Special clinical considerations
Reports during 2013-2017 from a large, sentinel sexual health service in Victoria showed that the proportion of newly-arrived Asian-born MSM with incident HIV infection did not decline whereas the proportion of all other MSM attending the clinic with incident HIV infection declined by 45% (6). At the same clinic during 2017, newly-arrived Asian-born versus all other MSM were less likely to report use of PrEP.
In Australia, access to Medicare is required to receive subsidised PrEP and HIV antiretroviral therapy. People who come to Australia to study who are ineligible for Medicare are required to have Overseas Student Health Cover, however anecdotal reports suggest that some students are reticent to use their private health cover for sexual health testing, prevention and treatment because of concerns about data privacy. People who come to Australia on a Working Holiday Visa (417) may be eligible for Medicare if they come from countries with reciprocal health cover arrangements, although none of these countries is within Asia (7).
Clinicians should refer people who are ineligible for Medicare or who are unable or unwilling to use private health-care cover to public sexual health clinics that offer free HIV and sexually transmissible infection (STI) testing and provide PrEP prescriptions. These PrEP prescriptions can be filled by paying the full, unsubsidised amount for a private script, or by personal importation of PrEP through online pharmacies.