Who to talk to:

If you want to get PrEP, you have to ask a doctor, infectious disease specialist, or nurse. If you have a family doctor, and feel comfortable with them, they are a great person to talk to. If not, you can book an appointment at a sexual health clinic, see a nurse practitioner, or visit a walk-in clinic (it’s best to call ahead at your local walk-in clinic to ensure they offer this service). A study at Dalhousie University was completed recently carving the way for pharmacists to begin prescribing PrEP – and excitingly, as of July 1, 2024, pharmacists can now prescribe PrEP.

They’ll talk to you about why you might need PrEP. If you both agree that PrEP is right for you, they’ll go ahead and give you an HIV test to make sure you’re negative, give you tests for other STIs, and test to make sure that your kidneys are healthy. If everything looks good, they’ll write you a prescription. While you’re on it, you will be asked to get these tests repeated every 3 months.

How to have the conversation:

Not every doctor will respond the same way to a conversation about PrEP, so it’s best to be prepared for what that conversation might look like. Unfortunately, not all doctors are educated around HIV, HIV prevention, and HIV treatment. The more educated you are going into your appointment, the better chance you will have of advocating for yourself and ensuring you are receiving the care you deserve. You can always reach out to us if you want to talk through feeling prepared for this conversation.

You may also worry about stigma, homophobia, transphobia, or any intersecting forms of oppression when asking for PrEP. This can be especially true in smaller towns where you may know your healthcare providers in contexts outside of your doctor/patient relationship. If travel outside of your town is an option for you, that may be a way to get around this – however it doesn’t necessarily mean you will receive better treatment than what’s offered near your home.

It is important to have a support system you can talk to before or after your appointment. If you have a friend, family member, or partner who would make this situation feel safer for you you can always bring them into the appointment with you. Be sure to know that it’s not okay to experience stigma on any level. If something happens at an appointment that you don’t feel good about, consider reaching out to a local queer organization, a trusted person in your life, or even sending feedback to the healthcare clinic with a request for your practitioner to get training on the subject.

If you’re thinking of asking your doctor about PrEP, but you’re afraid you won’t know how to ask about it, check out this script from The Sex You Want to give you an idea of how you might want to approach this conversation.

How much will it cost?:

Health Canada has approved the drugs emtricitabine and tenofovir for use in combination with safer sex practices to reduce the possibility of sexually acquired HIV. Typically, Truvada or Descovy – the brand names of PrEP – will cost up to $800-1000 a month. However, generic versions of the drug can cost down to $200 a month at some pharmacies across Nova Scotia. Generics have been approved by Health Canada and are as effective as Truvada.

For certain populations of Nova Scotia residents the Truvada PrEP is covered by Nova Scotia Pharmacare. Nova Scotia

Pharmacare defines these populations as:

• ‘Men Who Have Sex With Men (MSM) and Transgender Women (TGW): For pre-exposure prophylaxis (PrEP), in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 infection in adults at high risk who report condomless anal sex within the last six months and any of the following:
  • Infectious syphilis or rectal bacterial sexually transmitted infection (STI), particularly if diagnosed in the preceding 12 months;
  • Recurrent use of nonoccupational postexposure prophylaxis (nPEP) (more than once);
    Ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200 copies/ mL. (i.e. not on ART or >200 copies/mL); or
  • High-incidence risk index (HIRI)-MSM risk score ≥ 11. Please refer to the BC-CfE PrEP guidelines or the Canadian PrEP Guidelines which include details about how to calculate the HIRI-MSM risk score
• Heterosexual exposure: For pre-exposure prophylaxis (PrEP), in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 infection in heterosexual men and women at high risk of acquiring HIV infection who meet both of the following:
  • Condomless vaginal or anal sex; and
  • Ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200 copies/ mL. (i.e. not on ART or >200 copies/mL).
• People who inject drugs (PWID): For pre-exposure prophylaxis (PrEP) for PWID who are at high risk of acquiring HIV infection and meet both of the following:
  • Report sharing of injection equipment; and
  • Have an HIV-positive injecting partner who is not receiving stable ART and/or does not have an HIV viral load < 200 copies/mL.

If you fit into one of these groups, have your doctor fill out this form to get your PrEP covered by Nova Scotia Pharmacare’

The language defining these categories can be tricky to understand, so if you think PrEP might be right for you we recommend talking to your doctor or giving us a call at HEAL NS to see if you might fall into one of these categories.

If you have private health insurance — including through your work or school — then your plan may cover some or all of the cost of PrEP.

If you have questions about coverage you can reach out to your insurance providers to ask about what drugs / medications are covered under your plan.

Refugees in Canada can access PrEP through the Interim Federal Health Program. You can also access PrEP via your Canadian Forces Health Care Identification Card or Veterans Affairs Canada Health Program. Visitors to Canada who aren’t permanent residents, but who have foreign coverage may be able to import their medications to Canada, check out this link to learn more.

The full cost of Truvada as PrEP is also covered by the Non-Insured Health Benefits (NIHB) Program. NIHB is a federal program that covers costs for certain medications and other health resources for some First Nations and Inuit people. Eligibility to receive NIHB has some restrictions based on a person’s legal recognition as part of First Nations or Inuit communities and their residency status. If you are a First Nations or Inuit person and are not sure if you are eligible for NIHB, you can contact the Atlantic office of NIHB at 1-800-565-3294 or NIHB National Headquarters at 1-866-225-0709.

Conclusion:

We’re at an exciting time in HIV treatment and prevention. The science of anti-retrovirals like PrEP, HIV treatment and PEP has changed rapidly, and already the medications people use for these treatments have gotten easier to take and have fewer side effects. It’s very possible that new developments will make PrEP and HIV treatment even better, such as taking injectable treatments or other changes in the use and availability of these drugs.

This section was adapted, with permission, from The Sex You Want Website.

You can learn more about where we got this information from at: PrEP Nova Scotia, Nova Scotia, Dalhousie, Nova Scotia, CBC

*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references