HIV prevention drug should be funded for immigrants - advocates

Safe sex advocates want funded access to an effective HIV prevention drug widened to all immigrants.

Pre-exposure prophylaxis (PrEP) reduces the risk of being infected with HIV by up to 99 percent and prescriptions are funded for some people in New Zealand.

But access to the drug can be costly for people like Brandon Goh, a Malaysian man who's been in New Zealand on a student visa for four years.

He faced a bill near $600 when all associated costs are included, compared to people qualifying for a funded prescription only paying the cost of their doctors appointment and possibly a $5 pharmacy charge for a three month supply.

Goh's GP suggested the drug for him and he was able to bring the cost down to about $300 with the help of the New Zealand Aids Foundation.

However, he never repeated his prescription because he found it too expensive and it was not covered by his insurance - a visa requirement as he is not eligible for funded healthcare.

It was the cost of health tests required for a prescription that pushed up the cost, Goh said.

His Labtests bill shows required tests cost $381.50, which was nearly double the cost of the drug a 90-day supply currently costs $183.45 but will reduce to $46.35 from July 2022.

"You're basically weighing [up] between financial viability or protecting your health ... you don't get both."

Goh uses other safe sex measures, like condoms, but "of course" wanted to be on PrEP.

It mattered to him because homosexuality is illegal in Malaysia, where he said life would be "very dangerous" if he were to contract HIV, let alone exist as a gay man.

Goh ultimately felt that rules restricting access to PrEP meant health systems were "failing queer people".

Dr Massimo Giola, a member of the New Zealand Sexual Health Society executive, said it made him "feel terrible" and "sad" seeing patients unable to access prevention tools.

He acknowledged HIV prevention wasn't a one-stop shop from a single prescription but rather part of an ongoing "comprehensive sexual health wellbeing programme".

"It's very clear PrEP is one of the main public health tools in our toolbox to achieve HIV elimination in New Zealand, together with condoms and prompt access to testing and treatment."

Giola quoted Prime Minister Jacinda Ardern speaking about Covid-19 on 23 September, 2021, which, like HIV, is an infectious disease: "I've always said that I don't want a situation in New Zealand where we simply shrug our shoulders and accept that we have an infectious disease that takes lives when that can be prevented."

The Prime Minister's office has been contacted for comment.

Giola said it was paradoxical that anyone in New Zealand with HIV - from citizens through to people on tourist visas - would have their treatment paid for by the Ministry of Health but access to effective protection against the virus had barriers determined by residency type.

"Public health prevention tools must be available to everyone."

HIV care is "by and large more expensive and lasts for a lifetime" compared to only needing to be on PrEP while having sex considered at-risk of contracting the virus, Giola said (PrEP wouldn't be recommended to someone in a long-term monogamous relationship).

HIV peer support organisation Body Positive executive director Mark Fisher said access to PrEP was important because "the reality is not everyone's using condoms".

He said PrEP was similar to women using contraceptive pills and "empowers you as an individual to be safe".

"If you're a newcomer [to sex] then your position of power for negotiating condom use becomes really problematic and so you're in a vulnerable space," Fisher said.

Fisher said the government's forthcoming National HIV Action Plan needed to see a focus on the health of gay immigrants, including their access to tools like PrEP, "because that's where there's still risks and there's still risky activities happening".

"We need to get really nimble and creative in our solutions to make sure that everybody has access to the tool that they want."

In Budget 2022, the government allocated $18 million over four years to implement the action plan, which RNZ understands is due to be revealed mid-year.

A Ministry of Health spokesperson also said it funded about $5m a year for HIV prevention services as well as, last year, providing $4m over four years to support the mental wellbeing of Rainbow young people.

The Ministry did not explicitly address questions relating to whether the Ministry itself could do more for HIV prevention and did not answer questions about the action plan.

PrEP changes proposed by Pharmac

After Budget 2022 was announced last week, Pharmac put out a proposal to overhaul the funded prescription criteria for PrEP.

The current criteria includes that patients must have had unprotected receptive anal intercourse with a casual partner in the previous three months, although it is known that some patients and doctors lie to access the drug.

Pharmac's proposal would reduce the criteria to the patient testing negative for HIV and their doctor thinking its "clinically appropriate" for them. If approved, the criteria would change from the start of July.

The move came as a surprise to advocates because it will bypass Pharmac's original intention of looking at widening access during a meeting in June, on top of advice from September 2020 it was already reviewing.

Chief executive Sarah Fitt said the main influence for change was Pharmac's $191m boost it received in the Budget, with the agency pulling the proposal together in just a few weeks.

She said widening PrEP access was "high on the list" of things the agency wanted to do.

"Any sort of preventative treatment does usually stack up to be very cost effective," she said, citing savings if it prevents people getting HIV and needing treatment for life.

Fitt said the proposal was not linked to the government's HIV Action Plan - "we would have done it anyway" - but imagined it would work in favour of a plan towards eliminating local HIV transmission.

The widened criteria would still not include Brandon Goh because there were no proposed changes for those unable to access funded healthcare.

Fitt said the exclusion of immigrants was not something Pharmac could comment on.

Goh said the proposal made it "more stark" for officials to make change to include immigrants. "Love does not discriminate, a virus also does not discriminate; and hence our approach to sexual healthcare in New Zealand should not discriminate."

Body Positive's Mark Fisher said "there needs to be a pathway, which may not be through a Pharmac change but some other solution".

Pharmac has also put out a proposal to widen access to post-exposure prophylaxis (PEP), a course of medication within 72 hours of exposure to HIV.

Submissions on Pharmac's proposal are open until 2 June, 2022.