Gay men and HIV PrEP: who would use it and would it help?
Pre-exposure prophylaxis (PrEP) involves the prescription of antiretroviral drugs to HIV-negative people to reduce the chance of HIV infection. In the last two years, three international trials of PrEP have found efficacy levels ranging from 44% to 73%. Better efficacy was found among people who adhered closely to the prescribed pill regime (usually a pill a day).
These landmark trial results have led the U.S. Centers for Disease Control and Prevention to publish interim prescription and monitoring guidelines for PrEP use among men who have sex with men (MSM) in the U.S., and doctors are now prescribing PrEP to gay and bisexual men who are willing to use it and whose practices put them at risk of HIV.
In Australia, there has been a slower response to PrEP, and no moves so far to make it available to gay and bisexual men, the primary affected group by HIV in Australia. However, questions remain about interest in using PrEP among Australian gay and bisexual men: whether there are particular men who would benefit from PrEP, and what the impact of PrEP might be on current safe-sex practices.
The PrEPARE Project led by Dr Martin Holt of the National Centre in HIV Social Research together with the Australian Federation of AIDS Organisations, set out to answer these and other related questions.
Hepatitis C treatment in opiate substitution settings
The hepatitis C virus epidemic is a significant public health challenge in Australia and the burden of disease is increasing. In Australia, as elsewhere in the developed world, the primary risk factor for contracting HCV is injecting drug use (IDU). With over 200,000 Australians living with chronic hepatitis C national health policy currently targets a doubling of treatment uptake to ameliorate the looming healthcare burden of end-stage liver disease and transplantation.
Although treatment has improved substantially in recent years it is still widely regarded as a physically and psychologically arduous and exacting regime lasting up to 12 months in duration. Typically provided via a hospital-based specialist within a dedicated multidisciplinary team the low rates of treatment uptake have led to a growing interest worldwide in the provision of care and treatment within opiate substitution treatment (OST) programs (‘methadone clinics’). A high proportion of people attending clinics for opiate substitution treatment are
known to be living with chronic hepatitis C.
Researchers at the National Centre in HIV Social Research (NCHSR) have been collaborating on a project led by The Kirby Institute to examine the feasibility of delivering hepatitis C treatment in these settings.
Making Disease, Making Citizens: The Politics of Hepatitis C
November sees the publication of a major book co-authored by NCHSR Adjunct Associate Professor Suzanne Fraser and Dr Kate Seear of Monash University. Making Disease, Making Citizens: The Politics of Hepatitis C is a key outcome of an ARC Discovery Project led by Assoc Prof Suzanne Fraser, Professor Carla Treloar (NCHSR) and Professor David Moore (NDRI, Curtin University).
This is the first book-length social science analysis of hepatitis C. Works of this kind are common in other fields, such as HIV, where books by the likes of Denis Altman, Gary Dowsett and Paula Treichler have contributed enormously to understandings of HIV and sexuality, medicalisation, treatment regimes and gay culture and sociality. Assoc Prof Fraser and Dr Seear felt that a work of equivalent scale and ambition on hepatitis C was sorely needed.