History lessons

Have your say about changes to access of HIV medications

The Federal Minister for Health, the Hon. Peter Dutton MP announced that from 1 July 2015, people with HIV will be able to access HIV medication from community pharmacies. This is an important change and will increase convenience for people with HIV.

Positive Life (PosLife) has asked us to help them gauge community feeling about these changes. They are forming an Advisory Committee and have launched an online survey. We have provided the links here for your convenience.

You can also have your say on our forum or by emailing us nuaa@nuaa.org.au or tweeting to us @NUAANSW.

Resources

Number 1 in the series, Testing and Diagnosis - hepatitis C and HIV, provides information for injecting drug users who are considering getting tested for hepatitis C or HIV. Now available online (PDF, 2.2 Mb)

Number 2, Staying healthy with hepatitis C, focuses on issues relating to hepatitis C and injecting drug use such that those of us with the virus can live healthily. Now available online (PDF, 2.5 Mb)

In the same vain is Number 3, Staying healthy with HIV, which looks at similar issues but for those of us with HIV. Now available online (PDF, 2.1 Mb)

Number 4, Co-infection and drug interactions, looks at issues affecting those of us who have both hepatitis C and HIV and also looks at interactions between illicit drugs and treatments for hepatitis C and HIV. Now available online (PDF, 2Mb)

Number 5, Discrimination, Privacy and Confidentiality, looks at the various issues affecting injecting drug users including those with hepatitis C and/or HIV. Now available online (PDF, 2.4Mb)

Finishing off the series is number 6, Planning ahead, which provides information for planning for the future for people with hepatitis C and/or HIV. Now available online (PDF, 2.2Mb)

TREATMENT

PrEP, Acronym for Pre-Exposure Prophylaxis. A preventive course of anti-HIV medications taken daily by persons who are regularly at high risk of contracting HIV. My partner is living with HIV but I am not, so I decided to use PrEP to lessen the risk of contracting HIV.

If you are regularly at high risk of contracting HIV, PrEP (Pre-Exposure Prophylaxis) aka the HIV prevention pill, may lessen your chances of getting the virus if you take it every day.

Condoms and lubricant remain the most effective barrier against the transmission of HIV and the majority of sexually transmissible infections (STIs).

However over many years in NSW there has been a consistently high rate of condom use amongst gay men and other homosexually active men without any significant reduction in HIV transmission. It has become apparent that repeated promotion of condom use in itself is not likely to be sufficient to meet the targets outlined in the NSW HIV Strategy 2012 - 2015.

Pre-exposure prophylaxis, or PrEP, is a prevention option for people who are at high risk of getting HIV. It’s meant to be used consistently, as a pill taken every day, and to be used with other prevention options including condoms and lube. It's the same antiretroviral medication used in PEP (Truvada REGISTERED TRADEMARK SYMBOL) but taken daily for prevention rather than after a single episode of high risk.

The World Health Organisation in its updated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations released in July 2014 "strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection (pre-exposure prophylaxis) alongside the use of condoms".

In NSW, draft guidelines have been developed for introducing PrEP into the arsenal of anti-HIV strategies as an additional prevention choice within a comprehensive HIV prevention package.

A number of international studies have demonstrated that PrEP is effective in preventing HIV acquisition. How well it works is dependent on a number of variables, and trials undertaken in different places with different types of people have had different results. However, among gay men with access to care and in settings comparable to NSW, and among serodiscordant couples, the efficacy of PrEP has been shown to be very high.

It is recognised that PrEP could have a considerable impact on the incidence of HIV amongst high prevalence communities, but at a cost. Researchers suggest that PrEP is most cost effective when targeted at high risk groups. Higher uptake of PrEP amongst high risk groups has lowered rates of HIV acquisition and therefore reduced onward transmission, resulting in benefits for both the individual taking PrEP and the community.

Many stakeholders in the HIV community sector consider that the availability of PrEP is an important component of an effective combination prevention response.

You can read about the positions of various organisations on their websites and access their fact sheets: ACON http://www.acon.org.au/sites/default/files/PrEP-Position-Paper-2014.pdf AFAO http://www.afao.org.au/library/topic/hiv-prevention/3.-AIDS-2014-Background-Briefing-PrEP_FINAL.pdf NAPWHA http://napwha.org.au/publications/pre-exposure-prophylaxis-prep same same http://www.samesame.com.au/features/7812/The-HIV-prevention-pill

PEP, Acronym for Post Exposure Prophylaxis. A course of anti-HIV medications that can prevent a person getting HIV after a single instance of exposure to HIV.

If you think you’ve been exposed to HIV, PEP (Post Exposure Prophylaxis) may prevent you becoming infected – if you act quickly.

PEP is a course of anti-HIV medications taken over a four week period that can prevent you becoming infected. For PEP to work it needs to be started as soon as possible after exposure – and definitely within 72 hours - before the virus has time to rapidly replicate in your body. PEP consists of two to three antiretroviral (ARV) medications taken for 28 days. These medications keep HIV from making copies of itself and spreading through your body. It is extremely important that a person who may have been exposed to HIV through contact with blood or body fluids from an HIV positive person seeks medical advice as soon as possible.

PEP may prevent infection in anybody who has engaged in unprotected anal or vaginal intercourse (including condom breakage) with a partner who is HIV positive, or shared injecting equipment such as needles or syringes with a person who is HIV positive.

Your doctor will determine what treatment is right for you based on how you were exposed to HIV. and whether you know if the person whose fluids you were exposed to might be HIV-positive.

There can be a range of side effects during treatment but not everybody experiences them. Nausea, abdominal pain, diarrhoea or headaches are the most common. None of the side effects are life threatening and can be treated. PEP will reduce the risk of HIV infection following an exposure to infected blood or bodily fluids. In the case of occupational exposure in a workplace (e.g. needlestick injury in a clinic), PEP has been used for a number of years and has been effective in most cases. Studies have also shown the use of PEP to be effective in cases of non-occupational exposures (e.g. sex or sharing injecting equipment) in people who completed the full course of PEP. PEP is not 100% effective. It does not guarantee that someone exposed to HIV will not become infected with HIV. But it does significantly decrease the chances of becoming infected.

PEP will not make people immune to future HIV exposures. People still need to practise safe sex and in the case of people who inject drugs, safer injecting practices as these remain the best ways to prevent HIV infection. This involves using condoms with water-based lubricant and the use of clean, sterile injecting equipment at all times.

If you think you’ve been exposed to HIV, the best thing is to call the 24-hour PEP Hotline as soon as possible. You can find out if you’re eligible for PEP and where you can get it.

Tel: 1800 PEP NOW or 1800 737 669. (It's a free call from inside NSW)

Generally, you can get PEP at a sexual health clinic or in the accident and emergency sections of most hospitals. There is also a 24 hour service at the Albion Street Clinic, in Surry Hills.

You will be asked to return for more HIV testing at 4 to 6 weeks, 3 months, and 6 months after the potential exposure to HIV. (Talk to your healthcare provider about the recommended follow-up schedule for you.)

Some links you might find useful

Research and Conference Papers