On 27-Mar-2017, there was a CATIE webinar on PEP/PrEP in BC. On this page, I have posted the transcript of the statement I made and I will respond to the questions that I was unable to answer due to time constraints. Questions can be emailed to DavieBuyersClub@gmail.com. Thanks again to CATIE for inviting me to share this story.
Good morning everyone,
Thank you for inviting me to share the story of the Davie Buyers Club with you today. I’m sorry to do so anonymously – this story will reveal my rationale for this.
I am a local health care provider in Vancouver. Much of my practice is serving men who have sex with men and at least once daily for the past couple of years, I am asked by my patients about PrEP.
I have diagnosed some of these patients with an STI like syphilis or rectal gonorrhea – infections highly associated with HIV seroconversion — and many of these patients asked me for PrEP. In the absence of a publicly-funded program or the right extended-health plan, I was powerless to help them access PrEP. Some of these patients would later be diagnosed with HIV; one young man in particular that I recall, seroconverted within six months of having this conversation.
There is a term called Moral Distress, which is defined as the stress that “occurs when one [believes one] knows the right thing to do, but institutional or other constraints make it difficult [or impossible] to pursue the desired course of action.”
I felt a high degree of moral distress seeing these men diagnosed with HIV despite there being a tool for prevention that would be highly effective and acceptable to them.
My distress and frustration with the status quo did not translate into action until I saw a presentation from Joshua Edward of the Health Initiative for Men. In the final slides of his PrEP 101 presentation, he touched on how generic importation was becoming increasingly common in countries like Australia and the UK, facilitated by instructional websites that referred to reliable online pharmacies. This was my ‘eureka moment.’
Evenings of research and vetting of the Australian & UK websites, the pharmacies they recommended, and regulations and laws of Canada and the USA culminated in the creation of my website in late June 2016. Named after Vancouver’s Davie street and the 2013 film Dallas Buyers Club, I hoped the clever name would make its purpose instantly recognizable.
As it stands now, DavieBuyersClub.com guides Canadians to connect with a primary care provider to be assessed for and prescribed PrEP, to register at a parcel-receiving service in the US near the Canadian border, to ship an FDA-approved generic version of emtricitabine/tenofovir, and to import the 90-day supply to Canada on the user’s person with their valid prescription. The medication is produced by Mylan in India, shipped by Dynamix International pharmacy in Thailand, and the cost is about $75 CAD per month.
Since June 2016, the website has had over 4,000 unique visitors. Communication with the pharmacies has given me a rough estimate that at least 100 Canadians are accessing PrEP through the Davie Buyers Club process. Though this is vastly smaller than the number who could benefit from PrEP, it has been extremely gratifying to hear about the difference DBC has made in the lives of those individuals. From a public health perspective, with 100+ people on PrEP who wouldn’t otherwise be able to access it, and a statistical Number Needed to Treat as low as 13 (to prevent one HIV infection), it is reasonable to suggest that people’s participation in this website has prevented up to 7 real-world HIV infections this year. By averting the estimated $1.3 milllion in direct and indirect costs associated with each HIV diagnosis in Canada, the website’s participants may have also saved the public purse up to $9.1 million.
I chose to remain anonymous because although I have no doubt that my creation of this website is a correct, ethical, and safe endeavor, I worry that my professional regulatory body could conflate my informative website as a concerned citizen with a recommendation by a healthcare provider to “go buy drugs on the internet.” As such, I don’t want to chance risking my livelihood or my capacity to continue to serve my patients.
Though I celebrate the early successes of this grassroots movement, it is crucial to note that there is much to be done. Canadians should NOT have to travel to another country to receive their medicine. Real PrEP accessibility by all who need and choose it, as a tool achieving zero new-infections, requires meaningful action by policy makers and the pharmaceutical industry — not just frustrated, concerned citizens on the internet. I would like to thank the presenters today, Joshua Edward, Dr. Mark Hull, and Leah Kelley for their continued hard work in this field. Many thanks as well to the Davie Buyers Club participants for making the website a success through their feedback, support, and promotion both online and off.
I did not receive any additional questions from CATIE or the webinar’s participants, other than the request to post the transcript of my statement. Please email me at email@example.com if you have an unanswered question after reading the main page and the FAQ.