Sat 25 Jul 2015 In: New Zealand Daily News View at Wayback View at NDHA
An announcement that the taking of HIV treatment medications by people who have not contracted the virus is now a proven way of warding off infection has been greeted with caution by the NZ AIDS Foundation, which is hoping to run a demonstration project in this country towards the end of the year. “The science on PrEP [Pre-Exposure Prophylaxis] is overwhelming and its conclusions are clear: PrEP works when taken,” said Chris Beyrer, IAS 2015 International Chair and International AIDS Society President at the end of a major HIV conference which has just wound up in Vancouver. Beyrer cited recent studies presented to the conference showing that using the medications prior to unprotected sex to avoid HIV infection works well when the medications are taken regularly and reliable. “Access to PrEP is now a public health and human rights imperative. The studies presented here provide the most detailed data to date on PrEP implementation successes and challenges, underscoring that the intervention is feasible and effective in the real world. We hope these studies launch the beginning of a new PrEP era.” The NZAF has long tiptoed around the wider introduction of PrEP in this country, pointing out that men who have sex with men in New Zealand have a stronger adherence to condom use than most other similar nations where HIV is predominantly a gay and bisexual men's epidemic. While it acknowledges that “the science shows that PrEP does work when taken as prescribed” and that “the latest results reported in the US PrEP Demonstration Project show that 65% of these men took the drug as prescribed in a real-world setting,” the Foundation is not as optimistic about the technique of using costly medications as an alternative to cheap and effective condoms. “Another study presented at the same conference showed 34% adherence among young MSM, reinforcing that PrEP doesn't work for all high-risk men,” says NZAF Executive Director Shaun Robinson. “PrEP is not a silver bullet. We need to make it accessible to high-risk men in New Zealand while also maintaining community-wide support for condom-use, increasing testing, and improving early access to treatment.” “The Ministry of Health are supportive of a PrEP demonstration project in Auckland to prove that high-risk gay and bisexual men (those who've had multiple episodes of unprotected anal sex and who resist condom-use) can be effectively engaged to use PrEP and that they can be effectively supported, by local clinicians, to manage the risks of non-adherence and other STIs,” says Robinson. But he notes that “this pilot is not being funded by the Ministry of Health or PHARMAC and relies on the goodwill of the agencies involved.” Robinson says the next step after the demonstration project is to get support for a broader roll out to the highest-risk gay and bisexual men. “The cost, around $1200 for a one-month supply, is likely going to be a big hurdle so we need to be communicating the cost-benefit of potential HIV infections prevented.” He says indications are that Truvada, one of the most-used PrEP drugs, could come off patent soon, with generic versions accessible as early as 2017. “Provided the TPPA doesn't get in the way, generics would make a big difference”. Another to acknowledge the promise of PrEP while believing it should be introduced into NZ with caution is Dr Peter Saxton, Director of the Gay Men's Sexual Health research group at Auckland University."If we can offer PrEP to gay and bisexual men who are most likely to acquire and transmit HIV, especially those at the centre of HIV transmission clusters, then not only can it help them avoid HIV but it could also limit HIV transmission to their sexual partners," says Saxton. "Fewer circulating undiagnosed HIV infections is what we need to wrestle control of this epidemic back." "In a health system like New Zealand's that has to ration scarce health resources, a local implementation pilot can help define who would benefit most, at what cost, and who would pay for that. It would also assess the capability of sexual health systems to administer and monitor a PrEP programme in New Zealand." "If used carefully and in a targeted way then PrEP offers a potentially effective addition to HIV prevention. But we also have to be very mindful of the limitations and risks. PrEP does not offer complete protection against HIV, nor protects against other STIs. Individuals on PrEP must be closely and regularly monitored for pill adherence, for recent HIV acquisition including resistance, and for condom use. PrEP can have side effects."