Israeli Health Ministry Approves Pre-exposure Prophylaxis for HIV

In unprecedented move, Knesset panel agrees to ministerial plan for instituting PrEP protocol, based on drugs already administered to carriers of the virus that are also effective in preventing infection.

Ido Efrati
Ido Efrati
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A red ribbon is put on the sleeves of a man by his friend to show support for people living with HIV during a program to raise awareness about AIDS on World AIDS Day, in December 2013.
The red ribbon symbolizing support for people living with HIV, on World AIDS Day in 2013.Credit: Reuters
Ido Efrati
Ido Efrati

The Israeli Health Ministry has for the first time approved pre-exposure prophylaxis that will help prevent HIV infection. The PrEP process, as it is called for short, involves taking drugs that substantially reduce the chances of contracting the immunodeficiency virus that causes the infection.

Specifically, the PrEp protocol calls for using the same drugs that are administered to carriers of the virus, and prevents its development in the bloodstream. Taking these precautions when one is HIV-negative effectively prevents possible infection.

On Tuesday, Neta Harel, the Health Ministry’s national welfare coordinator for AIDS and TB, reported at a meeting of the Knesset's Labor, Welfare and Health Committee that a ministerial subcommittee dealing with ways to fight the spread of HIV and AIDS had recommended implementing PrEP in Israel. Harel noted that Moshe Bar Siman Tov, the ministry’s director general, had accepted the recommendation.

Ministry officials are now dealing with the operative aspects of implementing the procedure, including how to distribute the drugs in question to AIDS centers, health maintenance organization branches serving at-risk groups or other places. Likewise, the Health Ministry is expected to examine its arrangements for distributing drugs and their availability to at-risk groups. Officials are examining which groups to focus on: for example, gay men who have sex with other men considered to be at-risk because of their behavior, drug addicts who shoot up with needles, or women in at-risk groups.

“While anyone can be infected by HIV, we must not ignore the fact that men who are having sex with other men are the group with a very high infection rate relative to its size. Thus, there are some in the gay community who will be prevented from contracting infection by this [PrEP] treatment," said Yuval Livnat, CEO of the Aids Task Force. He adds that while such men do not constitute a large proportion of the community, they typically do not use condoms on a regular basis.

Using Truvada before having sex is effective in preventing HIV,” says Dr. Hila Elinav, an expert in infectious diseases at Hadassah University Hospital, referring to an anti-HIV drug that is already in use. “There are people who do not use a condom, and so we need to prevent them from at least contracting HIV. The people who receive the treatment need medical follow-up.”

At the meeting in the Knesset, Dr. Gal Wagner, a physician at the Gan Meir Proud Clinic in Tel Aviv, said: “We have the medical and social tools to eradicate the HIV plague. They also included PrEP. The American Center for Disease Control confirmed Truvada’s effectiveness in preventing diseases. The World Health Organization also concluded that it is an important treatment for people at risk, and in November it recommended giving it to everyone at risk. The infection rate in San Francisco is similar to that of Israel, and the prevention scheme there includes a series of exams and treatment for HIV, together with preventative medical treatment. There are zero infections among those who took the treatment.”

Increasing numbers of men in the gay community are talking about prophylactic treatment, Wagner noted, adding, “It has already been included in the (drug) basket in France, and in America, too. We see that other countries are joining in." He noted that there are three new cases in Israel of homosexual men who have become HIV carriers, and that 10 percent of homosexual men in Tel Aviv can be categorized as such.

“We are very close to reaching a number [of carriers] that demands treatment, according to criteria abroad and in places where the [preventive] treatment is available,” Wagner said. “Today, there is a black market and demand for Truvada from abroad. The community wants to take responsibility for its health. We need the Health Ministry to help us.”

Following the discussion, committee chairman MK Eli Alalouf (Kulanu), said in conclusion: “We will continue discussions and have determined that by June, there will be a working plan in place related to the pride community. I will ask that the Health Ministry present its progress on the subject. I will hold meetings with the director general and the minister.”

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