As a gay man whose community has been devastated by AIDS, Matt Numer obviously wants to see the disease eradicated.
But as a scientist, he’s intrigued by the way the virus can infiltrate the human body.
“HIV replicates by getting into what’s called our CD4 cells (white blood cells), our immune defence system,” said Numer, who’s an associate professor in the school of health and human performance at Dalhousie University. “If it wasn’t for the human cost, it’s such a fascinating way that it works. It goes in and it replicates itself within the very cells that fight off disease and infection in your body.”
Researchers have found a way to put a defensive shield around CD4 cells and prevent AIDS from developing in the first place. The treatment, called pre-exposure prophylaxis or PrEP, has proven to be extremely effective.
“It was originally developed for treatment, it’s actually an older drug,” Numer said.
“But in 2010, 2011 they started doing trials on people who are at risk for HIV but didn’t have it and found that it prevented HIV significantly - 99 to 100 per cent when taken regularly. So it’s a game-changer in terms of HIV prevention.”
But at a cost of about $250 a month, most people can’t afford Travuda, the drug that has been approved as the main PrEP treatment for HIV. After lobbying from advocates such as Numer, the Nova Scotia AIDS Coalition and the Nova Scotia NDP, the provincial government added Travuda to the pharmacare drug registry in 2018.
While that helps people on low incomes and seniors, they would still face co-pay expenses and premiums, and it would obviously exclude people not in the pharmacare program, said Dartmouth North MLA Susan Leblanc, who speaks for the NDP on 2SLGBTQ+ issues.
"If we prevented one case, we could pay for it inside of a year."- Matt Numer, health and human performance professor
The answer, say Leblanc and Numer, is universal coverage.
“That would mean anyone that qualifies as an at-risk person would be able to go to their doctor and get a prescription and it would be free,” Leblanc said in an interview. “They wouldn’t have to pay any money to take it.”
Besides eliminating unnecessary suffering, Leblanc said universal coverage makes financial sense because the total yearly cost of universal PrEP coverage is about the same as the lifetime costs of a single HIV infection.
Numer figures it would cost the province at most about $1.5 million annually - if the number of eligible people was in the 800 range - but he said it would more likely be roughly $500,000.
"If we prevented one case, we could pay for it inside of a year," said Numer, who began taking the drug himself three years ago.
In a news release Monday, the day after World AIDS Day, the NDP said British Columbia, Alberta, and Saskatchewan all provide universal coverage for PrEP.
Chris Aucoin, the incoming executive director of the Nova Scotia AIDS Coalition, welcomed the NDP’s move to bring the universal coverage call back into the spotlight.
He said the number of new HIV cases spiked to 29 in 2018, compared to the previous average annual number of 15 to 17.
So far in 2019, the number of new cases appears to have dropped back to the previous levels but that’s still too many, Aucoin said.
“We have the tools available to us right now, PrEP being one of them, that could actually end new HIV infections within a decade,” Aucoin said. “That’s not going to happen unless we actually implement those tools, unless we make them available to the people who could most benefit from them.”
In an email in response to the NDP’s call for universal coverage, a Health Department spokeswoman didn’t directly address whether the province is considering that option.
“We continue to work with the Nova Scotia Advisory Commission on AIDS and community-based partners to raise awareness, reduce stigma, prevent infection, and provide care, treatment, and support for people living with the disease,” Heather Fairbairn said. “Last fall, we convened an in-person consultation and conducted stakeholder interviews to discuss further ways to reduce financial barriers to PrEP. Government is currently considering the various options for reducing the transmission of HIV and AIDS.”