30 months on from PrEP first being available in NZ, Body Positive Executive Director Mark Fisher tells us about Australia’s new PrEP guidelines on event-based dosing for gay and bisexual men.
PrEP debuted in NZ with the NZPrEP trial for 150 people in Auckland in Feb 2017. PrEP was funded in March 2018 and since then 2400 have started. Some people haven’t continued and currently, there are reported to be around 1500 people on PrEP in NZ which includes people getting funded PrEP and those people that aren’t eligible but are importing it themselves (for around $30 per month). The initial target for PrEP was around 6000 people so we have a fair way to go to ensure that everyone who needs an extra layer of protection to prevent getting HIV has it. Australia has around 18,500 on PrEP.
All the science has shown that PrEP prevents you from getting HIV if you take it as prescribed – in NZ that means taking a pill a day. There have been roughly 5 breakthrough transmissions in the world but these were in extenuating circumstances and are extremely rare. PrEP is more effective than condoms at preventing HIV.
There are strict criteria to access PrEP in NZ as it’s only funded for groups of people that are deemed high risk which includes people that have an HIV positive partner that is not undetectable, cisgender or trans men having receptive intercourse with men without condoms or people that use crystal meth. You also need to be able to access the local health system which excludes international students and the like. The criteria have just been expanded in Australia to include basically everyone that expresses interest as we know it’s an effective tool, so why deny it?
Australia and the World Health Organisation have just updated their PrEP guidelines for gay/bi guys to clarify how to initiate PrEP. The new guidelines simply have you take a double dose (2 pills) at least 2 hours before sex. This provides a high level of protection and then you continue taking a single tablet daily to maintain this protection. When you decide to stop taking PrEP you take a pill daily for 2 days after your last sex. If you have Hepatitis B talk to your doctor before stopping PrEP to avoid any flare-ups.
This update makes starting and stopping simple with no stress or ongoing pill burden. It also means that you could take as few as 4 pills to cover a single occasion (double dose 2 hours before sex and 2 days of follow up pills to finish) which is known as PrEP211 or event-based dosing. This can reduce the number of pills you need to take if you are having sex infrequently, potentially reducing kidney issues and any side effects as well. It can also help reduce cost if you’re importing the medication yourself.
This is only recommended for gay/bi guys (not including trans) – it may work for other people (women for example) but they haven’t been studied specifically so the current guidelines remain – take PrEP for 7 days to start and 28 days to finish for adequate protection.
PrEP is appropriate for anyone that is not using condoms consistently and may come into contact with HIV which usually occurs through sex. If you’re not using a condom every time with your casual hookups then you should consider PrEP for an extra layer of protection. You may also have a period where it could be a useful tool such as leaving a long term relationship or before an overseas trip that may get a bit frisky.
PrEP only works for HIV – not other STI’s but you do get a checkup every 3 months to ensure these are treated if you come across any. NZ has a syphilis epidemic which existed before PrEP came onto the scene so everyone that’s sexually active should get a regular sexual health checkup – condoms help but they don’t stop STI’s. If you do get an STI – get it treated and tell your sexual contacts so that they can get treated as well – otherwise, you will just get it again next time you connect.
Talk to your doctor or Sexual Health Clinic if you think PrEP might be a good tool for you.