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As anticipated, on 9 February the Pharmaceutical Benefits Advisory Committee (PBAC) announced its decision to recommend PrEP for federal subsidy. This will cut the cost of Truvada (the drug used as PrEP) drastically, with an estimated 31,000 people — mostly men who have sex with men (MSM) — benefiting from the move. “Gay and bisexual men continue to carry the greatest burden of HIV in Australia, and we expect that PrEP will sharply drive down the rates of HIV for this community,” said chief executive of the Australian Federation of AIDS Organisations (AFAO), Darryl O’Donnell.
Meanwhile, the Kirby Institute’s Professor Andrew Grulich called the announcement an essential step in Australia’s response to HIV. “PrEP has been a game-changing tool for HIV prevention. I applaud PBAC for this recommendation, and am hopeful that that the Australian government will quickly make this life-saving medication accessible to the people in Australia who are at high risk of HIV. It places Australia in a very strong position to be the first country in the world to virtually eliminate HIV transmission.”
Before the watershed announcement, PrEP — the use of an antiviral drug to prevent HIV transmission — was only available in Australia through state-funded trials, at retail prices via a prescription from a GP, or online imports. While a PBS-listing date has yet to have been announced, Positive Living understands that PrEP will be made widely — and affordably — available during the first half of the calendar year (prior to PBAC’s announcement, federal health minister, Greg Hunt, made a commitment to “list it and list it quickly”). As soon as it is listed, any doctor or GP can prescribe PrEP to an Australian resident who holds a Medicare card.
So who’s eligible? Well, anyone considered high risk of contracting HIV — such as sexually active MSM, transgender people, and heterosexual people with an HIV-positive partner who does not have an undetectable viral load. Dispensed through local pharmacies, PrEP will cost patients $39.50 for a 30 days’ supply; those with a concession card will face a co-payment of $6.40. Doctors will be able to prescribe a three months’ supply at a time — one script with two repeats. When visiting the doctor for a fresh PrEP script, individuals will receive routine screenings for HIV and other STIs.
PBAC’s decision now puts Australia at the front of the global pack providing equitable, affordable access to PrEP. It is anticipated that its introduction will liberate thousands of men from the fear of sex — a fear that has hung over the gay community for decades. It’s also hoped that PrEP will usher in an era of shared responsibility around HIV prevention.
“Equitable access to PrEP for HIV-negative people is an important advancement for those already living with HIV. It will help counter stigma and discrimination against people living with HIV,” said Cipri Martinez, president of the National Association of People Living with HIV Australia. “By keeping those at risk of HIV safe, PrEP gives both partners control and confidence. This helps everyone share responsibility for HIV prevention equally.” Describing PrEP as a “necessary and urgent tool”, Nic Holas, co-founder of The Institute of Many (TIM) — a peer-support group for positive people, agreed: “PrEP offers HIV-negative people the opportunity to take more responsibility for their own safety.”
But, according to O’Donnell, for PrEP to achieve maximum effect, access for all is crucial: “The challenge now is to spread the message about PrEP to everyone who needs it. PBS listing of PrEP is critical, but we must make sure everyone can access it."
- PrEP is highly impressive at preventing HIV transmission with 99 percent effectiveness among MSM
- As a result of the state-funded PrEP trial alone, NSW has recorded the greatest drop in new HIV transmissions since the epidemic began
- A single averted HIV transmission will save the Australian taxpayer $1m in lifetime treatment and costs
- With regular screenings a prerequisite to accessing the drug, PrEP leads to significantly improved sexual health