Last year the HSE obtained legal advice regarding accessing medicines over the internet and related issues of concern for prescribers, users of generic PrEP, and non-medical groups sharing information about accessing online PrEP.

The full legal advice was published in June of this year and we’ve uploaded it here.

Of particular note for people currently using PrEP or considering it, the advice makes clear: “There is no law in Ireland prohibiting an individual patient from accessing medicine via the internet with a prescription.” However, it also notes that “It is a criminal offence to obtain prescription medicine without a prescription.”

So what does that mean? It means that the biggest risk you face if you get a prescription and order PrEP online is that it will be seized by customs. It seems unlikely that the authorities would want to prosecute people for ordering generic PrEP without a prescription, but since getting proper medical support is an important part of using PrEP safely, it’s probably a good idea for people to talk to a doctor about using PrEP and ask the doctor for a prescription.

The advice letter goes on to state that “there is no law restricting the specific information that a physician can and cannot provide to their patient” about PrEP, including referring them to sites like iwantprepnow.co.uk that provide comprehensive information about PrEP as well as links to sites that can supply generic PrEP.

Doctors will also be glad to know that they’re “not under a legal obligation when providing a prescription to either state where the medicine is to be sourced, or to satisfy himself/herself that a patient is not sourcing the medicine online.” You don’t necessarily have to talk to your doctor about where you’re going to get PrEP, but it’s not something they need to ask you about as a condition for writing a prescription or not.

The legal advice was obtained in July of 2016, but was released in June as an appendix to the “Action plan: Response to the national increase in HIV and STIs in MSM” report from the HSE’s National MSM HIV/STI increase response group interventions subgroup.

Today ACT UP Dublin held a demonstration outside the HPRA offices in Dublin to demand action from the Government and HSE to make PrEP available in Ireland without further delay. Our press release is available for download here.

This is the full text of the press release:

FOR IMMEDIATE RELEASE
August 4, 2017  2:00pm

Contact: act.up.dublin@gmail.com
www.actupdublin.com

PrEP STOPS HIV: Ireland needs PrEP now.

ACT UP Dublin today called on the Irish Government to make PrEP (Pre-Exposure Prophylaxis) available through the HSE immediately.

Angered by recent reports of increased seizures of generic PrEP by Irish Customs, and the HSE’s failure to provide even limited access through a pilot PrEP programme, advocates gathered in front of the HPRA offices on Earlsfort Terrace at lunch time to demand that the Minister for Health, Simon Harris, make a commitment to address Ireland’s HIV crisis and make PrEP available and accessible in Ireland without further delay.

New HIV diagnoses in Ireland are at record levels with one new HIV diagnosis every 18 hours. Delays on PrEP lead directly to entirely avoidable new HIV infections.

We know more about HIV treatment and prevention than ever before…
yet new diagnoses continue to rise.

Powerful new tools like PrEP have the potential to dramatically impact the epidemic…
yet they are unavailable here.

It’s time for this Government to show that it’s serious about Ireland’s HIV crisis. 

It’s time for leadership instead of foot dragging.

It’s time for PrEP in Ireland.

————————

In 2015, Ireland reported the highest number of new HIV diagnoses in the history of the epidemic. Preliminary figures from 2016 are even higher. The LGBT community has been particularly impacted as new HIV diagnoses among gay and bisexual men quadrupled between 2005 and 2015.

Pre-Exposure Prophylaxis for HIV—better known as PrEP—is a safe and highly effective way for HIV-negative people to prevent HIV using antiretroviral medication. The World Health Organization recommends that PrEP be offered to people at substantial risk of HIV as part of a comprehensive HIV prevention package.

Currently only one medication, Truvada, has been approved for use as PrEP in Europe. Although doctors in Ireland can prescribe Truvada as PrEP, the HSE does not yet provide reimbursement for the medication. Purchased privately through a pharmacy in Ireland, Truvada would cost hundreds of Euro per month—much more than anyone can realistically afford.

A growing number of people in Ireland, fed up with the Government’s failure to provide access to PrEP, are taking responsibility for their own and the community’s health. Following a model established in the UK (where it is legal to import generic medication for personal use) they are purchasing generic versions of PrEP online. In the UK, the widespread use of these generics is credited with helping to produce a dramatic reduction in new HIV diagnoses among gay and bisexual men in the last year.

UK-based websites like iwantprepnow.co.uk provide comprehensive information about PrEP—how it works, how to use it, how to get the necessary clinical support—and provide links to sites known to be reliable sources for authentic generics.

Unfortunately, the HSE currently provides no formal, dedicated clinical support services for PrEP users. Although the tests can be obtained through existing health services, those who are able to source more affordable generic versions online must manage their own clinical care. There is no consistent clinical monitoring by properly-trained medical providers, no systematic data about current PrEP users is being collected, no official information is available for current or potential PrEP users.

Instead of making PrEP available directly, or offering badly needed clinical support services to those who are taking initiative and already using PrEP, Irish health authorities are seizing packages, harassing suppliers, and trying to undermine public confidence in the only available route to obtaining PrEP for people in Ireland.

It’s time for Minister of Health, Simon Harris, to show leadership in tackling Ireland’s HIV crisis. 

Making PrEP available in Ireland without further delay must be a priority of this Government. 

What is ACT UP?

ACT UP Dublin is a local chapter of ACT UP, The AIDS Coalition to Unleash Power, an international HIV activist organisation. ACT UP Dublin was founded in July 2016 to take action on Ireland’s HIV crisis. We seek a more urgent and effective response to HIV from government, community organisations, and the public at large.

In response to the news that Irish Customs has been cracking down on imports of affordable generic versions of PrEP into Ireland, ACT UP Dublin has organised a demonstration for Friday, August 4th. We’ll be outside of the HPRA offices on Earlsfort Terrace (across from the National Concert Hall) from 12 to 2pm.

Please join us as we call on the government to show it’s serious about addressing Ireland’s HIV crisis by making PrEP available now.