Gay Zone, the Centretown health centre for gay men, has become the first clinic in Ontario to offer free “prophylactic” HIV treatment as part of a pilot project to make prevention of the life-threatening infection more accessible to high-risk populations.
Drugs described as “post-exposure prophylaxis” can prevent the transmission of HIV in as many as 80 per cent of cases if taken within 24 hours of exposure, says Dr. Patrick O’Byrne, the University of Ottawa researcher leading the project.
It can be even be taken by those who don’t show signs of being infected with the virus, but are worried they may have been exposed, he adds.
PEP has been available in emergency rooms since 1996, but is only covered by the province in cases of sexual assault or work-related exposure. Others have to pay up to $2,000 for the medication.
The year-long pilot project is a collaborative effort between the Ontario HIV Treatment Network – which put up $51,000 to fund the project – Gay Zone, Ottawa Public Health, and the AIDS Committee of Ottawa. It offers PEP free of charge and anonymously to ensure that those who need the treatment have access.
“We wanted to take PEP out of emergency rooms and remove the financial barriers to see if people would actually use this treatment that, with fairly good certainty, we know works,” says O’Byrne.
The program focuses on gay men because they are most at risk of being infected through sexual contact, but O’Byrne says women seeking the treatment won’t be turned away.
Guidelines in Gay Zone’s fifth-anniversary report note that “PEP should be taken as soon as possible, within 72 hours of being exposed to HIV.” The medication must be taken for 28 days.
Gay Zone is located in the Centretown Community Health Centre. It opens every Thursday from 5-8 p.m. for free, anonymous treatment and consultations.
Robert Alexander, ACO’s gay men’s health co-ordinator involved with programming at Gay Zone, says PEP has been particularly inaccessible to gay men because of the stigma surrounding homosexuality.
In his experience, he says, most gay men are worried of being judged when discussing their sexuality with the medical professionals. “If you’re always worried about what people are going to think of you, that might make you less likely to seek treatment,” he says.
While O’Byrne doesn’t think PEP will do much to reduce that stigma, he says that the project is spreading awareness about HIV. “People have been asking us about it more often and it’s a chance where we can actually engage in an honest dialogue. But so far, it’s only been a matter-of-fact, medical discussion.”
Alexander says that while the project is a positive development, there needs to be ongoing education about the possible dangers of the treatment so that people don’t think it’s a quick fix for HIV that allows riskier sexual practices. Accordingly, Gay Zone’s report outlines new activities for the next year, such as workshops with people who have taken PEP discussing the negative side effects of the drug.
“That’s what Gay Zone is intended to do,” says Alexander. “We give the clinical piece and we are also there to educate people.”
Although the provincial government is not currently involved in funding the program, O’Byrne says that the success of the pilot project would provide grounds to lobby for policy change that would make the service more widely available.
“We’ll have an evidence base rather than just our ideas,” he says. “It’s different to say, ‘We should do this because I think it would work’ than to say ‘we’ve actually done it, and we saw that it works.’ ”
O’Byrne says that to achieve these changes, the medical community needs to focus more on putting existing methods to use.
“We continue to develop new prevention initiatives and we fail to figure out how to effectively implement the ones we already know work. We need researchers to pick this up and figure out how to make it work – not in clinical trials, but in real life.”