How Australia Could Almost Eradicate H.I.V. Transmissions

How Australia Could Almost Eradicate H.I.V. Transmissions
The most recent advance in Australia’s decades-long fight against the virus is the rapid adoption of a preventive drug regimen known as PrEP.
By Livia Albeck-Ripka
Jul 10 2019
https://www.nytimes.com/2019/07/10/world/australia/hiv-aids-prep-prevention-drug.html

MELBOURNE, Australia — It took universal health care, political will and a health campaign designed to terrify the public, but nearly four decades into the H.I.V. crisis, Australian researchers say the country is on a path toward making transmissions of the virus vanishingly rare.

The fight is not yet won, the experts caution, and the last stretch of disease eradication efforts is often the toughest. But in the past five years, the number of new infections with the virus has dropped by almost a quarter in Australia, with higher declines among gay and bisexual men, according to a report released last week by the Kirby Institute, an infectious disease research center in the state of New South Wales.

In 2018, just 835 H.I.V. diagnoses were recorded nationally. At their peak, in 1987, there were 2,412.

The most recent advance in Australia’s battle against the virus, which is seen as a model around the world, is the rapid adoption of a drug regimen known as PrEP. Under the regimen, patients typically take a daily pill, which — even without the use of condoms — is close to 100 percent effective at preventing contraction of H.I.V., experts say.

In Australia, more than 40 percent of gay men considered to be most at risk of infection are on PrEP, according to the Kirby Institute. Adoption rates are lower in the United States. While the Centers for Disease Control and Prevention has said that more than 1.1 million Americans need PrEP, one group that tracks data on the regimen says that only about 270,000 are on it. The C.D.C. is expected to release new figures on Thursday about the use and awareness of the regimen in the United States.

“Provided we don’t take our foot off the pedal, we stand a chance of eliminating H.I.V. by 2030” in Australia, said Andrew Grulich, an author of the Kirby Institute report and a professor of epidemiology at the University of New South Wales.

Truvada, which is used for H.I.V. treatment and PrEP — the abbreviation stands for pre-exposure prophylaxis — was formally added as a preventive medication to the list of pharmaceuticals available at subsidized rates under Australia’s universal health care program in April 2018.

Since then, any permanent resident or citizen of Australia has been able to get the pill, or its generic alternative, by obtaining a prescription from a doctor and purchasing it from a pharmacy. For these people, it usually costs about 40 Australian dollars, or $28, per month.

“If you have a universal health care system like Australia does, then getting yourself on PrEP is easy, whether you are unemployed or a millionaire,” Dr. Grulich said.

Truvada was developed in the United States and first approved for use in H.I.V. prevention there in 2012. But the medication has been slow to gain a foothold in the country because of a variety of obstacles, including what Dr. Robert Grant, a professor of medicine at the University of California, San Francisco, called a “byzantine system” that many patients find impossible to navigate.

Some cities, including New York and San Francisco, have made strides toward providing free or subsidized access to PrEP, with corresponding declines in H.I.V. diagnoses. Gilead Sciences, the maker of Truvada, also recently promised to supply 200,000 uninsured patients with the pill.

And as of last month, most private health insurers are now required to offer the medication — which has a list price of about $2,100 per month — at no out-of-pocket cost to their policyholders.

But in poorer and more rural areas, patients and even doctors may not have heard of Truvada, said Dr. Grant, who led the development of PrEP. Costs for doctor’s appointments themselves might be prohibitive, or patients may be unaware of the assistance available to them, he said. In addition, Truvada has been stigmatized in some parts of the United States as promoting promiscuity, creating barriers to access and use.

Bill Bowtell, a strategic health policy consultant who helped lead Australia’s response to the AIDS crisis and continues to advise governments on H.I.V. policy, said the system in the United States “could not be set up better to maintain a continuing H.I.V. and AIDS pandemic.”

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