# PrEP Medication



## robertjordansullivan (23 Aug 2016)

I hope this is the right section to ask this question for medical personnel working on base/in recruitment on safe sex/prevention; if not, I apologize!

I've received my offer and I'm currently taking Truvada as PrEP in combination with condoms. I started a little while ago under supervision of my civilian doctor, long after the recruitment medical exam. A few questions:

1. Am I permitted to take medications like PrEP during BMQ or do I have to stop taking it until after BMQ?
2. If I am permitted, what do I need to provide (prescription, note from doctor, etc.) and when (pre-BMQ, upon arrival at BMQ)?
3. Can base pharmacies provide refills for Truvada? I ask because from what I understand, I cannot use civilian doctors/pharmacies once in the CF.
4. Is it covered by the CF health plan?

Please only reply if you understand what PrEP is or have experience with it in the CF. Thank you!


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## mariomike (23 Aug 2016)

For reference, perhaps this will be merged with,

Medication During Basic Training  
http://army.ca/forums/threads/117979.0

Prescriptions during BMQ  
http://army.ca/forums/threads/98313.0

A question regarding taking meds at BMQ
http://army.ca/forums/threads/86663.0

etc...

_As always,_  Recruiting is your most trusted source of information.


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## Blackadder1916 (24 Aug 2016)

r082316a said:
			
		

> . . .  I started a little while ago under supervision of my civilian doctor, long *after the recruitment medical exam*. . . .



Did you contact the recruiting centre medical section to ask these questions or to inform them of a change in your health history?


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## robertjordansullivan (24 Aug 2016)

Thank you very much for your replies!

I followed the links, but my medication is a different from those cases:

1. I can cease taking PrEP at any time, starting again whenever I choose, because it's a preventative medication. I'm not going to be in pain, have allergies, acid reflux, or side effects if I just stop or start taking the medication.
2.


			
				Blackadder1916 said:
			
		

> Did you contact the recruiting centre medical section to ask these questions or to inform them of a change in your health history?


I want to contact them, but I'm on the fence. I don't think a lot of medical professionals (civilian or Forces) understand PrEP and there may still be a lot of stigma around anything HIV-related, despite the fact that this is being use as a pre-exposure prophylaxis, much like getting your Hep B, Hep A, or HPV vaccine.

I guess what I really want to ask is: would it just be easier to stop taking it and not bring the medication to BMQ, but bring my prescription from my doctor and see if MIR will will approve and fill it, leaving no question as to whether or not it's permitted? Or should I just continue taking it and let recruitment know?


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## PuckChaser (24 Aug 2016)

How do you know what medical professionals understand in the Forces? You're not in yet, nor are you a medical professional. You need to speak with one to get their guidance, I'm willing to bet you're not the first, nor last.


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## mariomike (24 Aug 2016)

:goodpost:



			
				r082316a said:
			
		

> I followed the links, but my medication is a different from those cases:



Not surprising. There are many different medications!  

But, "Medication during BMQ" is a Frequently Asked ( and answered ) Question.

Good luck!


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## sarahsmom (24 Aug 2016)

r082316a said:
			
		

> 3. Can base pharmacies provide refills for Truvada? I ask because from what I understand, I cannot use civilian doctors/pharmacies once in the CF.
> 4. Is it covered by the CF health plan?
> 
> Please only reply if you understand what PrEP is or have experience with it in the CF. Thank you!



4. It is covered by the DND/CAF drug plan, without special authorization. However it needs to be prescribed by a military doctor or civilian doctor contracted by the military, or by a specialist the military referred you to. Type in the "truvada" as the brand name at the following link : 
http://www.cmp-cpm.forces.gc.ca/hs/en/drug-benefit-list/index.asp#regular-benefit

3. Most base pharmacies likely do not carry this drug. If you have a prescription issued to you by your military MO or other health provider in the CF, AND have coverage under Blue Cross (Reg F, Res for duty injury or while on long term contract) then you can use a civilian pharmacy to fill your prescription. Check with your MIR to see which pharmacies they have MOUs or agreements with to make your life easier.


