Wednesday, June 10, 2015

The PrEP Files: Part 3 It is always darkest before dawn

I had originally planned a number of separate posts detailing talking to my doctor and getting the prescription filled.  Having gone through the whole process however I think I need to provide a more current update as I would have done things differently had I known then what I do now.

Here are some things point form that I discovered while trying to get my prescription filled:

  • No one will know what to do with you.  The systems in Alberta are not designed to deal with this usage yet so every step will be a process of education and clearing out miss-information. 
  • Getting the prescription filled is not as easy as going to your local pharmacy only two pharmacies provide truvada in the Edmonton area (the Rexall at the Royal Alex and University of Alberta Hospitals) and they are not super easy to get to.  Accessibility is something I took for granted and those who are dealing with the healthcare system in Alberta with HIV have a number of barriers accessing services and medication.  
  • Only an infectious disease doctor can prescribe truvada and get it covered by Alberta Health.  This is a huge deal and something I will go into more detail on later in the post.
  • People will treat you differently.  My local pharmacist looked like I had handed her a bomb when I tried to get my prescription filled.  That look was echoed by every health care person I have had to deal with in getting the pills.
  • Be sensitive to your privileged status as a negative person trying to access medications used as a critical life saving tool for many people. 
  • Also note that groups and organizations that you may have relied on for help in the past may not support the use of PrEP.  This kind of political bullshit really pissed me off as I was reaching out for informational resources from local queer groups that should have been able to provide at least some help and all I received was silence.  
  • PrEP is very expensive and establishing how you are getting it covered should be the first thing you do.  It was the last step we took and so far has been the most difficult and very expensive.  
  • There are great resources out there if you know where to look.  This facebook group has been by far the most helpful.  I learned more on that page than I did from any other official resources.
Step 1:  Talk to your Doctor and provide them with education materials.  Be open and honest with them about your sex life.  If you can't do this you should try and find a doc you can trust.  We found ours through our local pride centre.

Step 2: Establish that you can get coverage.  As of today I can confirm that Manulife Group Benefits will never cover the medication in Alberta until the CMA recognizes it as a legitimate use and treatment.  Talk to your benefits provider.   This is a lengthy process for most benefit companies because they don't have answers ready and often there is paperwork that you and your physician may have to fill out for pre-approval.   There are no programs currently in Alberta that help people find coverage for PrEP.

Only after doing both of these should you even consider getting PrEP.

I was asked this past pride weekend if all the work and expense was worth it?  My answer is not a simple yes or no.

For a short while I was able to experience sex the way it should be without fear or concern of the big bad wolf that I was raised to be terrified of.  It is a freeing experience and I am glad I had it. Traveling this path has been difficult and it has opened my eyes to a great many things that I had been ignorant to. There is little doubt in my mind that this treatment should be in the hands of every single person who needs it.

Accessibility is the problem and until that issue is solved PrEP in Alberta will never be ready for the average person who needs it most.  Until then the small handful of people fighting, educating and pushing the medical corporate establishment and the queer community will continue to do so but it takes a chorus of voices to enact change.

So please go out and educate yourself educate others and ask those power brokers why this isn't being provided to a community seeing a rapid increase in infections.  Together and only together can we solve the problem of accessibility.

Thursday, March 05, 2015

The PrEP Files: Part 2 Educate Yourself

After making the decision we started researching.  PrEP is a relatively new way to use a well established product.  I powered up the google machine and started doing research on not only it's uses but on how it is being implemented in Canada.   I also touched base with a number of friends who were using it to see if there was anything I had to be concerned about.  

Before you can talk to your physician you need to prepare yourself so that you can educate them about PrEP.   Some of these are newer links and I wish I had access to them before I started this process.

Here are some great links to get you started.

CATIE PrEP Introduction and Canadian Information (this site is amazing and I would say it is required reading for anyone interested)

New studies are being published every day.  It is a really exciting time for research related to PrEP but it is also one of flux with each study shedding light on appropriate uses and issues related to real world implementation.

Monday, March 02, 2015

The PrEP Files: Part 1 Making the Decision

Over new years we were very lucky to get get to spend the holiday in Mexico with the fella's company.   I had never been to Puerto Vallarta before but I was amazed at how gay and gay friendly it was.   We even ran into a friend down there.

While on the trip it became clear to us based off of discussions with not only friends but just by reading people's profiles that so many gay men are taking PrEP (Pre-Exposure Prophylactic) treatment to help protect themselves from HIV.  I had heard that this was becoming more popular but to hear first hand what a positive experience taking PrEP had been it convinced me to try and find a way to start protecting myself with it.

The only problem is the Alberta government and Canada as a whole has been dragging it's heels on approving PrEP for use. Gilead the maker of Truvada has not even applied to have it approved for use in Canada for PrEP.

As there is significant lack of information about PrEP and how to get on it in Canada I thought it would be valuable to document my experience in trying to protect myself.

Now there are a ton of articles about using PrEP out there and a bunch of research studies.  I would advise using the wonders of google to find out if PrEP is something that is appropriate for you and your lifestyle.  It is not for everyone.

Personally for me as a gay man in a loving but non-monogamous relationship PrEP represents an added layer of protection for both myself and the fella.  We generally do not bareback with others but no method of protection is perfect.  We have had condoms break at bad times before and it always causes a huge amount of anxiety around something that should be a celebration of life.

For me the value is knowing I can worry less about the condom snapping and more about enjoying the act.  That freedom has never been something I have had.  

Since we both have good drug coverage and the ability to pay the remainder it made the decision to go on PrEP much easier for us.

Next Up: Part 2 Education