It has been nearly 10 years since PrEP became broadly accessible in Australia, initially through the EPIC-NSW trial. It is widely understood to have been a key factor in driving down HIV notifications in gay, bisexual and other men who have sex with men in Australia. In 2015, the last full year before the PrEP roll out began, there were 740 notifications attributable to male-to-male sex and in 2024 this had reduced to 472.
However, there are challenges with ensuring that people who want to use PrEP have access to it, and are supported to maintain use when having sex that has a risk of HIV transmission. Two recent pieces of qualitative research by the Australian Centre for Sex, Health and Society at La Trobe University have explored some of these challenges; Interruptions and Newly Positive.
The Interruptions: Experiences of discontinuing oral HIV pre-exposure prophylaxis (PrEP among HIV-negative gay and bisexual men study was commissioned by Health Equity Matters to explore patterns of PrEP use and the reasons that HIV-negative gay men stop and restart PrEP use. In this study, stopping PrEP as a deliberate decision was most commonly associated with changes in the type of sex the person was having. However, side effects were also an important reason for stopping. Many participants were proactive in using other risk-reduction methods to manage HIV risk, although some relied on assumptions about their partners’ HIV status.
Interruptions posits that enhancing or setting up new ways to access PrEP will support people to remain on or recommence PrEP use. This includes providing access through pharmacies or setting up recommencement pathways and services to make it as easy as possible to restart when the risk of HIV acquisition increases. Given that people have different patterns of stopping and recommencing PrEP, a range of interventions are going to be required.
In the Newly Positive: Experiences of HIV seroconversion and diagnosis study, the focus is on the experiences of people who have recently acquired HIV, and this includes information about current and past PrEP use. PrEP awareness was high among respondents who were born in Australia or Europe, but low among people born in Asia. Perceptions of high cost among overseas-born participants had dissuaded some from even attempting to access it.
Some respondents reported previous PrEP use and for a variety of reasons participants in this study had stopped or had inconsistent PrEP use. Some participants raised perceived costs and the challenges of accessing PrEP-friendly services as reasons for stopping or inconsistent use. In this study, many respondents did not describe a deliberate decision to stop PrEP
These two studies provide fascinating insights for people working in both health promotion and policy and advocacy. For all of PrEP’s impact on the Australian HIV response to date, there is still more that can be done to facilitate access, and sustain use. For some people this use will be long time, for others it will be periodic, and we must ensure that we have the systems and knowledge in place to support people to access and use PrEP in the most effective way possible.