Blogs2 PrEP

A report on Sheena McCormack's presentation "PrEP: What's happening in Europe and the world in general"

This presentation outlined the current status of PrEP uptake around the world. It touched on some of the challenges and outlined some of the anticipated new medications and new modes of delivery of PrEP.

The overwhelming message is that PrEP using TDF/FTC either daily or on demand is effective in averting new HIV infections ( PREVENIR study 85 HIV infections averted; EPIC N.S.W. 31.5% decline in recent infections compared with previous year, 25% reduction attributed to  PrEP; Soho London clinic 80% decline in HIV cases since 2015).

A report on Jean-Michel Molina's presentation "STIs among MSM: New challenges in prevention, diagnosis and treatment"

The success of Antiretroviral therapy (ART) in the treatment and prevention of HIV has resulted in a marked reduction in the perception of risk of HIV, AIDS and death, termed “risk compensation”, and has resulted in reduced condom use. From 2013 to 2017 community level change in consistent condom use with casual partners fell from 46% to 31%. Over the same period, STI rates in 12 months increased from 17% to 31%.  This was accompanied by increased HIV, and presumably other STI testing. Of note, over the same period both those with HIV being treated with ART increased to 94% and with those with an undetectable viral load also increased to 94% (Holt M. et al Lancet HIV 2018).

A report on the proffered papers session on day 3 of the Conference.

In this session I was particularly interested in the studies from NSW and Victoria looking at the impact of PrEP on STI trends in high risk gay and bisexual men following the introduction of PrEP after the rapid scaling up of access to PrEP.

PrEP of course targets those already at high STI risk, including recent STI in eligibility criteria. STI incidence was increasing in the years prior to ramping up of PrEP. Condomless sex in Australian gay and bisexual men had also increased from 27% in 2000 to 39% in 2015 prior to easier access of PrEP.

A report on the symposium session “Engaging primary health in testing and PrEP Provision and HIV treatment as a strategy for reaching diverse communities”.

The 2018 HIV AIDS Conference in Sydney has started as promised; full of challenges, opportunities and hope.

The options of proffered papers as always made it hard to choose which to attend. This year I chose not to race between individual presentations, but to immerse myself in the theme of a full session. As a Nurse Consultant working in Community Health, the theme of Engaging Primary health in Testing and PrEP Provision and HIV treatment as a strategy for reaching diverse communities appealed to me.