Day 4 started with a session on PrEP in High Income Settings with a panel from USA and Europe and Jean -Michel Molina from France where PrEP has already been implemented.
It was interesting to listen to the discussion - everyone was in agreement of the value of PrEP and no-one had concerns about resistance or side-effects. There was debate about daily PrEP or on demand PrEP and how the choice will improve uptake and adherence.
There was concern about the cost of PrEP and who will access it and Keith Rawlings from Gilead in USA gave an excellent presentation on the demographics of the HIV positive population in the USA and the demographics of the PrEP accessing population - those that need it most do not access it.
There was also an interesting presentation about delivery modes - tablets, long acting injectables or slow release preparations - a Dapivirine vaginal ring.
Should treatment for Rectal Gonorrhoea and Chlamydia include PrEP??
The most surprising statement that was made today was in the last session of the day by Dong Wie from Nanjing China. In China, they only have access to six antiretroviral drugs. I found that difficult to believe but made me appreciate the range of drugs that we have in Australia.