Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
PrEP in Australia
We had a wonderful symposium tonight where key HIV clinicians, researchers and community members came together and oozed optimism for the 'PrEP program'. And I deliberately emphasize that PrEP is not just about taking a pill but a program i.e. users take Truvada and be engaged with their health provider in getting regular HIV/STI and kidney function testing (3 monthly).
There is no doubt about PrEP's effectiveness with the latest studies (PROUD and IPERGAY) showing 86% effectiveness in reducing HIV seroconversion. But if PrEP was used daily, effectiveness approached 100%.
It was interesting to see data from San Francisco (Street Survey) showing that 63% of PrEP users reported condomless anal intercourse with 6 or more partners in the last 6 months. This is important because PrEP is being used by those at highest risk for HIV (or in the words of Prof Bob Grant - those who are "popular and affectionate"). There is ongoing debate about who should access PrEP. Should it be only dispensed to those at highest risk for HIV as defined by the current Australian PrEP guidelines? This remains a contentious point as a modelling study by David Wilson from the Kirby has shown that PrEP was cost-effective only if we dispensed it to those at highest risk. However there was a strong sentiment in the room to allow PrEP to be freely available to whoever wanted it.
Even if we agreed that anyone should be able to choose to be on PrEP, access is still an issue in Australia. Although we are starting to see many clinics throughout Australia prescribing PrEP, access to Truvada can only be obtained by importing the drugs from overseas through online pharmacies like www.aids-drugs-online.com or www.alldaychemist.com This is approximated to cost ~$88/month. This may still put PrEP out of reach of those who are socioeconomically disadvantaged. So it was heartening to hear from A/Prof Darren Russell that the HIV Foundation in Queensland is launching a program to allow access to PrEP to those who are financially disadvantaged.
Another interesting point from the panel of speakers was that PrEP had multiple fringe benefits including empowerment, and healing of prior trauma and fear. This was emphasized particularly from current PrEP users.
It is difficult to determine how many people in Australia are currently using PrEP but we may still be at the stage where PrEP users are the innovators or early adopters. But as the community continues to grow in their experience of using PrEP, we may see this becoming an important part of the armamentarium of HIV biomedical prevention.