP isn't free and I was struggling to figure out the point of it. However when you compare it with the pill, yeah, it prevents something that's far more expensive to the public purse in the long run and I do think the pill should be made available for free so yep - thanks for clarifying.

Ten of Swords

The cost of subsidized medicines is $5 NZ dollars (approx €3) per prescription. Automatic entitlement to this subsidy is reached once you have filled any 20 prescriptions in one calendar year (you, spouse and dependents over 13 years old are all added up for this calculation). Once you have done this you are entitled to have all other prescriptions for the remainder of the year to be fully subsidized by the government at a cost of $5 NZ dollars per prescription. The scheme runs from Feb 1st to Jan 31st every year.

From March 1st 2018 New Zealand are adding PrEP to the list of subsidized medicines.

The NZ health department have also published guidance on how to import generic PrEP if you are not entitled to subsidized medicine and can't afford Truvada. There is also a map on their site showing all doctors that can prescribe PrEP in all parts of the country.

These are very positive measures in my opinion, I wonder what political courage something like that would take in Ireland.

https://endinghiv.org.nz/stay-safe/prep