Access to Subsidized Health Care Affects HIV Pre-Exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men in Australia: Results of National Surveys 2013–2019

Abstract

Background: We assessed willingness to use HIV pre-exposure prophylaxis (PrEP) and current PrEP use among gay and bisexual men (GBM) in Australia. Methods: National, online cross-sectional surveys of GBM were conducted in 2013, 2015, 2017, and 2019. Willingness to use PrEP was measured on a previously validated scale. Trends and associations with key measures were analyzed using multivariate logistic regression. Results: During 2013–2019, 4908 surveys were completed. Among HIV-negative and untested men not currently using PrEP, willingness to use PrEP increased from 23.0% in 2013 to 36.5% in 2017 (P < 0.001) but then plateaued at 32% in 2019 (P = 0.13). The proportion of current PrEP users increased significantly from 2.5% in 2015 to 38.5% in 2019 (P < 0.001). In 2019, factors independently associated with being a current PrEP user (compared with non-PrEP users who were willing to use PrEP) included having subsidized health care (Medicare), knowing HIV-positive people, being recently diagnosed with an STI other than HIV, having higher numbers of recent male sexual partners, recent condomless sex with casual and regular partners, and frequent PrEP sorting. Conclusion: Willingness to use PrEP has plateaued as its use has rapidly increased among GBM in Australia. PrEP use is concentrated among more sexually active men with access to subsidized health care. Free or low cost access schemes may facilitate broader access among GBM who want or need PrEP but lack access to subsidized health care.

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

“…48 GPs, however, indicated that although the detailed prescribing guidelines were difficult to integrate into standard 15-min general practice appointments, often resulting in appointment delays, the clinical dimensions of prescribing PrEP were not necessarily difficult. 21 The concern for ensuring equitable financial access to PrEP echoes the longstanding concern with equity in the international 49,50 and Australian literature, 20,37 which continues to shift as numbers of new infections decline, revealing ever more starkly who the populations are that are being left behind. Amidst these reconfigurations of services, participants were considering the expansion of PrEP dosing regimen options in Australia; that is, supporting alternatives to daily dosing.…”

“…53 Given that nurses demonstrated the competencies to provide PrEP, but did not have the prescribing authority to provide PrEP outside of trial conditions, exploring the professional role boundaries in sexual health and PrEP provision services is also warranted. 54 In addressing disparities between different populations acquiring HIV in Australiaparticularly MSM born overseas from Central and South East Asia [35][36][37] a public subsidy of PrEP for all Australian residents (temporary or permanent) would enable equitable financial access to PrEP. This study's findings extend the limited literature on understanding the clinical aspects of providing PrEP in Australia.…”

“…35,36 Survey research shows that men without Medicare in Australia, particularly those born in Asian countries, are overrepresented among those who are willing to use PrEP, but are not actually using it. 37 The primary focus of PrEP delivery in Australia has been on daily PrEP, although on-demand dosing 38 has been included in guidelines as an option for cisgender MSM since 2018. 9,39 Echoing the early Australian trials (which studied daily PrEP), MSM in Australia typically report using daily PrEP, although use of on-demand PrEP has grown over time.…”

COVID-19 Vaccination Uptake and Hesitancy in a National Sample of Australian Gay and Bisexual Men

“…Data were collected as part of the PrEPARE Project, a repeated, cross-sectional study of Australian GBM’s attitudes toward HIV prevention that has been conducted every two years since April 2011 [ 22 – 24 ]. The 2021 round was a national, online, cross-sectional survey of GBM conducted in April–June 2021 using Qualtrics software (Provo, UT).…”

“…We collected data on demographics including age, sexual identity, country of birth, education level, residential location, employment status, and income. Age, sexual identity, country of birth and whether GBM reside in inner city, suburban or regional areas have been previously identified as affecting access to and uptake of HIV testing, prevention and risk of HIV in Australia [ 24 – 31 ]. Younger men, bisexual men, GBM born in Asia and those in suburban or regional areas are less likely to access testing or use PrEP and more likely to reports risks for HIV.…”