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Once a day, Tim Lagman takes a pill that reduces his risk of contracting HIV, a precaution he’s taken since 2017.
Pre-exposure prophylaxis, or PrEP, is part of the daily routine for a growing number of Canadians at risk of exposure to HIV through sex or injection drugs.
While most people take it in pill form, Lagman, a sexual health educator and podcaster in Scarborough, Ont., is hopeful about a new, longer-lasting injectable option given every two months.
“The option of injectable PrEP would help people at risk of HIV to not worry about it so much,” he said.
“Every other month would be a lot easier for me, my peace of mind and my schedule.”
The long-acting injectable drug for PrEP, cabotegravir, sold under the brand name Apretude, was approved by Health Canada in 2024 to reduce the risk of sexually acquired HIV. The antiretroviral medication is administered every two months through intramuscular injections.
Quebec is the first province to cover the costs of injectable Apretude under its public prescription drug insurance plan.
“This is the first treatment by injection for prevention for HIV, so it is very, very special,” said Dr. Réjean Thomas, co-founder of Montreal sexual health clinic L’Actuel.
Thomas has been at the forefront of the fight against HIV and AIDS for decades and in that time has seen life-saving advances in treatment and prevention.
Quebec’s coverage of injectable PrEP is an important step, he says, and it could be a game-changer for some patients who struggle to take daily pills. The drug is among a number of recent advances in the treatment and prevention of HIV.
“It is very important because I think it’s the future in the fight against AIDS,” said Thomas.
‘A major advance’
In Canada, the number of new HIV infections increased by 35 per cent between 2022 and 2023, according to the Public Health Agency of Canada.
In explaining the rise, experts point to limited testing during the COVID-19 pandemic, new immigrants who may not have known their status or didn’t have access to treatment in their home country, and insufficient access to screening and prevention tools.
“It means that our strategies are not reaching the right population enough,” said Dr. Cécile Tremblay, an infectious disease specialist at the CHUM hospital in Montreal.
“We need to innovate in terms of ways to reach out to these people and make the treatment available.”
Between 2010 and 2021, new HIV infections decreased globally by almost 22 per cent, suggests a new study from The Lancet HIV medical journal. But in Canada, the opposite is happening: in 2023, there was a 35 per cent increase compared to the year before.
One of those ways, she says, would be to increase screening options so people can know their status and find out if they need treatment or prevention medication.
The next step, most experts agree, is making treatments free.
So far, Quebec is the only Canadian province to publicly reimburse for injectable Apretude for PrEP. Even with that coverage, or with private insurance, many users still have to pay part of the cost out-of-pocket. That’s the case for oral PrEP, too. The costs vary depending on the drug and the coverage plan.
“It is good that at least it’s reimbursed,” Tremblay said. “But we would still want to go further and to have all kinds of PrEP available completely free.”
Right now that’s only the case for some people, and only in some provinces. But many advocates, like Tremblay are pushing to change this.
Dr. Darrel Tan, a clinician scientist at St. Michael’s Hospital in Toronto, says the more options there are for HIV prevention, the better it is for people at risk.
“Not everyone has the ability for all kinds of personal, circumstantial, structural reasons to adhere to a daily pill-taking regime,” said Tan. “So this is a major advance and really something that meets an existing need.”
More options for HIV treatment, prevention
There are also injectable treatment options for people living with HIV, and promising developments in prevention drugs that last even longer. Trials for the drug lenacapavir showed injections just twice a year were highly-effective against HIV.
Ken Monteith, executive director of Quebec’s network of AIDS organizations (COCQ-SIDA) in Montreal, said things have evolved since the 1980s, when HIV was a fatal diagnosis with no treatment options. He said activism and advocacy helped push the science forward and that that work continues.
Monteith, 64, was diagnosed HIV positive in 1997. He takes antiretroviral medication every day to keep his viral load low. It keeps him healthy and prevents him from transmitting the virus.
The daily regiment works for him, but he sees how a long-acting injection could help others — for treatment or prevention.
“We want to make sure that people have all the choices possible so that we are adapting their treatment to their lifestyle and not the other way around,” said Monteith.
Despite advances, experts still see issues in Canada, and globally, that are getting in the way of reaching the United Nation’s goal to end AIDS by 2030.
Access to screening, treatment and prevention — and awareness about these tools — are barriers in Canada, said Tremblay, at Montreal’s CHUM hospital. But she also points to global challenges, including uncertainty around the future of U.S. foreign aid, upon which many HIV programs depend.
“Science has discovered the tools,” she said. “Now politics has to make sure that the services are there to distribute this means of protection.”
