Brisbane community forum hears case for PrEP as statewide trial begins

QUEENSLAND gay men and men who have sex with men are now being recruited for a statewide and state-first pre-exposure prophylaxis (PrEP) trial.

The trial, which will be run in conjunction with the HIV Foundation Queensland (HIVFQ) and the Department of Health, was announced at a community forum on Monday night held at the foundation’s headquarters in Fortitude Valley, Brisbane.

Tackling a range of issues and questions surrounding PrEP medication Truvada and its possible future approval by the Therapeutic Goods Administration, the forum also sought to clear up any questions the community may have had.

PrEP is a course of medication for HIV-negative people that involves taking a pill – Truvada – once a day as a HIV preventative measure.

The forum was facilitated by Victorian AIDS Council’s Heath Paynter and featured panellists Dr Andrew Redmond, an infectious diseases physician at the Royal Brisbane and Women’s Hospital, HIV medication prescriber Dr Fiona Bisshop and Cairns Sexual Health Centre clinical nurse consultant Simon Doyle-Adams.

The were also accompanied by Queensland Positive People executive officer Simon O’Connor and all shared their particular expertise on PrEP and its implementation, along with details of the statewide trial starting in June.

Known as QPrEP, the trial will be combined with sexual health research to look into the feasibility of providing Truvada through HIV clinics.

The trial will track and study the usage of PrEP by 50 men across the state who engage in condomless anal sex with casual partners, with the possibility of more participants being added depending on demand and funding.

QPrEP will be managed by several sexual and general health centres across in Cairns, the Gold Coast, Ipswich, Sunshine Coast, Townsville along with Brisbane’s Stonewall and Gladstone Road medical centres. Availability will be on a “first come, first served” basis as long as the participants meet the selection criteria.

Redmond spoke of the results of a range of recent PrEP studies from around the world, all with varying levels of effectiveness — but was keen to highlight that in trials where effectiveness appeared to be low, people in those trials had poor adherence to taking the daily medication.

He even suggested that in the trials that had shown the best outcome for PrEP, results would have been even better if adherence was 100 per cent.

“The effectiveness of PrEP is probably even higher than the 86 per cent effectiveness shown in the two best outcomes,” Redmond said.

Both Redmond and Bisshop discussed the concerns regarding side effects of taking Truvada daily, including a perceived substantial impact on renal function and bone density. The doctors provided figures indicating that there was a negligible effect on bones and only a one to two per cent reduction of renal function.

Another key issue discussed was that of community shame and stigma associated with taking PrEP, referring to the derogatory term “Truvada whore” and the misconception that the medication would result in complacency around safe sexual conduct and promiscuity.

Bisshop rejected this idea and said that providing an option for men who cannot use condoms for a myriad of reasons, was a vital option adding to the toolbox of safer sex practices available to gay men.

“We need PrEP because HIV rates are rising, condoms don’t work for all people, and people are already using it,” she said.

“It does not lead to more condomless sex, and it doesn’t lead to more STIs.”

O’Connor spoke of his personal battle against eradicating HIV and his hope that PrEP would help to realise his hope for an end to HIV transmissions.

“I think that we should be welcoming the fact that we have yet another choice that has appeared on the horizon that we can take advantage of to stop the spread of HIV,” he said.

“Clearly condoms alone isn’t doing it and this isn’t about pitting one thing against the other, ‘condoms are better than Truvada so you shouldn’t be using it, or that Truvada is better than condoms’… it’s about providing people with a range of choices that they can use to establish the best thing for them.

“It’s incumbent on us as a community to use every tool available to us to ensure that we keep a firm focus on the fact that HIV is the enemy, not each other.”

Dr Darren Russell, HIVFQ chairman and director of the Cairns Sexual Health Service, said he was pleased with how the forum went and believes PrEP will play an essential role in the plan to end HIV notifications by 2020.

“I believe that in order to end HIV in Queensland by 2020 we will need to find a way to roll out PrEP to those gay men who want it, and that will be a challenge,” Russell said.

“The HIV Foundation is examining ways in which PrEP can be funded, but we don’t expect any simple answers anytime soon. We will keep trying to ensure that it is available to as many guys as possible, though.”

For more information about the QPrEP trial and PrEP, visit http://hivfoundation.org.au/about-hiv/prevention.