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## ModlrMike (24 Aug 2016)

r082316a said:
			
		

> I want to contact them, but I'm on the fence. I don't think a lot of medical professionals (civilian or Forces) understand PrEP and there may still be a lot of stigma around anything HIV-related, despite the fact that this is being use as a pre-exposure prophylaxis, much like getting your Hep B, Hep A, or HPV vaccine.



*No, you're not on the fence, you have an obligation to advise the CF of a change in your medical status. *

Regardless of what you think, the simple act of taking PrEP results in a temporary medical category, and makes you unfit to attend basic training. The CDC defines PrEP as "Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected." Despite any stigma you may think is attached to HIV, the fact that you think your risk is sufficient to take PrEP of significant concern to the CF.

Even if you stopped taking it, you might have to be off medication for an extended period to ensure you remain disease free.



			
				r082316a said:
			
		

> I guess what I really want to ask is: would it just be easier to stop taking it and not bring the medication to BMQ, but bring my prescription from my doctor and see if MIR will will approve and fill it, leaving no question as to whether or not it's permitted? Or should I just continue taking it and let recruitment know?



No, as the end result would be the same, and you might wind up being released for not disclosing a pre-enrollment medical condition. The CF takes a very dim view of people not being honest and transparent during the enrollment process.


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## robertjordansullivan (24 Aug 2016)

PuckChaser said:
			
		

> How do you know what medical professionals understand in the Forces? You're not in yet, nor are you a medical professional. You need to speak with one to get their guidance, I'm willing to bet you're not the first, nor last.



Thanks for your reply, I hope that didn't come across condescending. It's just common here on the civilian side for doctors to have a lack of understanding. Sorry to assume.





			
				paleomedic said:
			
		

> 4. It is covered by the DND/CAF drug plan, without special authorization. However it needs to be prescribed by a military doctor or civilian doctor contracted by the military, or by a specialist the military referred you to. Type in the "truvada" as the brand name at the following link :
> http://www.cmp-cpm.forces.gc.ca/hs/en/drug-benefit-list/index.asp#regular-benefit
> 
> 3. Most base pharmacies likely do not carry this drug. If you have a prescription issued to you by your military MO or other health provider in the CF, AND have coverage under Blue Cross (Reg F, Res for duty injury or while on long term contract) then you can use a civilian pharmacy to fill your prescription. Check with your MIR to see which pharmacies they have MOUs or agreements with to make your life easier.



Thank you! This information is a great help to me to follow the proper channels.





			
				ModlrMike said:
			
		

> *No, you're not on the fence, you have an obligation to advise the CF of a change in your medical status. *
> 
> Regardless of what you think, the simple act of taking PrEP results in a temporary medical category, and makes you unfit to attend basic training. The CDC defines PrEP as "Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected." Despite any stigma you may think is attached to HIV, the fact that you think your risk is sufficient to take PrEP of significant concern to the CF.
> 
> ...



Could you provide any proof that taking Truvada makes one unfit for joining the CF? Anyone who engages in sex is at risk for STIs, including HIV. Would using condoms, being vaccinated for Hepatitis, and being educated on sexual health also exclude one from joining?

Why would I have to stop taking a preventative medication to "remain disease free?" I'm taking the medication to avoid contracting a virus in the first place. 

To everyone else in the forum, thank you for answering my questions with information, guidance, and constructive advice.


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## ModlrMike (24 Aug 2016)

r082316a said:
			
		

> Could you provide any proof that taking Truvada makes one unfit for joining the CF?



I don't have to prove anything. You as the applicant have to prove you're fit for enrollment.



			
				r082316a said:
			
		

> Anyone who engages in sex is at risk for STIs, including HIV.



Yes, in the broader context.



			
				r082316a said:
			
		

> Would using condoms, being vaccinated for Hepatitis, and being educated on sexual health also exclude one from joining?



A false argument; you're describing justifiable prudence. If your risk is sufficient to need to take PrEP, then that's a completely different consideration. Personally, I don't care why you think you're at risk. The CF on the other hand cares a great deal.



			
				r082316a said:
			
		

> Why would I have to stop taking a preventative medication to "remain disease free?" I'm taking the medication to avoid contracting a virus in the first place.



