Hundreds missing out on HIV prevention drug

Lead author Cameron Leakey and Associate Professor Peter Saxton have published results from a study that involved surveying 1,307 people who could benefit from HIV-preventative medicine.

Although 98 percent were aware of the drug called PrEP – pre-exposure prophylaxis – less than half were taking it, says Leakey, a former Master of Public Health student at Waipapa Taumata Rau, University of Auckland.

The researchers found 87 percent of eligible participants were willing to use the medicine, which is about 99 percent effective in preventing HIV infection.

"The biggest drop occurs between willingness and use," says Leakey.

"That tells us the problem isn't awareness. It's about making sure people can get PrEP when they need it."

The study provides New Zealand's first national framework tracking awareness, willingness and use of PrEP, and helps identify who is missing out on HIV prevention services.

Study co-author Saxton, an associate professor of Population Health, says the findings have emerged at a crucial time.

"PrEP is one of the most effective prevention tools available.

“These findings show exactly where we need to improve uptake if we're going to eliminate HIV transmission."

The study revealed significant inequities in PrEP use.

Leakey says Māori participants were more likely to meet the criteria for PrEP than Europeans, but Europeans but were less likely to use it.

Among those eligible, 39 percent of Māori reported using the medication, compared with 48 percent of Europeans.

Younger participants and those living outside Auckland reported lower rates of taking the drug.

The findings help explain inequities in progress in the response to HIV, Leakey says.

“HIV diagnoses among European gay and bisexual men have fallen sharply over time, but Māori have not experienced the same level of improvement.”

The results highlight the need for more flexible delivery of HIV prevention services, Leakey says.

"We need to make it easier for people to get PrEP in ways that fit their lives.

"That could include pharmacies, telehealth services and other access pathways that remove barriers to care."

The study found uptake was highest among people who had more than 10 recent sexual partners, suggesting the medication is reaching many people at increased risk of HIV.

The researchers used data from the 2022 Sex and Prevention of Transmission Study (SPOTS), a major nationwide survey that collects information about HIV prevention, sexual health and behaviours among gay and bisexual men and men who have sex with men.

The value of the new research lies in its ability to guide future action, says Leakey, a former research assistant with SPOTS.

The Ministry of Health has already started using the researchers’ PrEP framework in its annual HIV monitoring reports to track progress towards New Zealand's goal of eliminating HIV transmission.

Initiatives are also underway to address gaps revealed by the research. These include proposals to expand access to PrEP through community pharmacies and telehealth services, and the recent decision to extend fully funded PrEP to people on short-term visas, including many international students, from 1 December.

Saxton says the study is a reminder prevention only works when people can access it.

"Eliminating HIV transmission is within reach, but only if effective prevention options are available to everyone who needs them."

• Read the study, published in the Australian and New Zealand Journal of Public Health.