This week at PrEPing Malta we held an interview with PrEP user Ivan Chircop. Ivan, originally from Malta, is now based in Sydney where he enrolled into the EPIC-NSW study.* After the 25% drop in the number of new cases among MSM within the first year of the study, the government subsidized PrEP through Pharmaceutical Benefits Scheme. Ivan now access prep through medicare for the price of AUD40 (circa €25).
Continue reading to learn more about Ivan’s experience with PrEP and being a trial participant.
How did you hear about PrEP?
My doctor had suggested it after we discussed that my ex-partner and I had decided to open our relationship. At that time, it was free if you enrolled to be part of the EPIC-NSWL study and were ready to commit to the research.
Where did you get reliable information about it from, and how long did it take you to decide whether to start taking it or not?
After our discussion with my doctor, we spoke what is the process and what’s the commitment of it all. I was also given a booklet about the medication and its research. I decided to get into the trial soon after i I got all the information from my doctor.
When have you started using PrEP and what instigated you to try it?
I started using PrEP nearly 3 years ago when my relationship with my then partner stopped being monogamous I thought it was a wise thing to do since my relationship became open and we both started having casual sex with people whose HIV status we did not know.
What type of services and support are you being offered by the researchers and health care providers in the trial?
After I subscribed to be part of the trial, I was called in to have a urine test, a rectal swab, a throat swab, and a blood test for HIV, and liver and kidney function. I was given 3 bottles (3 months’ worth of medication - 1 pill per day). During the same appointment, we scheduled another appointment to have all test again a week before my medication runs out. Also, every 3 months, I received an email questionnaire about my sexual life and activities, if I felt any side effects and if I have missed any of my daily dose of my medication.
Did you face any barriers while considering PrEP uptake?
None at all
Why do you think there is an element of stigma associated with PrEP?
I felt a bit of stigma at the beginning of “what if it won’t work and……?” but my Doctor’s opinion and how it was marketed in the gay community, I got over the stigma very quickly.
Do you think that PrEP has affected your daily life (any side effects)?
Not at all
Why do you think is necessary for more people who might qualify for it to actually consider it?
I think it’s necessary for more people to consider it because it works! It’s a tool to stop the acquisition of HIV until scientists find a cure.
Ivan’s is a PrEP success story. Ivan started taking PrEP after a discussion with his clinician, having received all information and underwent the necessary tests. One should discuss their intentions to start taking PrEP with their clinician who could recommended the necessary tests before starting PrEP and also other monitoring tests that might be necessary from time to time. Ivan was one of the lucky ones who managed to access PrEP through a trial before the government decided to subsidize it.
Unfortunately, the story is not transposable to a local context. Frankly, running a similar study in Malta could be something the Public Health Directorate together with the Ministry for Health might consider. However, we argue that this would slow the process of reaching out to all those individuals who would be eligible for PrEP.
Currently PrEP is not accessible through our healthcare systems and nor there are any PrEP trials. However, there are PrEP users who are accessing the medication through online channels. while it is important to have a discussion with your health care provider before starting any type of new medication, these discussions are more necessary than important when the medication considered requires tests to ensure efficacy and prevent any possible complications in the future.
Not having access to PrEP through healthcare system and have only online access for the medication through online channels can prevent people from having these discussions putting their health in danger in case of complications.
To add insult to injury, the new investment which the government has recently reported does not seem to cover PrEP; another missed opportunity for Malta to get on top of the ever increasing number of new HIV infections in Malta.
For us to have similar results, we need to either introduce PrEP on the NHS without any further delay (or if not financially feasible, subsidized by the government), bigger and wider community campaigns which seek to inform those at high risk of acquiring HIV about PrEP and how to access it.
*The EPIC-NSW (Expanded PrEP Implementation in Communities in NSW) study is run by the Kirby Institute aimed to assess the impact of rapid expansion of PrEP amongst those at high risk of acquiring HIV. (Learn more about the EPIC-NSW study on https://endinghiv.org.au/stay-safe/epic-nsw/).