PrEP drug Truvada

Recent HIV infections in gay and bisexual men in New South Wales (NSW) have declined by almost one-third following the trial of HIV prevention medication PrEP.

According to Kirby Institute research published today in The Lancet HIV these globally unprecedented reductions provide strong evidence to support the large-scale, targeted provision of Pre-Exposure Prophylaxis(PrEP) to prevent HIV transmission.

The findings were from a NSW trial called EPIC- NSW, which was launched in March 2016, is the first trial globally to study the impact of PrEP on reducing HIV in a large population.

The EPIC-NSW trial enrolled 9,714 HIV negative people at high risk of HIV and provided them with PrEP. The study ceased enrolling on the 30 April 2018, following PrEP being made available through the Pharmaceutical Benefits Scheme.

Professor Andrew Grulich from the Kirby Institute at UNSW Sydney led the trial and said the speed of the decline seen in new HIV infections during the trial is a world first.

“In the year following the trial, state-wide new HIV infections in this population decreased by one third, from 149 infections in the 12 months prior, to 102 in the 12 months after,” said Professor Grulich.

“These numbers are the lowest on record since HIV surveillance began in 1985.

“Our research tells us that these reductions are a result of PrEP, implemented on a background of high and increasing HIV testing and treatment rates.”

The declines were highest among Australian-born gay and bisexual men (48.7%) and gay and bisexual men living in the ‘gay suburbs’ of Sydney (51.8%).

Professor Andrew Grulich
Professor Andrew Grulich

“These communities had the highest uptake of PrEP, and in these populations, new HIV infections have halved since the trial began,” said Professor Grulich.

“However, we did not see the same reductions across the board. Reductions were lower in non-English speaking immigrants with a smaller 21% decline among those born in Asia.

“We need to improve education and promote access to PrEP, particularly amongst culturally and linguistically diverse men who have sex with men, and those outside the gay neighbourhoods of Sydney.”

NSW was the first state in Australia to trial PrEP at a large scale.

“The results from EPIC-NSW provide an important evidence-base to inform our response to HIV globally,” added Professor Grulich.

“We now know that PrEP implemented quickly, at a large scale, and targeted to high-risk populations can help turn the HIV epidemic around.”