Because if your risk is sufficient to need to take preventive medicine, you would need a period of observation to ensure you hadn't contracted the virus in the first place. PrEP reduces the chance of infection, it does not eliminate it. You could be HIV+ right this second and not know it.

Just so that you know where I'm coming from, I've done hundreds of recruit medicals in my 30 years of service in the CFMS. You can accept or reject my advice as you see fit, but I sense from your previous replies that you only want advice that conforms to your already declared position.


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## robertjordansullivan (24 Aug 2016)

> A false argument; you're describing justifiable prudence. If your risk is sufficient to need to take PrEP, then that's a completely different consideration. Personally, I don't care why you think you're at risk. The CF on the other hand cares a great deal.



I am at risk just as much as someone who chooses only to use condoms as a form of risk prevention. Increasing my protection does not increase my risk. The former you know for a fact, the latter is based on your assumptions of my behaviour. I would never assume what is best for your health, and neither should you.



> Because if your risk is sufficient to need to take preventive medicine, you would need a period of observation to ensure you hadn't contracted the virus in the first place. PrEP reduces the chance of infection, it does not eliminate it. You could be HIV+ right this second and not know it.



I asked for people who were knowledgeable with PrEP.

A civilian doctor will not prescribe PrEP to anyone until they have been tested for their HIV status, STIs, bone density, and kidney function (among other parameters). You cannot be prescribed PrEP in Canada if you are HIV positive.

I would expect a military doctor to run the exact same tests on me before prescribing Truvada. The period of observation you're talking about is standard.

I've never stated that PrEP eliminates the risk. Just like condoms and vaccinations, PrEP only reduces risk. But the point is, it reduces risk more than just using condoms. If we already have seatbelts, why do we need airbags?


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## Blackadder1916 (24 Aug 2016)

r082316a said:
			
		

> . . .
> 
> *I asked for people who were knowledgeable with PrEP.
> *
> ...



You're getting a tad defensive, but considering the "sensitivity" of the underlying issue, some (but not much) defensiveness may be expected.  However, the suggestions you've received so far, especially Mike's, are probably the best you are going to receive on these means.  This is an open forum on the internet, you don't get to determine who can or cannot respond to your question.  What makes this particular forum better than most is that it is well moderated and generally the individuals who respond intelligently have experience directly related to the subject broached.  The actual pharmaceutical you've been prescribed or the reason that you've been prescribed it is irrelevant.  What ModlrMike said applies in most cases.  What you think is a legitimate reason or what your civilian doctor thinks is legitimate is irrelevant; the only one who matters is the applicable CF health authority at whatever level.  Some who have responded to you have been that applicable authority at the lowest level, the one who actually examines potential recruits, however most questions such as yours would be referred to the RMO in Ottawa.  Obviously, if it is an issue (and you don't get to decide that), it cannot be addressed (and corrected) unless recruiting medical authorities are informed prior to you showing up at BMQ.  It "may not" be an issue, the only way to find out is to inform the RC.




			
				r082316a said:
			
		

> 4. Is it covered by the CF health plan?



You cannot think of the "The Canadian Forces Spectrum of Care" in the same manner as you do being covered by provincial health insurance and (perhaps) a supplementary medical insurance plan.

http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/index.pagehttp://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/index.page


> The CF Spectrum of Care document provides direction to CF health care providers, Base/Wing Surgeons, Dental Detachment Commanders, CF chain of command and CF members. It authorizes the use of public funds to ensure that CF members have access to a standard of health services that is comparable overall to that received by Canadians under provincial health care plans. Inclusions and exclusions apply everywhere in Canada and abroad, regardless of what health services are covered by provincial or allied health plans. The Spectrum of Care’s primary focus is not on equity with the provinces, but rather on operational benefit: i.e having the right person available for operations with the right level of health fitness.
> 
> . . .
> 
> The Spectrum of Care document consists of guidelines that are regularly updated in response to changes in technologies and in provincial health care plans. It does not constitute a list of rights, and the final decision as to whether or not a service is provided, approved, and/or funded for a specific CF member is made by the applicable senior medical or dental authority.



