HIV prevention was allocated A$43.9 million over three years on this week’s federal budget. Some $26m of that is for “PrEP” for people without access to Medicare.
PrEP means pre-exposure prophylaxis – the preventative use of antiretroviral medication in individuals who don’t have HIV, but who’re prone to it.
Antiretroviral medications are the drugs used to treat HIV, but when used before exposure, can prevent someone acquiring the virus.
Here’s why this extra funding is so essential, what it means for people prone to HIV, and for public health more broadly.
Why take PrEP?
PrEP is highly effective at stopping HIV. It does this by stopping HIV replicating within the bodystopping the establishment of a chronic (long-term) infection.
It has some major benefits over other ways to stop acquiring HIV, similar to condoms.
First, it allows people to plan their HIV prevention ahead of time and never need to use something in the warmth of the moment. Second, it enables a one that has receptive sex – whether anal, vaginal or each – to be answerable for their very own protection, and never need to depend on the actions of their partner(s).
There are differing kinds
Currently, there are two ways to take PrEP in Australia – as a each day pill or “on demand”. There is an injectable formbut this is just not yet widely available.
“On demand” involves 4 tablets. You take two pills immediately before sex, one a day afterwards, and one other the day after that. It is fiddlier than each day dosage, but good for individuals who have dangerous sex periodically.
For most gay and bisexual men, the efficacy of those three sorts of PrEP is roughly equivalent. But “on demand” PrEP is less effective for vaginal sex since the drug concentration is lower within the vagina. “On demand” PrEP can also be not useful for individuals with chronic hepatitis B, since the episodic use of PrEP drugs could increase the risk of resistance to hepatitis B treatment.
Daisy Daisy/Shutterstock
Is PrEP on Medicare?
PrEP is currently subsidised under the Pharmaceutical Benefits Scheme for individuals with access to Medicare. And there are high levels of uptake in Australian-born gay and bisexual men.
But access for overseas-born gay and bisexual men has been a problem. Many temporary residents and visitors to Australia will not be eligible for Medicare. This is an issue not only for somebody who is perhaps prone to acquiring HIV, but in addition for public health.
Funding PrEP for people not eligible for Medicare is an element of a collection of interventions that goals to optimise Australia’s HIV response.
Australia is aiming to eliminate HIV transmission by 2030. This means reducing HIV transmission to below 91 recent cases a yr, at which point it’s deemed not a public health threat.
Early diagnosis is important
While HIV diagnoses in Australia are low, 44% of them in 2022 were classified as “late” diagnoses. This signifies that by the purpose of diagnosis people had already sustained significant immune damage, indicating they’d likely been living with HIV for some years.
Early diagnosis of HIV means people can access effective treatment. This treatment stops immune suppression, meaning people can live long, healthy lives. Treatment also means they can’t transmit HIV to their sexual partners. But a late diagnosis means people didn’t seek testing for a few years, didn’t know they were living with HIV, and could have inadvertently exposed others. This is bad for the person, and for public health.
HIV testing, then, is the cornerstone of an efficient HIV response. The provision of recent money on this week’s federal budget to expand testing options is subsequently welcome.
One of those initiatives is $3.8m to make HIV self-tests from vending machines more widely available. Another $2.5 million has been allocated to expand self-testing kits available by mail.
Both these programs provide a discreet way for people to access testing without having to face one other person. They are intended to handle the barrier of shame or stigma some people may fear in accessing in-person services. They also avoid the expense of seeing a GP for testing.
How our HIV response has modified
Over the past 40 years there have been major highlights within the response to HIV: the arrival of combination therapy, which transformed a life-threatening infection to a chronic, manageable illness; the invention that antiretrovirals could work as prevention; and the treatment that forestalls individuals with HIV from transmitting to sexual partners.
In comparison, these recent initiatives could seem modest, but that might underestimate their importance. In responding to barriers that might exclude people from the prevention and care services they need, this funding supports the lofty goal of eliminating HIV.
