The Malta Independent 18 May 2021, Tuesday

PrEP: is the price tag offsetting its increasing availability?

Karl Azzopardi Sunday, 2 February 2020, 11:00 Last update: about 2 years ago

With last year’s introduction of the Pre-Exposure Prophylaxis (PrEP), Malta experienced a step in the right direction when it comes to the treatments for HIV. Multiple pharmacies across the island have started selling this treatment, making it more accessible to potential patients. However, its price tag is still a concern among those who wish – or rather, need – to make use of it.

The Malta Independent contacted representatives of two of the prominent organisations that played a crucial role in getting such treatments to our islands and get their opinion on this precarious situation.

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Community Manager of Allied Rainbow Communities (ARC) Clayton Mercieca said that he is quite happy with the current situation when it comes to the PrEP pill as the number of pharmacies making it available for purchase is growing at a steady rate.

When it comes to price he pointed out that “last year it was priced at around €90 and now it has been brought down to €56.70, which we believe is fair in the current situation.” However, he still believes that there should be subsidies for those who cannot afford it as is done by the National Health Services in England wherein people with high risk of contracting HIV, such as sex workers, get PrEP services for free.

Joe Grima, Coordinator of HIV Malta and representative of MGRM, was also contacted and he said that when taking into consideration that the price only covers a month’s worth of treatment, it is still expensive.

“Our problem with it is that the same supply with the same brand and ingredients is €30 in England so Maltese patients are paying twice the price,” he explained.

This only alternative is getting a prescription from the GU Clinic and ordering PrEP online. The problem with this is that, even though one is purchasing the same brand and ingredients, buying things from online removes that point of contact one gets at a local pharmacy wherein the pharmacist gives out information on how to take the pill, precautions and the like.

“Our (HIV Malta’s) policy has been to encourage people to buy the pill from wherever they like. So, if one cannot afford to pay €60 per month, than its better if they pay €30 and have some form of protection – which so far is being scientifically proven to be equivalent – than not be protected against HIV.”

He also touched on Post-Exposure Prophylaxis (PeP), which is even more inaccessible for those who might have been exposed to HIV due to its €600 price tag.

“The price is ridiculous and people have been turned away from treatment because they couldn’t afford it,” he said. “We do not have statistics of people who have been refused treatment and got HIV, but the risk is there.”

Grima explained that ARC has a funder wherein they help people who cannot pay for the treatment, but he believes that the need for this is ridiculous within itself and he fears that the government will start to rely on NGOs rather than taking initiative itself.

When asked if they have been in contact with the Ministry of Health, Mercieca said that there wasn’t any at the moment and ARC is hoping get more clarification on what will be happening with the new HIV Clinic to which a tender was released last year but wasn’t discussed since then.

From MGRM’s side, Grima explained that at the start of 2020 the organisation had sent a number of questions to Prime Minister Robert Abela and Deputy Prime Minister Chris Fearne during their run-up to become leader of the Labour party and by consequence prime minister.

One of the questions revolved around the introduction of medical prevention of HIV such as PrEP trials. “These are trials to see how efficient PrEP is and determine if it will bring a decline in HIV rates and in return give PrEP for free for a limited period.”

Grima said that “while Abela was a bit evasive by simply stating he was firm in his commitment to keep Fearne as Minister of Health, Fearne had said that he was looking into introducing PrEP trials.”

These trials have proven to be effective in multiple countries abroad with London HIV cases dropping by 70% which is beneficial to the government as the consequence of all this would be 70% less chance of having to fund HIV treatment for life.

The Malta Independent asked Grima whether Fearne is willing to provide PrEP for free if the results of these trials turns out to be a positive one to which he replied that the minister did not commit to this but usually medical trials are done to for either subsidising the medication or giving it for free.


What is Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (or PrEP) is a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day.

The pill contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.

When taken daily, PrEP is highly effective for preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.

Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily. PrEP is much less effective if it is not taken consistently.

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