NOS: Why is HIV miracle drug not covered?

Prevention is better than cure, especially with a deadly illness such as HIV. Luckily there is a pill that can prevent infection with the HIV virus: PrEP (Pre-Exposure Prophylaxis).

Together with the AIDS Fund and STI AIDS Netherlands, the PHS Gelderland-Zuid is trying to create more publicity for the cure, since in reality it turns out that clients, as well as health care professionals, often don’t know of PrEP’s existence.

“A lot of professionals know too little about this cure”, says Rinske van der Bij of PHS Gelderland-Zuid. “They don’t know what to provide to people who are at risk for HIV. With this project we will inform and train doctors, the PHS and potential PrEP-users.”

It has been sufficiently proven that the medicine works, says Sven Danner, professor of Internal Medicine at the VUmc. “There multiple experiments with PrEP have been carried out, and the number of HIV infections significantly decreased. It is effective, but you will have to use it consistently.”

Test results of the PHS in Amsterdam show that in most cases, PrEP is used regularly. “We have been involved in an experiment with 375 men for a year and a half, to see how they use PrEP”, says Anna Nijsters of the AIDS Fund. “The majority uses PrEP daily. Next to that the number of STI’s isn’t increasing, which means that they use it in addition to condoms.”

PrEP currently isn’t covered by Dutch health insurance companies. When used daily, Truvada (approved by the Netherlands as a form of PrEP) costs over 550 euros a month. Cheaper, generic imitations of the drug cost almost 100 euros a month.

In countries such as Belgium, France and Norway, PrEP is covered. “The Netherlands hesitates because of a few different reasons”, says Danner. “On the one hand there is the old-fashioned idea of personal responsibility and blame: you can also use condoms to protect yourself. It’s the same story as with helping methadone addicts. Of that you could say: “You shouldn’t have started with that stuff.”

“And then there is the financial argument: since it is a small group of people who could benefit from this, should everyone pay for that? But think of it this way: the medical care of someone with HIV costs 14.000 to 15.000 euros a year. Those prevention pills are a lot cheaper.”

“For us, it isn’t necessary to incorporate this in the basic health care insurance package”, says Nijsters. “We realize that this is for a select group. But then give them the option to choose an additional package. We will talk with health insurance companies, but we also want to demand pharmacists to lower the price of the cure.”

Illegal circuit

Currently, the high price of PrEP drives users towards an illegal circuit, according to Nijsters. “We know that the medicine is often bought abroad. Thailand is especially cheap, there it only costs 30 euros a month.”

“We understand why people do this, but a doctor’s supervision is necessary. For one you would have to know that you don’t have HIV already. If you do and still use PrEP, HIV blockers won’t kick in. A doctor should also monitor your kidney functions, since PrEP could effect this.”

The project mainly focuses on men who have sex with men. “A large part of that target group is located in Amsterdam”, says Van der Bij of PHS Gelderland-Zuid. “There, the cure is already used, but in the rest of the country there is still little knowledge.”

This is part of the reason why the project is initiated from Gelderland-Zuid. “In this region our target group wishes to stay anonymous and doctors have less experience with HIV control. So it’s good to fuel this project within this area, so that we can share the knowledge that we already have here.”

Early 2018 the Health Council will advise the House of Representatives on making PrEP available. Denner thinks it’s a good idea to incorporate the cure in an additional health care package, but only for a limited group. “If PrEP is widely used, people might develop resistance. But for this small group of people who are at a high risk of infection, I think it’s a really good idea.”

Source: (Dutch only)

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