Preparing for PrEP

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PrEP, or pre-exposure prophylaxis is a prescription medicine that can be used to help reduce the risk of getting HIV-1 infection. It is not yet available widely in New Zealand, but efforts are being made to allow doctors to prescribe it free of charge. This is not a new drug and it has already been funded in New Zealand for people living with HIV. However, it is not funded for HIV-negative people to use for reducing the risk of acquiring HIV.

Public Health officials railed against the drug being made freely available as they believed people would abandon using condoms and become reckless in their sexual behaviour. Folks in America who commenced taking PrEP drug Truvada were labelled ‘Truvada Whores’ on the presumption that people were taking the drug to avoid the risk of transmission and no longer using condoms as their prevention tool. I seem to remember similar arguments when they introduced the contraceptive pill for women to avoid pregnancy.

Where Truvada has been taken up as a prevention regime (San Francisco), we have seen a reduction in the cases of HIV transmission, but we have also seen an increase in the transmission of other STIs, which demonstrates that some have abandoned using condoms. No, PrEP is not the complete answer – but I do think it has an important part to play in the fight against HIV.

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So how effective is PrEP? There is now plenty of evidence to demonstrate that people who regularly take the medication can reduce the risk of acquiring HIV. In fact, for some people, PrEP has been a godsend. I recall one young man divulged he could not let his partners wear condoms as he suffered a severe allergic reaction. He trusted his partners’ declarations that they were not infected with HIV. Sadly, one of his partners was not so truthful. In this instance, PrEP may well have saved this young man from acquiring HIV.

Here in New Zealand, whilst PrEP is not yet available, we are seeing a consortium of Auckland Sexual Health, NZ AIDS Foundation, Body Positive, and Auckland University’s Gay Men’s Health Research Project put together a trial project to make PrEP available for people who are unable or otherwise unwilling to use condoms.

We hope this project will be available shortly. Alas, the drug is expensive and as in Australia, people must meet a criteria set out by health officials to participate. I expect we will see something of this nature follow in New Zealand. Unfortunately, the project will only be funded by the drug company for two years. I am hopefully that Pharmac will agree to fund the drug for PrEP in New Zealand before this free supply exhausts.

Some individuals import a personal supply of Truvada and whilst this may meet the immediate need, it is costly and carries risks. These risks can include financial loss and fraud by buying over the internet – the risk of delay and quality of the product cannot be guaranteed. To remedy this, we need government support.

I believe that with the passage of time we will see PrEP fully-funded in New Zealand and will be recognised as just another tool in the chest for the prevention of HIV.

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