The Spanish national health system (SNS) has started financing a tablet that can prevent HIV infection in high-risk patients.
The pre-exposure prophylaxis (PrEP) with emtricitabine (FTC) and tenofovir disoproxil fumerate (TDF), is given to people at risk of HIV infection, such as men who have intercourse with other men, HIV-negative transsexuals with certain characteristics and HIV-negative sex workers who say they do not habitually use condoms.
This was decided earlier this year by the Interministerial Committee for Pricing of Medication, which sets the prices for financing drugs on the SNS and in which several ministers and the regional authorities form part. The tablets, which won't cost the patients anything but are valued at 187.39 euros, will be dispensed by hospital pharmacies and authorised centres. They will be prescribed by HIV and Sexually Transmitted Infection experts who work in SNS centres which provide essential care for and monitoring of patients for whom this medication is suitable.
As well as homosexual men and HIV-free sex workers who do not normally use condoms, HIV-negative transsexuals over the age of 18 will also have access to the medication under certain criteria.
The use of tenofovir with emtricitabine has been used to prevent HIV in Spain since 2016, but no decision had been taken about whether to include it in national health financing. On 10 October, the secretary of the National Plan against Aids, Julia del Amo, announced at the XI Congress of the State HIV and Aids Coordinator (Cesida) that it would be included from now on.
Sunday 1 December is World Aids Day, and the news that this tablet is now free in Spain has been welcomed by those involved in the medical sector. Recent figures from the European Centre for the Prevention and Control of Illnesses and the European Men-Who-Have-Sex-With-Men Internet Study have shown that half a million homosexual men in Europe have no access to PrEP, although they need it.
This is despite the fact that its use to prevent HIV infection in people who are HIV-negative, and its effectiveness, have been well documented. For example, a study in 22 health centres in Paris of 2,000 men who have sex with other men indicated that providing PrEP daily or upon request reduces the number of new contagions to almost zero.
According to the latest official figures, between 130,000 and 160,000 people in Spain are infected by HIV, and about 18 per cent are unaware of it. Every year about 3,400 new cases are diagnosed in this country, most of them young men who have sexual relations with other men.
This makes it difficult for Spain to achieve the 90-90-90 target set by ONUSIDA for 2020: 90 per cent of people with HIV diagnosed; 90 per cent of those diagnosed receive treatment; and 90 per cent of those who receive treatment have an undetectable viral load.
Spain would fail on the first of these objectives, because only 82 per cent of the Spanish population with HIV has been diagnosed. However, in terms of the other two targets, the country registers 95 per cent.