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20 Oct 2020 5:14
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  •   Home > News > International

    PrEP anti-HIV medication use declines in Australia amid COVID-19 pandemic

    Most people stopped taking PrEP because they weren't having casual sex. But there's concern a lack of knowledge around starting and stopping the medication could increase risks of HIV transmission.


    Social distancing measures saw almost half of gay and bisexual men in Australia using HIV-prevention medication stop doing so when the coronavirus pandemic began, according to new research from the Kirby Institute.

    PrEP, or pre-exposure prophylaxis, is a daily pill taken to prevent the transmission of HIV during sex. It's estimated to be used by almost 40,000 Australians.

    In April, researchers surveyed 847 gay and bisexual men in Australia. They found that of the 400 participants using PrEP prior to COVID-19, 42 per cent had stopped taking the medication.

    Lead author Dr Mohamed Hammoud said the decline in PrEP use could be attributed to social distancing restrictions, a subsequent reduction in sexual encounters and a perceived lower risk of HIV infection.

    "Since 2014, we've seen a steady increase in PrEP use among gay and bisexual men in Australia," he said.

    "The impact of COVID-19 restrictions has dramatically impacted this upward trajectory."

    The majority of men who discontinued PrEP use said they had done so because they were not having sex.

    "It's not like they're being reckless — they're making informed decisions," Dr Hammoud said.

    But researchers said the findings, published in the Journal of Acquired Immune Deficiency Syndrome, raised concern that HIV transmission may increase in the short term if men do not recommence PrEP when they reengaged in casual sex.

    "While this research also shows us that casual sex has decreased since COVID-19, [having] sex with casual partners [without using a condom] is still the primary risk for HIV among gay men if [they aren't] protected by PrEP or HIV treatments," Dr Hammoud said.

    The latest monitoring data on PrEP uptake in Australia has also found a reduction in use.

    PrEP use and casual sex

    The survey found men who discontinued using PrEP were more likely to have stopped having sex with casual partners during the coronavirus pandemic, but that one in six men reported still doing so.

    However, of this group, nearly all participants described themselves as having less sex during COVID-19 restrictions — and generally, men who stopped taking PrEP were far less likely to have casual sex compared to those who continued using the medication.

    Dr Hammoud said although there had been a substantial reduction in casual sex when social distancing restrictions first came into place, patterns of sexual activity were likely to change as COVID-19 restrictions did.

    "Between April and now, sexual behaviour has fluctuated … really depending on the restrictions," he said. "So we're going to see changes in the way PrEP is used."

    One of the major concerns about changes in PrEP use was that most men who stopped using the medication during the COVID-19 pandemic had no previous experience of stopping and then restarting PrEP.

    "Potential issues include the length of time required from initiation [of drug use]to protective coverage, potential side effects of restarting, and the need for HIV testing prior to reinitiation of PrEP," they wrote.

    Nicolas Parkhill, CEO of LGBTIQ community health organisation ACON, said targeted messaging about recommencement of PrEP was critical.

    "With restrictions easing, it's vital that men resume PrEP in a way that works for them.

    Most people take PrEP medication daily, but it is also possible to use it intermittently — known as "on-demand" use. This requires taking PrEP between two and 24 hours before having sex, and then again afterwards.

    If people were unsure or had questions about the regimens, Dr Hammoud said it was important to speak to a doctor or a community sexual health organisation.

    "The main thing is that we ensure men who start having sex are getting the right information on how to commence [PrEP] before they actually engage in sexual activity," he said.

    Keeping HIV rates low

    Prior to COVID-19, HIV infections in Australia were decreasing, in part thanks to the rapid uptake of PrEP in recent years.

    Garrett Prestage, the study's senior author, said he was confident gay and bisexual men would continue to prioritise the health of themselves and their communities, and take steps to protect themselves and each other.

    "Gay communities have always come together to find ways to protect themselves and each other," said Dr Prestage, an associate professor at the University of New South Wales.

    "Regardless of the sexual setting, or frequency of sexual contact, HIV prevention strategies need to be accessible.

    "With appropriate resources, gay men will be able to continue to keep HIV infections low."

    © 2020 ABC Australian Broadcasting Corporation. All rights reserved


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