Indications for PrEP in Australia
Overall, recent declines in HIV incidence and notifications concurred with Initiatives focused on improved uptake in HIV testing and treatment with simpler HIV treatment regimens. Consequently, 74% of people living with HIV in 2017 reached viral load suppression, thereby achieving zero risk of onward HIV transmission (1).
By the end of 2018, 18,530 people, of whom 99% were male, were receiving Pharmaceutical Benefits Scheme (PBS)-subsidised PrEP in Australia (4). Largely related to PrEP implementation, a 25% decline in new HIV diagnoses was observed among MSM in New South Wales, from 295 in the 12 months before the Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) study commenced to 221 in the 12 months following study commencement (2).
As described above, HIV notifications in Indigenous populations increased by 41% between 2013 and 2016 and diverged from the trends in the Australian-born non-Indigenous population (1). This divergence in HIV rates between the two populations possibly relates to a number of factors including a higher proportion of undiagnosed cases of HIV in the Indigenous population, sexual and drug-injecting practices and, importantly, a slower adoption of biomedical prevention strategies such as treatment as prevention and PrEP (5). Hence intensive HIV prevention and treatment efforts, including the use of PrEP, are required to reverse this alarming trend (6).
There are no available recent data about HIV testing uptake and access to antiretroviral drugs for PrEP for temporary residents who are ineligible to access Medicare (including short-term visitors, international students, skilled workers and some temporary residents awaiting decisions regarding their permanent residency as partners of citizens or permanent residents, asylum seekers and refugees).
In other population groups, harm reduction strategies for PWID and HIV and sexually transmissible infection (STI) prevention strategies for sex workers have been highly successful in keeping the prevalence and incidence of HIV at extremely low levels in Australia and among the lowest in the world. Current health promotion and HIV prevention strategies support PWID and sex workers to maintain these achievements, while access to PrEP may expand HIV prevention options (7).