Even though Truvada may be included in the Drug Benefit List (as a previous poster mentioned) does not necessarily mean that it would be authorized for an "off-label" use (as PrEP is).  I do not know and probably most of the usual suspects that show up here are in the same level of ignorance.  Again, the only way to find out is to inform CF medical authorities.  If you're looking for "proof" in the form of a policy document that says either yes or no, you may be out of luck.  Just as you experienced that a lot of civilian medical types were not familiar with PrEP, it may be equally so in the military, maybe more so since the expectation (mine, I don't know about the institution) is that those who fall within Truvada's high risk profile may be less likely to be in military service.  Questions concerning whether there may be category implications or drug cost coverage in these rare, one off cases are made based on the individual circumstances once all the facts are known.  Don't expect to show up and get an immediate answer.


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## robertjordansullivan (24 Aug 2016)

Blackadder1916 said:
			
		

> The actual pharmaceutical you've been prescribed or the reason that you've been prescribed it is irrelevant.  What ModlrMike said applies in most cases.  What you think is a legitimate reason or what your civilian doctor thinks is legitimate is irrelevant; the only one who matters is the applicable CF health authority at whatever level.



Thanks for your concise reply, I appreciate it! I didn't want to exclude people from replying, I suppose I should've just said that I would like to hear from people with experience in the matter. I apologize.

Would you say then that the best course of action is to come into BMQ without any prescriptions or medications, and then eventually have a conversation with medical personnel regarding my options? I don't want to cause any issues for myself or other members, but I also care about my own health. I want to find a balance.



> You cannot think of the "The Canadian Forces Spectrum of Care" in the same manner as you do being covered by provincial health insurance and (perhaps) a supplementary medical insurance plan. Even though Truvada may be included in the Drug Benefit List (as a previous poster mentioned) does not necessarily mean that it would be authorized for an "off-label" use (as PrEP is).  I do not know and probably most of the usual suspects that show up here are in the same level of ignorance.  Again, the only way to find out is to inform CF medical authorities.



Thank you for mentioning that it's not as clear cut as my previous job's private insurance. Truvada is no longer off-label. It's been approved as HIV prevention in combination with safer sex practices since February of this year, see this link: http://www.cbc.ca/news/health/truvada-hiv-1.3469836. This is in civilian healthcare, however. Not sure if that affects healthcare in the Forces.


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## Blackadder1916 (24 Aug 2016)

r082316a said:
			
		

> Would you say then that the best course of action is to come into BMQ without any prescriptions or medications, and then eventually have a conversation with medical personnel regarding my options? I don't want to cause any issues for myself or other members, but I also care about my own health. I want to find a balance.



No!  As ModlMike previously posted "you have an obligation to advise the CF of a change in your medical status".  By the simple fact that you saw a medical practitioner and started on a significant course of medication, your health history has changed.  It may or may not affect the medical category you were assigned (personally, I think it may turn out to be an non-issue after review by Ottawa). You may get by not informing the RC and embark as you suggest above.  If that is the case then you would be a lying sack of shit and I would have no regret to raising a good glass of whisky in celebration of the organization if they chucked you out on your ass for irregular enrollment.  Concise enough?  Have I made myself clear about your best course of action?


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## Scott (25 Aug 2016)

And there we have it.

I don't think there's anything more to be contributed here.

If you have changes to your medical condition you are required to inform the CF. Period. End of. Full stop. The "experience in the matter" is that people have been chucked out on their ass for not disclosing changes to their medical condition ie, being "lying sacks of shit" (you lie by omission, just so I don't have to see that hair get split), so it behooves you to be straight about it.

I'll be straight with you: we have just a little bit of experience with folks coming here and trying to get people to say what they want to hear. That's what it looks like, objectively, to me. You asked for advice and got it from one of the best sources on this forum. Take it or do not take it. I'll be more straight: you come off as willfully deceptive. Nobody appreciates that.

Locked

Scott
Staff


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