New Kirby Institute research, published in the Journal of AIDS, has investigated the factors that influence gay and bisexual men’s use of PrEP in Australia, and found that many are not using PrEP, despite being at risk of HIV.
To initiate PrEP in Australia, a person will speak with their general practitioner in order to assess their risk of HIV. Based on the Australian prescribing guidelines, eligibility criteria for PrEP include engaging in sexual risk behaviours such as condomless anal intercourse or methamphetamine use. However, according to data obtained from the Following Lives Undergoing Change (Flux) study, led by the Kirby Institute’s Mohamed Hammoud, 69.8% of gay and bisexual men who met the eligibility criteria had not subsequently commenced PrEP. The study is an online survey of the behaviours and attitudes of almost 4,000 gay and bisexual men in Australia.
“Australians are becoming increasingly engaged and aware of PrEP as a highly effective HIV prevention tool,” says Mohamed. “Following its listing on the Pharmaceutical Benefits Scheme, we have seen significant reductions in HIV transmissions, particularly among gay and bisexual men.”
“However, our research found that more than two thirds of men who meet formal eligibility criteria for PrEP, are not initiating PrEP. These men were relatively less sexually active than their peers who had commenced PrEP, and were less socially connected to other gay men,” says Mohamed.
The study found that men who did not initiate PrEP, despite meeting eligibility criteria, may assess their risk as insufficient relative to others, because they engaged in less frequent ‘risky’ behaviours. “What this demonstrates is the need to reinforce the message that engagement in any HIV risk behaviour, regardless of the frequency, should entail the use of HIV prevention tools such as PrEP,” says Mohamed. “Although some men may not be engaging in high-risk behaviours as frequently as others, it can only take one episode to contract HIV.”
“In cases of infrequent risk behaviour, a non-daily regimen such as on-demand PrEP may be suitable, and those at risk should consult with their GP about their options.”
The Flux findings also raised questions about including methamphetamine use alone as one of the PrEP eligibility criteria. In Flux, men at risk of HIV infection and who initiated PrEP were using various drugs for sexual purposes, not just methamphetamine. “The use of any drug, legal or illegal, that is being used to enhance sex, commonly called 'chemsex', should be considered alongside methamphetamine as a criterion for PrEP eligibility,” Mohamed says.
Read the journal article here: https://doi.org/10.1097/QAI.0000000000002047