Jarrod McMaugh takes a look at Pre-Exposure Prophylaxis, stigma and why new AIDS cases are rarer than in the past

In Australia, an estimated 25,000 people are living with HIV, of which up to 10% may be unaware of their HIV status.

While HIV transmission can occur when sharing of intravenous drug administration equipment, in Australia new cases of HIV occur primarily through sexual contact.

Transmission from male-to-male sexual contact has stabilised over the last three years, contributing significantly to the overall reduction in new cases over the last five years. This is likely due to improved treatment for people who are living with HIV, and the availability of subsidised PrEP for sexual partners. New cases of AIDS are now much rarer due to effective treatments, with early detection being a key factor.

Despite the impact testing and treatments are having in the overall reduction in the number of new cases of HIV, there are still some populations where new transmissions of HIV have not reduced. Cases arising from heterosexual encounters have remained stable over the last five years, while new case reports have increased by 41% amongst Aboriginal and Torres Straight Islander people.

When looking at these trends, we can see that strong campaigns with positive health messages (rather than stigmatising messages) have been developed by groups who work with men who have sex with men and groups who work with injecting-drug users. Similar campaigns are needed for people in other at-risk populations to ensure that testing for HIV after potential exposure is not stigmatising.

As health professionals, pharmacists need to keep two important pieces of information in mind; new transmissions are stabilising (or reducing) because people are aware that HIV can be detected early and treated effectively. To achieve this, information about testing and treatment needs to find its way to people who are at risk of transmission in a way that doesn’t discourage treatment through fear, stigma, or ignorance.

Pharmacists have a role in providing information about HIV testing and treatment, and must do so in a manner that improves access.

PrEP

PrEP is an acronym that stands for Pre-Exposure Prophylaxis, and involves the use of antiviral medications for people who may be at risk of HIV transmission. This medication is now available on the PBS, making access for those who had not accessed state-based programs more affordable and predictable.

All states in Australia with the exception of the Northern Territory had implemented a PrEP access program, with a total of just under 16,000 men accessing PrEP prior to PBS listing. Funding for these programs continues, and provides free access in many cases to medication.

Medications utilised in a PrEP protocol are the same classes of medications used to treat HIV, and for Post-Exposure Prophylaxis.

Medications used in PrEP can have short term side effects such as nausea, abdominal cramping, headache/dizziness, or other side effects that may discourage a person from regular use. People may be interested in avoiding these side effects by taking PrEP “as needed”; while this may be an option, this may reduce the effectiveness of PrEP, especially if unplanned sex occurs.

Longer-term side effects include impact on bone density and kidney function. As with other medications that can have long-term impacts on organ function or bone strength, pharmacists can periodically remind people that these medications require regular monitoring to identify if there is any impact.

PrEP is effective for HIV only. While this may be clearly understood by many people who are using PrEP, the risk of other STIs should be clarified with any person who is utilising it.

Stigma

Stigma is a major barrier for many health conditions, and this is clearly the case for people who are living with HIV or at risk of acquiring HIV.

The health campaigns from the 80s and 90s generated a lot of fear and misconceptions about HIV. Pharmacists have an obligation as health professionals to overcome stigma, ensuring that their own beliefs and preconceptions do not contribute to an environment that discourages a person from accessing health services that should be readily available.

Jarrod McMaugh is a community pharmacy practitioner with Capital Chemist in the northern suburbs of Melbourne. He has extensive experience in developing and delivering professional services in the community pharmacy setting.