Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is the term used to refer to HIV-negative people taking antiretroviral drugs on an ongoing basis to reduce the risk of acquiring HIV.

There is now good evidence indicating that PrEP can be a successful prevention strategy for people at high risk of acquiring HIV sexually. The antiretroviral drug Truvada has been shown to be effective as PrEP in clinical trials among men who have sex with men (MSM), transgender women and heterosexual couples in some settings.

Making PrEP available to people at high risk of HIV infection would reduce HIV diagnoses among these groups.

PrEP is gaining acceptance internationally as an effective HIV prevention strategy, in its own right. Thus couples using this approach may be said to be engaging in protected or safe sex, even if they do not use condoms.

Availability of PrEP

Truvada is approved for use as PrEP in Australia, however the drug has not yet been listed on the Pharmaceutical Benefits Scheme (PBS), which would make it more affordable.

Until Truvada is subsidised for use as PrEP, there are several options for people who wish to use it:

  • Demonstration projects in some states are investigating the acceptability, feasibility and impact of providing Truvada for people considered to be at elevated risk of infection on an ongoing basis. There is a need to provide ongoing access to Truvada for participants at the conclusion of these projects.
  • Any doctor may prescribe Truvada as PrEP, however, AFAO recommends seeing a doctor who is authorised to prescribe HIV antiretroviral drugs (s100 prescribers), as they are familiar with the drug and its potential side-effects. This script can then be filled at any pharmacy, although the drug may need to be specially ordered, taking a couple of days. Australian pharmacies can only dispense the branded version of the drug and this costs approximately $10,000 for a year’s supply.
  • Individuals can import a generic version of Truvada (prices vary depending on the source and the quantity but a guide is $800 to $1,300 for a year’s supply). 

HIV organisations advocate for the broader availability of PrEP because it could significantly reduce HIV infections, especially among gay men who are the population most affected by HIV in Australia.

AFAO’s 2015 briefing paper on PrEP identified three priority actions:

  • Development of national PrEP prescribing guidelines
  • TGA approval of Truvada for use as PrEP (approved May 2016)
  • Funding of Truvada as PrEP for people at high risk of HIV infection.