New research has found that almost three in four gay and bisexual men in Australia that are eligible to take PrEP aren’t doing so.
The research, undertaken by the Kirby Institute, investigated the factors that influenced gay and bisexual men’s use of PrEP in Australia.
According to data obtained from the Following Lives Undergoing Change (FLUX) study, 69.8 per cent of gay and bisexual men who met the eligibility criteria to take PrEP had not commenced doing so.
The FLUX study is a national, online, observational study among gay and bisexual men that focuses specifically on licit and illicit drug use, rather than a cross-section general survey like the Gay Community Periodic Survey.
Kirby Institute researcher Mohamed Hammoud, who led the study, said despite the findings Australians were becoming increasingly engaged and aware of PrEP as a highly effective HIV prevention tool.
“Following its listing on the Pharmaceutical Benefits Scheme, we have seen significant reductions in HIV transmissions, particularly among gay and bisexual men,” he said.
“However, our research found that more than two thirds of men who meet formal eligibility criteria for PrEP are not initiating PrEP.
“These men were relatively less sexually active than their peers who had commenced PrEP, and were less socially connected to other gay men.”
To initiate PrEP in Australia, a person has to speak with their GP in order to assess their risk of HIV.
Based on Australia’s prescribing guidelines, PrEP eligibility criteria includes engaging in ‘risk behaviours’ such as condomless anal sex and methamphetamine use.
The study found that men who didn’t initiate PrEP—despite meeting eligibility criteria—may have assessed their risk as insufficient relative to others as they engaged in less frequent ‘risky’ behaviours.
Hammoud said the study demonstrated the need to reinforce the message that engagement in any HIV risk behaviour, regardless of frequency, should involve HIV prevention tools such as PrEP.
“In cases of infrequent risk behaviour, a non-daily regimen such as on-demand PrEP may be suitable, and those at risk should consult with their GP about their options,” he said.
Chair of PrEPAccessNOW (PAN), Michael Whelan, said it was important for people to work out whether PrEP was the right tool for them.
“It wasn’t too long ago that access to PrEP relied solely upon limited access trials and personal importation from a select few doctors willing to prescribe it,” he told the Star Observer.
“We’ve come a long way in just a few years, and we are seeing a dramatic increase of PrEP uptake. We’re seeing decreases in HIV transmissions across many states – so we know PrEP is working in our communities.
“My belief is that when new data from the Gay Community Periodic Survey is released later this year we’ll see a spike in those reporting PrEP as their primary method of HIV prevention.”
Whelan added that PrEP wasn’t the only tool available for gay and bisexual men wanting to prevent HIV transmission.
“There are a number of tools in the toolkit for preventing HIV,” he said.
“If PrEP isn’t the answer for two thirds of these men, there are a number of HIV risk reduction tools they can use.
“Undetectable viral load, condoms, regular testing, and PEP where it’s needed are all amazing tools. We need a comprehensive toolkit to eliminate the virus as well as HIV stigma. PrEP is just one of those great tools.”
HIV stigma remains pervasive, and can prevent a number of people from getting tested, let alone taking PrEP. But stigma isn’t the only barrier to PrEP use.
Whelan said that at PAN, the team receives countless messages from men looking to start PrEP who don’t have access to Medicare.
“For those people the cost of the medication and testing can be prohibitively expensive,” he said.
“PAN has free coupons available to anyone unable to afford the cost of their PrEP. People without Medicare, international students, and those on a low income shouldn’t be left behind while the rest of us benefit from PrEP.
“While any doctor in Australia can prescribe PrEP, not all of them know about it or are unsure how to do so effectively.
For general PrEP information or to find a PrEP-savvy GP who can prescribe a script for you, visit: www.pan.org.au