The NZ AIDS Foundation is advising a very cautious response to new research which is providing more support for an HIV prevention technique whereby men without HIV infection can take HIV medications to reduce the risk of any of the virus entering their bodies becoming an established infection. Results of an English medical study released at an HIV/AIDS conference in Seattle indicate that the pre-exposure prophylaxis (PrEP) technique of preemptively taking an HIV medication to reduce the chances of becoming HIV-positive can be highly protective against HIV for men who have sex with men, reducing the risk of infection by 86%. The AIDS Foundation has long resisted any suggestion that the PrEP technique be made generally available as an alternative to condom use as a defence against HIV transmission due to difficulties around ensuring that is is used effectively. On-going research suggests that gay and bi men in New Zealand have one of the highest rates of adherence to condom use in the world and our comparatively low incidence of HIV tends to bear this out. The NZAF believes the latest research results add some weight to the growing evidence that PrEP can be an effective tool to add to the preventative effects of condom use, especially among those men who consistently have unprotected receptive anal sex with other, possibly HIV-infected, men. But the organisation's Executive Director, Shaun Robinson, says there are many ifs and buts surrounding its use. He notes that most ways in which the PrEP medication could be taken are fraught with risks. For those wanting to go onto the drug permanently so they can have unplanned unprotected sex at any time he notes that the drugs have sometimes severe side-effects and to be effective they must be taken with a high degree of regularity and reliability, something which overseas studies show is extremely difficult to achieve. And he believes this scenario could only work properly if there is constant monitoring of compliance, usually achieved through regular blood tests. For those believing it might be taken as a kind of 'pre-weekend' preventative Robinson notes the drug would have to be taken for the several days before and right through the risk period for any protection to build up sufficiently. He also says that sex without condoms exposes both partners to the possibility of contracting other debilitating sexually transmitted diseases such as Hepatitis and gonorrhea. And for those considering buying the drugs online and self-administering them he says the same risks apply, to which is added the likelihood that any drugs purchased through non-formal sources are likely to be cheap copies and of dubious quality and effectiveness. But Robinson sees PrEP being useful for a small minority of men who are for various reasons unable to keep themselves safe from HIV in any other way. “In this context PrEP may be an additional tool to push our already low HIV infection rates even lower,” he says. “This will only happen if PrEP is carefully targeted to men who consistently put themselves and others at risk by not using condoms. We believe that PrEP could be useful if accompanied by clear prescribing criteria and medical oversight. This might be achieved by allowing sexual health doctors to provide PrEP to high risk men.” Truvada, the drug used for PrEP, is currently approved and funded in New Zealand only for use as a treatment for people living with HIV. Unfunded, the cost of Truvada is in the vicinity of $1000 per month. Robinson says the NZAF is working with other NZ health agencies to explore possibilities for the PrEP technique. But Robinson says they all believe that more research and observation are needed. “It's very easy for results like those presented at Seattle to be grasped at by those seeking alternatives to condom use, and increasingly these sort of results are made public at conferences or by press releases without the benefit of peer review so we do have to wait to be able to put the information in perspective.”
Credit: GayNZ.com Daily News staff
First published: Friday, 27th February 2015 - 11:18am