A PrEP trial of epic proportions

BEFORE taking pre-exposure prophylaxis (PrEP), Sam Thomson had a very different attitude towards HIV-positive men as prospective sexual partners.

“I think I was pretty harsh towards people who were HIV-positive, regardless of whether they were treated and undetectable or not,” he told the Star Observer.

“That was uneducated of me, because if we were using condoms there would be no reason we couldn’t have sex.”

PrEP is a drug that has been proven to significantly reduce one’s chance of being diagnosed with HIV when taken daily.

However, being on PrEP is more than just taking a pill every day, because to be truly effective health professionals advise that it also involves regular engagement with a GP, regular STI testing and getting relevant support to ensure it’s being used correctly.

Studies around the world have shown it can reduce the likelihood of HIV infection by up to 90 per cent, and in some instances, more.

Thomson began taking the PrEP four months ago and said his attitudes around HIV and sex have changed immensely.

“It helps to reduce the fear around sex because of the reduced risk of acquiring HIV,” he said.

“For men who have sex with men but don’t necessarily identify as gay it also removes the barrier of exploring sex because there’s no fear they might become HIV-positive.”

PrEP is yet to be approved in Australia by the Therapeutic Goods Administration (TGA) or subsidised on the Pharmaceutical Benefits Scheme (PBS), processes that may not be in effect until the end of 2017.

As a result many men currently import the drug from overseas, which can be a costly and time-consuming process.

However, a new study called EPIC NSW will allow up to 3700 people in the state at high risk of acquiring HIV to have access to PrEP over the course of two years.

The study is being run by the Kirby Institute in collaboration with a number of partners, including ACON, with the aim of assessing the impact of PrEP among those at highest risk.

Professor Andrew Grulich from the Kirby Institute said the increase of gay men on PrEP in NSW would have a major impact.

“Last year we got news from studies in France and the UK that showed the drug was 90 per cent effective,” he told the Star Observer.

“And the only people in existing studies who got HIV were those that stopped taking PrEP, so that indicates the statistic is closer to 100 per cent.

“We estimate with EPIC NSW that we should be able to decrease new infections by 50 per cent… and that’s not only within the high-risk group – we’re also preventing any potential secondary infections that would’ve come from those men.”

Grulich added that the goal of reaching zero new transmissions by 2020 was now in sight.

“The 2020 goal might have seemed until recently a bit ‘pie in the sky’, but we believe PrEP gives us the chance to hit the epidemic on its head,” he said.

ACON’s Director of HIV and Sexual Health, Karen Price, said the NSW Government-funded study was designed to test the reality of PrEP being readily available in NSW.

“It’s a real world implementation study that aims to demonstrate the impact of PrEP at a population level when you provide it to large numbers of people at highest risk of acquiring HIV,” she told the Star Observer.

“If you imagine a world where PrEP was available and men could afford it… we’re studying what the effect of large scale population coverage for those most at risk might be like.

“Those at highest risk who would have been more likely to acquire HIV will now be protected over the next two years.”

Price added that while PrEP is one of the key elements to combatting HIV, there are many other HIV prevention measures that should remain firmly in place.

“PrEP is the missing part in NSW. Because we have high levels of testing, high levels of treatment, and a strong safe-sex culture around condom use, we see PrEP as a key prevention tool that can tip the balance,” she said.

“I think a combination of PrEP as well as other prevention measures such as regular testing, early HIV treatment, undetectable viral load, and of course condoms — particularly in settings where a partner’s HIV status is unknown — are all critical…if you have one out of kilter with the other, you can’t expect to see HIV transmissions decline.”

On World AIDS Day last year NSW Health Minister Jillian Skinner announced the EPIC NSW study, which was a significant investment under the state government’s new NSW HIV Strategy 2016–2020.

Price said since the study was announced, demand to be part of it has been overwhelming.

“Our community has been very eager to know more, and we know there’s a high level of demand for PrEP,” she said.

“So this is a very welcome opportunity, we know that a lot of men are interested – we’ve had plenty register their interest on our Ending HIV website.

“It underlines how keen people are to protect themselves and their sexual partners, and it’s another example of the culture of care that exists in our community.”

• The EPIC NSW study is expected to commence in early March

• For information about PrEP and the EPIC Study, including how to get involved , visit endinghiv.org.au/nsw/stay-safe/epic

• If you believe you would benefit from PrEP but may not be eligible for EPIC NSW, talk to a GP who specialises in HIV regarding suitability and access options, including how to import PrEP until there is better access to the drug here in Australia.

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**This article was first published in the March edition of the Star Observer, which is available now. Click here to find out where you can grab a copy in Melbourne, Sydney, Brisbane, Adelaide, Canberra and select regional/coastal areas.

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