A daily pill to help prevent HIV is the most cost-effective method of managing the illness in Australia, medical professionals say, while some gay men say it will also help fight the stigma of having the virus.
Pre-Exposure Prophylaxis (PrEP) is being used in some parts of the world to prevent the contraction and transmission of HIV and has proven 90 per cent effective.
The medicine, known by the brand name Truvada, is not approved in Australia yet and access to it is challenging, particularly in the Northern Territory.
The daily pill works by using two separate antiviral drugs that interfere with HIV’s ability to establish itself permanently in the body.
Daniel Teudt is 30 years old and lives in Alice Springs, which has a large gay community.
He said the drug was another tool of protection and questioned why at-risk groups could not get hold of it in the NT.
“As a young gay man myself I’d like something else in my arsenal to combat what is potentially a risk for me,” Mr Teudt said.
“I think it helps to de-stigmatise any association with blood-borne viruses.
“This may not be 100 per cent effective, but it’s another tool to help us protect ourselves.”
Mr Teudt has friends who have contracted HIV and says “a pill like this could have helped stop that from happening”.
Available elsewhere in Australia
PrEP can be accessed within Australia via clinical trials in Queensland, NSW and Victoria.
The NT AIDS and Hepatitis Council (NTAHC) has been lobbying the Northern Territory Government to run one too, but so far that request has not been approved.
“I think that’s because we have lower rates within the gay men’s population, so its possibly seen there is not the need,” NTAHC executive director Kim Gates said.
Chief Medical Officer for the NT Government, Dinesh Arya, said the Territory had not been approached to have a clinical trial.
“If we do receive an application to do one here I would be very happy to consider if it is feasible or appropriate to do such a trial in the NT,” Dr Arya said.
In other parts of Australia, some HIV specialist doctors can provide ‘off-label’ scripts of Truvada as a prophylaxis.
But because this is not licensed in Australia, patients have to ask the local supplier, Gilead Sciences Australia, to supply the drug to the doctor at a cost of about $12,000 a year.
So the vast majority of people import the drug from international online pharmacies.
However for Territorians, online purchasing is still not an option because there are no specialised HIV doctors who can prescribe the drug off-label.
Dr Arya said so far there were no doctors who had expressed an interest in being trained to prescribe PrEP.
“Our recommendation is that only those people who have necessary skills, knowledge and expertise in use of these medicines … can prescribe these drugs,” Dr Arya said.
Side effects manageable
HIV prevention clinical researcher Edwina Wright said it was fantastic that people were showing initiative by importing the drug.
“By and large the companies where the drugs are coming are well-recognised drug manufacturing companies and have been approved by the American FDA,” Dr Wright said.
“I think that people are feeling confident that these drugs are well recognised, are from reputable companies and have been reviewed by different regulatory bodies in terms of the quality of their products.”
She said while there were some side effects, including diminished bone strength and a decline in the kidney’s filtering abilities over a long period of time, they were manageable.
“There’s a huge amount of excellent quality data to show how effective it is … that people take it well, adherence is good and seems to improve people’s quality of life,” Dr Wright said.
She said there was no reason why the drug would not be approved by the TGA and then subsidised under the Federal Government’s Pharmaceutical Benefits Scheme.
Dr Wright said that would ultimately be more cost-effective for the Government.
“What you’re doing is preventing an HIV infection, which currently costs about half a million dollars to support the individual for the rest of their life if they are HIV positive,” Dr Wright said.
Pill could ‘reduce stigma of HIV’
Mr Teudt also said he thought the drug would help break down the stigma of HIV.
“It would bring that conversation out into the open and have people talking about it and have measures in place so someone is taking control of their own health,” Mr Teudt said.
Mr Teudt says the drug is not only beneficial for gay men, since rates of HIV are higher in the heterosexual population in the NT.