In news that wouldn’t really be surprising to anyone who has been taking the magic blue pill, a new study has shown that HIV transmission dropped by as much as 40 per cent in three years when PrEP was made available to gay and bisexual men in New South Wales.

The results of the EPIC-NSW study, led by the Kirby Institute at UNSW Sydney was published in The Lancet HIV on Friday.

Around 10,000 gay and bisexual men participated in the study, funded by NSW Health, over three years and is the first study globally to measure the impact of PrEP on reducing HIV in a large population.

The study involved offering free pre-exposure prophylaxis (PrEP) to almost 10,000 high-risk gay and bisexual men for around two years and then continuing the study when the medication was no longer free but cost almost $40 per month. HIV transmissions dropped by 40 per cent when PrEP was available to the community and these historically low rates persisted after PrEP moved from being available free as part of the NSW clinical trial to being available at a subsidised cost through the Australian Pharmaceutical Benefits Scheme (PBS) in 2018.

“We are pleased that the modest cost of accessing PrEP had virtually no impact on HIV transmission among the study participants we followed for the first year of PBS-listed PrEP,” the Kirby Institute’s Professor Andrew Grulich, who led the study, said in a press statement.

“For the year following its listing on the PBS, we found PrEP use remained high among the study participants, and HIV rates remained very low, at about two in 1000 participants per year.”

“If we are to achieve HIV elimination in Australia, we will need to ensure even better adherence to PrEP among the young and in those living outside of the gay areas of the big cities. We also need to ensure that everyone at risk of HIV has access to PrEP, regardless of their Australian residency status” says Prof. Grulich.

PrEP trial couldn’t reach everyone

Professor Martin Holt from UNSW and Deputy Editor of the Journal of the International AIDS Society and Associate Editor of AIDS and Behavior, also points out that access to PrEP can be a challenge for some communities financially.

“That said, the cost of PrEP is an issue for some people – from PrEPARE we’ve also found that younger men (aged under 25), guys on lower incomes, or those not in full-time jobs are significantly less likely to use PrEP,” Professor Holt told Star Observer.

“To me, that indicates the cost of going to the doctor (particularly if the doctor doesn’t bulk bill) and of getting a regular prescription are barriers to PrEP use. If you add Medicare-ineligibility on top of that (which many temporary residents, like overseas students, face), then it gets that much harder – you’re relying on people to work out how to personally import PrEP to make it affordable. That’s why peer-based organisations like PrEP Access Now are so useful”

Karen Price, Deputy CEO at ACON, the LGBTQI community health organisation who worked closely with the team at EPIC-NSW to get the community engagement and education aspect of the trial to where it needed to be, says effective community engagement was key. 

“Community were meaningfully involved in leading this study; but real credit goes to thousands of gay and bisexual men for taking action to get informed and involved in this important study,” she says. “The combination of community leadership in the design and implementation of the study, as well as the actions taken by men in NSW, was fundamentally important in ensuring this critical HIV prevention tool got into the hands of as many of those who needed it, as quickly as possible.”

This is all great news for Agenda 2025: Ending HIV Transmission in Australia,  which launched last month and found that with just an additional annual investment of $53 million and fresh policy settings, HIV transmission could be ended by 2025.

Star Observer had reported in April this year that even though condom use has plunged in Australia, net use protection has increased thanks to the popular uptake of PrEP. With more ways to get it than ever before, you can be protected from HIV whether you like a cheeky dirty weekend away occasionally or prefer to be protected all the time so you can drop your trousers at a moments notice, the medical marvel that is PrEP has you covered!

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