Overseas-born men who have sex with men are still at higher risk of HIV—how and when to prescribe PrEP to reduce risk

PrEP, or pre-exposure prophylaxis, has been listed on the PBS since April 2018 for people who are HIV negative but at substantial risk of contracting HIV. But some GPs remain unaware of the drug or their ability to prescribe it.

To guide GPs in effectively prescribing PrEP, Associate Professor and sexual health physician Jason Ong, from Monash University and the Melbourne Sexual Health Centre, recommends a handy PrEP decision-making tool on the ASHM website.

“You first have to identify who is at risk of HIV. For Australian-born people, the HIV rates have dropped dramatically, but overseas-born men who have sex with men are still at increased risk of contracting HIV because of lack of access to Medicare or lower sexual awareness,” says Associate Professor Ong.

Unfortunately, those without access to Medicare are less likely to visit a GP in the first place, and so may not be aware of the prophylactic options—and cost can be a barrier particularly with PrEP, where ongoing follow-up visits and tests can add up. However, the not-for-profit PrEPaccessNow has detailed information about options to make the drug more affordable and improve access.

“Once you’ve decided someone should be on PrEP, test for HIV on the day to make sure they are not already affected. And then offer a sexually transmitted infection screen, including blood tests for syphilis, which is another epidemic out there.”

Associate Professor Ong says the PrEP drug, tenofovir, should be easy to find on GP prescribing software, provided they search using an HIV indication, as the drug has multiple purposes.

A patient can take the drug daily or for short on-demand periods.

“The vast majority of people use a daily PrEP, so one pill every day, just like the contraception pill,” Associate Professor Ong says.

“For people who are less sexually active or have specific periods of risk, we have a second option called on-demand PrEP, which around 15% of our PrEP users opt for.

Associate Professor and sexual health physician Jason Ong, from Monash University and the Melbourne Sexual Health Centre, is presenting an HIV update for GPs in an upcoming Healthed webcast. Register here to attend.

“You take two tablets two to 24 hours before a sexual episode, and then one tablet every 24 hours after that, stopping when you have taken two additional tablets after your last sexual episode.”

Monitoring should be done every three months, including tests for STIs as well as HIV. Renal function should be checked at PrEP initiation and at least every six months, as tenofovir can affect the kidneys.

“We need to be cautious about people above 50 or people with pre-existing kidney conditions,” Associate Professor Ong says. “For young people, who are often the majority of PrEP users, there are no significant side effects.”

Patients who have had a sexual encounter without a condom in the last 72 hours and are worried about contracting HIV, and are not on PrEP, can use a post-exposure prophylaxis (PEP).

Associate Professor Ong says only trained GPs, emergency departments and sexual health clinics can prescribe PEP. The Get PEP website shows where the nearest qualified PEP prescriber is located in each state and territory.

Associate Professor and sexual health physician Jason Ong, from Monash University and the Melbourne Sexual Health Centre, is presenting an HIV update for GPs in an upcoming Healthed webcast. Register here to attend.