By Dr Horas Wong

The federal government recently marked this year’s World AIDS Day by announcing funding of $39 million to improve access to HIV care to Medicare-ineligible people living in Australia.

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This move is something that we should celebrate, as currently there are no sustainable options for HIV-positive people who are ineligible for Medicare to access affordable antiretroviral therapy in Australia. 

‘Substantial Reduction of New HIV Diagnoses’

Now the government is finally taking steps to make HIV treatment more inclusive for HIV-positive people who are not covered by Australia’s universal health insurance. The next important initiative that many of us are waiting for is expanding access to the effective HIV prevention drug, PrEP. 

Since PrEP was first listed on the Pharmaceutical Benefits Scheme in 2018, the LGBTQ communities have registered a substantial reduction of new HIV diagnoses.

People with Medicare can obtain PrEP directly at community pharmacies with a monthly co-payment of $39.50. But for those without Medicare who wish to access affordable PrEP, they need to purchase PrEP from overseas suppliers, with delivery taking two weeks or longer.

While private scripts can be filled at some community pharmacies, the monthly cost can vary from $40 to $170 or more. To many, affordable PrEP is still not easily accessible. 

Wider Access Protects All of Us

Improving access to subsidised PrEP to all people regardless of Medicare eligibility not only protects our communities from HIV, but also helps achieve Australia’s target to end HIV transmission by 2025.

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In a recent research study published in the Journal of Acquired Immune Deficiency Syndrome which surveyed more than 4,900 gay and bisexual men in Australia, researchers at the Centre for Social Research in Health (CSRH), UNSW Sydney found that a lack of Medicare coverage is independently associated with non-PrEP use.

Similarly, the triennial Asian Gay Men’s Community Survey, also led by CSRH and in partnership with ACON, found that while the PrEP-use rate has increased among Asian communities in NSW over the years – from 10% in 2015 to 27% in 2018 and 35% in 2021, many temporary migrants, most of whom are Medicare ineligible, are much less likely to use PrEP. 

Australia is reopening its borders. We are going to reunite with our friends and family from overseas in the next few months. Migrants will return to help jumpstart the nation’s post-COVID economy.

At the same time, what should we do further to ensure that everyone is safe, and that all have access to equitable and effective HIV prevention? 

Horas Wong is a Nursing lecturer at the University of Sydney and an affiliated researcher at UNSW Sydney.

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