PrEP: A little blue pill in the toolbox
Taken as PrEP (Pre-Exposure Prophylaxis), the little blue Truvada pill could be one of the most exciting and empowering tools for fighting HIV that we have seen. PrEP is medication taken prior to having sex that stops HIV transmission from occurring. It is quickly becoming an essential part of many gay men’s options for managing their sexual health, even though it is not readily available in Australia.
Truvada might sound familiar: it’s the trade name for the drug combination Tenofovir Disoproxil and Emtricitabine, used to treat people living with HIV. Truvada can also be given to people who have been exposed to HIV as PEP (Post-Exposure Prophylaxis). PrEP has been accessible in the United States since 2012 as a recommended method for stopping HIV transmission, but is still waiting for that same support here.
Once upon a time, the idea that a pill could be taken to stop HIV transmission seemed like a fantasy. While finally a reality, it isn’t magical. The success of PrEP is dependent on adherence to a consistent daily medication regime. It can seem counter-intuitive to provide guys without HIV with the exact same medication that they’d need to take for the rest of their lives were they to get HIV, but for a lot of guys PrEP will not be a life-long treatment, but rather taken episodically depending on variable life circumstances.
Sex, pleasure and risk are subjective. Condoms are still a cornerstone of protection for many people to keep themselves safe from HIV and many other STIs. However there are some who, for a range of reasons, who do not use condoms or only do so irregularly. PrEP can give them much needed protection from HIV.
While PrEP has been controversial because of an assumption that everyone will throw caution, and their condoms, to the wind, these concerns do not appear to be replicated in reality. PrEP works so well that in 2011 the Partners PrEP trial was halted mid study because it was no longer ethical to continue providing the placebo, and in 2015 the results of a 2.5 year study of 600 participants in San Francisco (99% being men who have sex with men) concluded with zero HIV infections for those on PrEP.
In Australia PrEP is only available through trials, such as EPIC NSW and VicPrEP, or by prescription. That prescription needs to come from an informed doctor, and ideally full sexual health screening would be provided at the same time. As PrEP is not on the PBS, it costs around $1,000 for a month’s supply if purchased locally. To access an affordable supply, people have had to turn to online pharmacies. Most AIDS Councils have information to help, and websites such as PrEPaccessNOW.com.au assist guys to connect to pharmacies.
AIDS Councils across the country, with the support of Federal, State and Territory Governments, have committed to working towards the virtual elimination of HIV transmissions by 2020. This cannot be done with a business-as-usual approach to HIV health promotion. Australia can be proud of the success of efforts to limit HIV becoming a generalised epidemic during the 1980s, positioning us as a world leader in often controversial HIV prevention. However over the last 30 years the epidemic has changed, as have gay men. PrEP will not be for everyone, but everyone should be able to choose how they reduce their risk of getting HIV.
The AIDS Action Council will be hosting PrEP in the Pub on Wednesday 15th June as part of Men’s Health Week. If you would like to learn more about PrEP, including trials, side effects and how to access it, please join us.
For more information about PrEP please contact the AIDS Action Council on 02 6257 2855 or Canberra Sexual Health Centre on 02 6244 2184.