by Andrew Burry, CEO WA AIDS Council
Millions (and millions) of dollars are being spent in the states of Queensland, New South Wales and Victoria, to provide free PreExposure Prophylaxis (PrEP) to 8,400 homosexually active men willing to be part of research projects. But for those of us living in other jurisdictions like Western Australia, we don’t have that option.
So let’s take stock of where we are.
WA remains the only jurisdiction where the Government has issued an Operational Directive regarding the prescribing of PrEP. This is more than symbolism. It means that doctors employed by the Government who are specialised in prescribing HIV medicine (S100) can and should prescribe PrEP to patients who meet the eligibility criteria. These criteria are the same as those used to qualify guys over East to access the various trials.
Already there are over 100 guys in WA who have accessed PrEP in this way, and those numbers increase week by week. And, by the way, the Kirby Institute calculates that there are between 1,100 and 1,200 of us in WA who should at least be considering it. But even if we achieved that target, obviously not all of us would be amongst those in the Kirby calculation, so the real target for PrEP users would have to be closer to 1,500 and 1,800 if we want to achieve the goal of substantially eliminating new infections by 2020. We will also have to achieve those numbers within the next two years.
There is much talk about how expensive PrEP is, and how that cost acts as a significant barrier to those needing it now. In reality, the personal importation scheme and prescribing channels in Perth that are promoted by the WA AIDS Council and M Clinic result in an annual cost to the user of around $700. That’s four quarterly payments of $175. It’s not nothing, sure, but I suspect there are many more of us who would prefer not to pay for it than there are who genuinely can’t afford it. Cost is a barrier for some though, and we must collaboratively develop ways of addressing this fairly and equitably.
The Therapeutic Goods Administration (TGA) have now approved the use of Truvada™ for PrEP. The Pharmaceutical Advisory Committee (PBAC) has decided not to recommend the funding of Truvada™ for use as Pre-Exposure Prophylaxis (PrEP) through the Pharmaceutical Benefits Scheme.
On the face of it, it seems that 8,400 guys over East are well ahead of us over here. This isn’t necessarily or completely true. Whilst we are worse off by $700 per year if we import it ourselves, our experience with PrEP will not be confined within a research project. This means less time and energy having to meet research requirements and more time (and energy) to enjoy the added security that this form of prevention offers.
So the bottom line is, it isn’t particularly difficult to get PrEP in WA and it isn’t particularly expensive. It doesn’t even require much effort beyond making an appointment with a prescriber. It will be fantastic news if the Feds list it on the PBS and make it effectively free, but we don’t need to wait for that.
There is a note of caution though. We believe the decision to use PrEP is and should be a personal decision of our own, but it really is important to do so with medical advice. Although rare, there are medical reasons why PrEP should not be used by some of us for reasons of bone density or kidney function for example. These need to be properly checked out first. Some of us may experience side effects of the drug, but again this is rare.
Nonetheless, if we think we need PrEP we can and should be doing something about it.
Find out more:
PrEP Access Now website