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Over the past 30 years HIV prevention campaigns have been successful in decreasing the incidence of HIV infection amongst gay men.
Just as the campaigns have evolved due to the changing nature of the community and the epidemic, so has the technology on biomedical prevention. New biomedical approaches to prevention are being trialled around the world. The new biomedical prevention strategies include post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), microbicides, and rapid testing.
The only one of these biomedical prevention strategies which is readily available in Australia is PEP. PEP is a month-long course of anti-retroviral (ARV) medication that can help prevent HIV infection after a potential exposure incident, such as unprotected sex with a casual partner or someone who was HIV positive. PEP is available at certain GP clinics and hospital emergency departments.
Another biomedical prevention strategy is PrEP which is very similar to PEP but the main difference involves taking the ARV medication before a potential exposure incident.
A research trial for PrEP, termed iPrEx, indicated that PrEP can help prevent HIV infection in HIV negative gay men and within sero-discordant heterosexual couples. There are still research questions that need to be answered before PrEP could be provided as an option in HIV prevention.
Concerns about cost effectiveness, adherence, and the potential impact on condom use, as well as the outstanding research concerns, mean there are currently no plans to implement PrEP as a prevention strategy in Australia in the immediate term.
Another new strategy involves microbicides. Microbicides are gels which contain ARV drugs that can help prevent transmission to the receptive partner by killing the virus during transmission.
The initial research trials indicated that a vaginal microbicide was effective at preventing HIV infection in women and trials are currently underway for rectal microbicides with gay men.
The last biomedical prevention strategy is rapid testing which involves a finger prick or oral swab being taken instead of a blood sample and receiving the results within 30 minutes.
These types of tests are widely used in several countries such as the UK and the US. The research indicates that these tests are very specific and return accurate results.
Rapid testing is currently not available in Australia, however, there are trials at the Melbourne Sexual Health Centre to see whether the introduction of rapid testing would be appropriate for gay men in comparison to the usual HIV blood test.
Each of these biomedical strategies has the potential to help increase the prevention of HIV by adding to existing prevention options.
However, it must be pointed out that using condoms and water-based lube will always be the best method of preventing HIV, but stay tuned and listen out for more information and developments on these new biomedical prevention strategies.
By ADAM HYNES