Nearly 10,000 gay and bisexual men in New South Wales who took the HIV prevention drug PrEP as part of a three-year trial had a transmission rate 90% lower than otherwise expected, a new study has found.
A research study undertaken by the Kirby Institute between 2016 and 2019 followed 9,709 men who were initially taking the drug for free and then transitioned to paying $40 a month when PrEP was subsidised on the Pharmaceutical Benefits Scheme from 2018.
HIV transmission among the group over the course of the study was about 30 in total – or a rate of two in 1,000 participants each year.
The Kirby Institute’s Prof Andrew Grulich, who led the study, said that transmission was about 90% lower than researchers would have expected to see if the men had not been taking PrEP.
“It really was shown in the study that it really did continue to work extremely well. This is a group, historically, we would have expected to have [transmission] rates of about 20 in 1,000 so this is about 90% lower than we would have expected without PrEP. So really, really amazingly effective intervention at the population level.”
Grulich said the men who were diagnosed with HIV during the course of the study were not taking their PrEP pill daily as advised at the time of transmission.
“We didn’t see any cases of failure of daily PrEP.”
Tony Nhan, a 30-year-old from Erskineville who participated in the trial, said moving on to PrEP removed his fear of condoms breaking and reduced the stigma associated with getting tested.
“We need to reduce stigma by making testing a normal part of everyday life and not shaming others,” he said. “Taking PrEP was empowering for me to know that I am taking responsibility for my own health, regardless of the other person’s status.”
HIV transmission rates among gay and bisexual men in NSW have declined 40% since PrEP was introduced and 70% in the gay suburbs of Sydney.
“That’s pretty extraordinary. So that 70% gives us a sense of what the potential of PrEP is and [the need] get it out more broadly,” Grulich said. “It really is a gamechanger that enables us to dare to dream for the elimination of HIV.”
Grulich said the focus now should be on regional areas, people under the age of 25, and those who stopped taking PrEP who were more at risk.
A total of 206 people in NSW were diagnosed with HIV in 2020. Earlier this year, the state government announced a plan to eliminate HIV by 2025.
Part of the proposal includes making PrEP more available and trialling new technologies such as injectable PrEP.
Nationally, the Australian Federation of Aids Organisations has said it will take $53m a year of investment to eliminate HIV across Australia by 2025. The federation has proposed making PrEP available over the counter at pharmacies and available to all who would benefit at the PBS-subsidised rate, regardless of their visa status.
On-demand PrEP use instead of the daily version, where men who have sex with men take two tablets at least two hours before sex, and then one each day for two days after, was another way to drive up uptake, Grulich said.
“Nobody’s going to get hurt with a short course of PrEP like that – provided they take it correctly it will protect them.”
Nhan said after the trial there was initially friction getting PrEP from his GP because they were not informed about the medication. He said it would be easier if there were more options to obtain PrEP.
“Potentially this could include self-sexual health screening or at-home testing or it could mean maybe we could get our result via text or email instead of visiting the GP after a test.”