The case for PrEP

EVERY morning with breakfast, Daniel MacPhail takes a little blue pill to prevent himself from contracting HIV.

The bottle has a permanent home next to his toaster, helping to ensure that it’s the first thing he thinks about when he gets out of bed. It has become a routine, and one that MacPhail said he learned from his friends living with the virus.

“It’s not like taking a vitamin,” he said.

“You can skip vitamins every now and then and you’ll probably still be okay.”

The pill in question is Truvada, and it’s a form of pre-exposure prophylaxis (PrEP) — a HIV prevention method. In a two-and-a-half year program carried out in San Francisco, zero of the 600 men taking PrEP contracted the virus, and it has proven just as effective in similar studies carried out around the world.

It was approved by the US Food and Drug Administration (FDA) in 2012, but is yet to be approved or subsidised here in Australia.

For most local gay men on PrEP, the most viable way of sourcing the pill is to order it online from overseas, but this costs upwards of $100 per script and is a time-consuming process.

For it to be cheap and accessible, Truvada needs to be approved by the Therapeutic Goods Administration (TGA) — the country’s peak regulatory body for medicines — and placed on the Pharmaceutical Benefits Scheme (PBS), bringing Truvada down to around $38.80 per script.

ACON chief executive Nicolas Parkhill believes that being able to access it cheaply in Australia is crucial.

“If it is not subsidised then gay men on lower incomes may not be able to afford it,” he said.

“While there are some options around importation, our strong preference is for our community to be accessing it through established Australian structures.

“Of course, anyone considering online ordering must speak to a doctor familiar with HIV to get a prescription and have a discussion around whether PrEP is right for them.”

During the International AIDS Conference in Melbourne last year, all Australian health ministers committed to working towards the elimination of new HIV transmissions by the end of 2020.

ACON’s Ending HIV campaign is one of the key players in the push towards this goal, raising awareness around sexual health and the importance of trimonthly testing.

“Over the last few years there has been an incredible momentum building around Ending HIV,” Parkhill said.

“We are starting to see gay men mobilise around the very real possibility of a future without HIV transmission.

“This is demonstrated through increased testing rates, maintenance of safe behaviours and an increasingly nuanced understanding of the role and benefits of early treatment.”

Across the pond, the benefits of accessible PrEP are already apparent.

In San Francisco, where researcher Dr Robert Grant has undertaken various studies on HIV prevention, new transmissions have dropped by 30 per cent since PrEP was approved.

In an interview with BETA, Grant stressed that gay men who are at risk of contracting HIV should have access to Truvada.

“An important finding was that people who need PrEP the most, want it the most,” he told the long-running HIV news and features journal.

Grant also discussed the fear held by some that by making PrEP readily available, other safe sex practices such as condom use would be neglected.

“Interestingly, in our studies PrEP users themselves sometimes say, ‘well, if I’m going to use PrEP, I’m going to stop using condoms’,” he said.

“However, they often surprise themselves when they continue to use them… people get engaged and start thinking about HIV in calm moments, and they begin finding a variety of ways to protect themselves.”

Daniel MacPhail, a Melbourne resident who first found out about PrEP in a bar overseas, said his views around sex and HIV haven’t changed that much.

“I’ve always had HIV around me,” he said.

“My mum did a lot of work for the Queensland AIDS Council and their needle exchange program.

“Then growing up around gay culture I had a lot of friends living with HIV, so I knew what was going on.

For people that haven’t grown up around HIV, MacPhail believes PrEP helps their anxiety disappear.

“When that anxiety melts away, so too does the fear,” he said.

“And when the fear goes away, so does the stigma.”

In NSW, Parkhill believes having Truvada approved will allow Australia to emulate the success of PrEP overseas in areas like San Francisco.

“We have similar environmental conditions in NSW to San Francisco in terms of increased testing and early treatment,” he said.

“So we are very excited about the potential of PrEP in the NSW context.”

An application by pharmaceuticals giant Giliead has been sent to the TGA to have Truvada as PrEP approved locally, but the outcome of this application won’t be known until early next year. If approved, doctors will be more inclined to prescribe Truvada as a form of HIV prevention, but this won’t affect its current cost. This is because no application to the PBS have the drug subsidised has been made as yet.

“The introduction of community-wide access to PrEP is going to require a lot of heavy lifting, not just from our community organisations, government and research partners, but from gay men themselves,” Parkhill said.

“The upside to that is that we will be a stronger, healthier, and more resilient community, and the incredible suffering and pain of the early days of the epidemic will not have been in vain.”

ACON’s Ending HIV’s latest awareness campaign is around HIV testing, as part of the move towards ending new transmissions over the next five years.

A number of rapid HIV testing clinics are currently available in Sydney, Melbourne and Brisbane. This includes ACON’s new, free community testing service a[TEST], one of which is located on Oxford St, the historical heart of LGBTI Australia. Gay men accessing the service can undertake a HIV test and have the results in 30 minutes.

“In NSW we have made good groundwork in reducing the transmission of HIV among gay men by 2020, but to achieve this momentum must be enhanced,” Parkhill said.

“PrEP has the potential to transform the Australian HIV response.”

For more information on PrEP, visit endinghiv.org.au or acon.org.au

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**This article was first published in the October edition of the Star Observer, which is available to read in digital flip-book format. To obtain a physical copy, click here to find out where you can grab one in Melbourne, Sydney, Brisbane, Adelaide, Canberra and select regional/coastal areas.