An HIV-prevention drug called PrEP could soon be easier to access. 

PrEP, officially known as pre-exposure prophylaxis, is a drug that can prevent HIV-negative people from getting HIV. 

Pharmac, a New Zealand Crown Entity that decides which medicines and products are subsidised for use, has put forward a proposal that would remove many of the current barriers that are in place for people wanting to access PrEP. 

To access PrEP in Aotearoa, you  currently have to meet a very specific list of requirements. 

These requirements include:

  • identifying as a man (cis or trans) or a trans woman
  • having had sex with men
  • having had unprotected receptive anal intercourse with a man in the last three months
  • likely to have multiple episodes of anal sex without condoms in the next three months 

New Zealand Aids Foundation general manager Joe Rich says many queer people find the requirements a barrier to accessing PrEP.

“We know that one of the top barriers that people are experiencing accessing PrEP is discussing quite detailed or intimate sexual practices with doctors,” Rich says.

“Some people struggle with that, particularly if they haven’t come out to their GP.”

Under Pharmac’s new funding proposal, many of the requirements would be removed and patients would be able to decide with their doctor if PrEP is right for them. 

If the funding proposal goes through, these changes will occur from July 1.

Pharmac's chief medical officer Dr David Hughes says these are changes it has been wanting to enact for a long time.

“We’re trying to make it as simple and straightforward as possible for patients and prescribers,” Hughes says.

“We’ve had very strong feedback from advocacy groups and our central advisory committee that this is the right thing to do. 

“It has probably taken longer than we had hoped it would, but we're here now and we’re feeling very positive about it.”

PrEP was first introduced in New Zealand in 2018. 

Since then, there has been a sharp decrease in HIV diagnoses among men who have sex with men. 

This year has seen the lowest HIV diagnoses rate since the late 1990s. 

Rich says New Zealand could expect HIV diagnoses rates to drop even further if the new funding proposal goes through.

“We expect the proposal would make it easier to access which will result in more people who need PrEP using it. And hopefully we’ll see a decrease in HIV diagnoses as a result.”

Pharmac estimates that up to an extra 3500 people per year would be able to access PrEP as a result of the new proposal.

Under the new proposal, changes would also be made to the eligibility criteria for an emergency HIV-prevention drug called post-exposure prophylaxis (PEP). 

This drug can be taken up to 72 hours after a possible exposure event - for example, of the condom breaks during anal sex.

At the moment, to access PEP people must have had unprotected anal sex with someone who has a known HIV-positive diagnosis and an infectious viral load.

The new funding proposal would remove the requirement of knowing the HIV-status of the sexual partner, widen the criteria to receptive unprotected vaginal sex and remove the requirement to be the receptive participant in unprotected anal sex.

Currently you can only access PEP in specific places such as emergency rooms, hospitals and sexual health clinics.

The new proposal would also widen the number of clinicians who would be authorised to prescribe it.

Hughes says “these are significant changes in terms of broadening access for PEP”.

Rich says “for emergency pills such as PEP, it is crucial that they can be accessed very quickly”. 

“In cities like Queenstown where the nearest emergency room or sexual health clinic is a four-hour drive away, it makes absolute sense that GPs should be authorised to prescribe it.”

Feedback on the proposal can be sent to Pharmac and submissions close on Thursday at 5pm.

Top Image: PrEP pills on a person’s chest. Photo: Getty Images

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