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Editorials

Winnipeg Free Press - PRINT EDITION

Weigh the HIV risks, and costs

Posted: 10/5/2013 1:00 AM | Comments: 0

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Manitoba's pharmacare program levies a deductible, based on income, for those whose drug costs are not covered by private health insurance. The out-of-pocket cost has been found to cause numerous HIV-positive Manitobans to stop taking their drugs. This is something the Health Department should address because of its implications for the spread of HIV.

Untreated, HIV is severely debilitating and potentially fatal. Staying well requires a regimen of drugs, which can run to $30,000 a year. Manitoba's pharmacare program requires an individual to pay between 2.85 per cent and 6.46 per cent of their income (adjusted for dependents) on drugs before the province covers the cost: A single person earning $30,000 pays a $1,334 deductible; someone with a family income of $80,000 and two dependents will pay $3,818.

Health practitioners in HIV treatment and advocacy say that, each year, between five and 10 per cent of people with HIV stop taking their drugs, citing cost. While understandable, this is worrisome because of the risk of HIV spreading -- Manitoba has Canada's fourth-highest rate of new infections. Further, it is much more expensive to treat once the disease progresses.

In Manitoba, 1,100 people are known to be living with HIV, and 700 are on drugs (a big portion of the others do not yet need medication). New cases are more likely to be heterosexuals, and aboriginal.

At an average per-person drug cost of $25,000 annually, the province should see the obvious benefit of ensuring those who can't afford drugs are covered. Alberta found costs for a person with HIV who delayed taking drugs are $1,600 a month, compared to $550 for those who start early. Nine Circles, a health clinic that runs the Manitoba HIV program with the HSC, says the cost of those starting their drugs late in Manitoba is $700,000 a year, compared to about $125,000 for others. Much of this would be picked up by pharmacare.

Early diagnosis and treatment requires early testing. The Manitoba HIV program needs to become truly provincial, with mobile units and health centres that can administer rapid tests, providing diagnosis within minutes, in rural or northern communities -- 25 per cent of new cases are outside Winnipeg -- and professional support in treatment and counselling.

Some argue Manitoba should cover all HIV drug costs, as this would cut dramatically new cases. Pharmacare, however, should not lift the expense from private plans, and those who are able should pay the deductible. Health Minister Theresa Oswald needs to target the risk of leaving people incapable of paying for drugs untreated, which includes those they can infect.

Editorials are the consensus view of the Winnipeg Free Press’ editorial board, comprising Catherine Mitchell, David O’Brien, Shannon Sampert, and Paul Samyn.

Republished from the Winnipeg Free Press print edition October 5, 2013 A16

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