US health officials have recommended widespread use of pre-exposure prophylaxis (PrEP) for those at increased risk of HIV infection, including gay men and injecting drug users, prompting Australian HIV organisations to renew support for PrEP.
Clinical studies have shown PrEP can dramatically reduce the possibility of contracting HIV, providing up to 99 per cent protection. This marks a significant shift in the way US health authorities have approached the HIV epidemic, moving away from a largely condom-based strategy to one also incorporating pharmaceutical prevention.
The advice has come in response to years of HIV infection rates in the US remaining consistently high, and recent CDC survey results showing an increase in unprotected sex among gay men.
Although the CDC is recommending PrEP to prevent HIV transmission only in conjunction with condoms, officials have acknowledged a possibility widespread prescription of PrEP will result in decreased condom use. Despite this, they have argued the benefits outweigh the risks.
However, these claims have been disputed by local HIV organisations, with the Victorian AIDS Council (VAC) arguing evidence from global PrEP trials does not support some claims coming out of the US that PrEP leads to increased rates of condom-less sex.
“This assertion is unsubstantiated, and in the three major global studies on PrEP, there was no evidence that participants’ sexual behaviours changed as a consequence of being on PrEP,” VAC chief executive Simon Ruth said.
Ruth also said the risk of contracting other STIs such as syphilis and gonorrhoea were mitigated by the mandated STI testing associated with PrEP regimens in Australia.
He applauded the Victorian Government’s support of a local PrEP trial — currently underway — but criticised the Federal Government’s failure to engage with Truvada manufacturer Gilead to ensure PrEP becomes cheaply available in Australia as soon as possible.
Living Positive Victoria also welcomed the CDC’s statement, with executive officer Brent Allan telling the Star Observer it would greatly benefit sero-discordant couples, where one partner is living with HIV and one is not.
“It’s vital that the negative partner do what’s necessary to remain negative for the health of the relationship. And if PrEP is going to work … then I think it should be made available to that couple,” Allan said.
He also said cost should not be a barrier to people who wanted access to PrEP, and criticised prejudice in some sections of the gay community in the US against those who use it.
Although there is some community disagreement in Australia over the benefits of PrEP, it has been met with intense controversy in the US, with fierce debates in the gay community around whether it “encourages” sex without condoms.
AIDS Healthcare Foundation president Michael Weinstein issued a statement calling the CDC “ill-advised”, and claiming: “The government-sanctioned widespread deployment of PrEP will be accompanied with a shift to condom-less sex.”
However, the San Francisco AIDS Foundation is among those groups applauding the CDC’s move, with chief executive Neil Giuliano stating: “The CDC’s definitive PrEP guidelines recognise the reality of gay and bi men’s lives and provide a blueprint for providers to explore this new HIV prevention option with those who need it most in our community.”