Health promotion update Get PEP

HIV Australia | Vol. 13 No. 2 | July 2015

By Ben Wilcock

Post-exposure prophylaxis (PEP) is a month-long course of HIV treatments taken within 72 hours of suspected HIV exposure (the sooner the better) to prevent seroconversion.

PEP works because it can take a few days for HIV to become established in the body following exposure to the virus.

PEP drugs are administered within the first 72 hours of suspected HIV exposure in an attempt to support the body’s immune system to stop the virus from replicating (multiplying).

The cells originally infected with HIV die naturally within a short period of time without producing more copies of the virus.

PEP can be an effective HIV prevention tool after a high-risk event, such as condomless sex, sex where a condom breaks, and sharing injecting equipment.

For this tool to be effective, those at risk first need to be aware of how PEP works, its availability and where they can access it.

Data from the Gay Community Periodic Surveys shows that there is a significant knowledge gap among gay men regarding the availability of PEP.¹

Knowledge levels vary considerably across the country, ranging from less than half to almost two-thirds of gay men surveyed knowing about PEP and where to obtain it (see Table 1 and Figure 1).

Among the survey sample, knowledge about PEP is also lower among non-HIV-positive men (which includes HIV-negative men, and men of unknown and untested HIV status) than among all men (see Table 2 and Figure 2).^2–7

The Seroconversion Study, which focuses on the experiences of people recently diagnosed with HIV, also found a significant knowledge gap regarding the awareness of PEP among gay and bisexual men. Half of the survey respondents who had recently seroconverted were not aware of PEP.⁸

Health promotion update In more recent years, the Gay Community Periodic Surveys have also been asking survey participants about PEP usage in the six months prior to the survey.

These results vary across the country, ranging from just over one percent to approximately three-and-a-half percent saying they have accessed PEP in a six-month period (see Table 3).^9–14

These levels of PEP use highlight a gap between individuals who would be eligible for PEP (based on behaviour) and those that take it.

The Seroconversion Study found a number of reasons for people choosing not to access PEP following a high-risk event.

For the men who said they were aware of PEP at the time they seroconverted, reasons included not believing the risk was sufficient enough to have sought PEP.

Other reasons related to previous bad experiences when accessing PEP, such as negative attitudes by clinicians or hospital staff.

The survey found that these negative experiences can put some people off from accessing PEP after subsequent high-risk events.¹⁵

This reflects other anecdotal reports of people encountering negative attitudes when trying to access PEP.

With varying but relatively low levels of awareness about PEP among gay men around the country, and a gap between those men eligible for PEP and those that take it, the Australian Federation of AIDS Organisations (AFAO) has been developing a national PEP campaign as a way to increase awareness and improve uptake of this important HIV prevention tool.

The campaign is currently in the final stages of development. The primary audience of the campaign will be non-HIV-positive gay men and other men who have sex with men (MSM).

However, the campaign is targeted to all gay men and other MSM, including men living with HIV, who are able to inform their non-HIV-positive partners and other men about PEP.

The core information resource for the campaign will be the www.getpep.info website.

This is an existing site that will be updated and redesigned as part of the upcoming campaign.

The website will contain information about PEP (including what it is, how it works, and tips to follow while taking it), as well as where people can access it.

To help address some of the reasons why some men are not accessing PEP when they would be eligible for its use, the campaign will include information on the reasons or risk events where PEP would be offered, and how to help overcome issues that may be encountered when accessing PEP.

Campaign collateral will also include posters, advertisements, and other materials.

All other collateral and advertising will direct people to the Get PEP website for more information, including where they can access PEP.

In addition to the campaign, AFAO will also be working and communicating with a broad range of clinical organisations and bodies to increase awareness about PEP and the PEP prescribing guidelines among clinicians throughout Australia.

The development of AFAO’s PEP awareness campaign is currently being finalised and is due to be launched in the coming months.

References

1 The Gay Community Periodic Surveys are repeated, cross-sectional surveys of gay men, conducted in the metropolitan areas of six Australian states and territories. Available at: csrh.arts.unsw.edu.au

2 Hull, P., Mao, L., Kolstee, J., Duck, T., Prestage, G., Zablotska, I., de Wit, J., Holt., M. (2014). Gay Community Periodic Survey: Sydney 2014. Centre for Social Research in Health (CSRH), UNSW Australia, Sydney.

3 Lee, E., Mao, L., Watts, P., Mackie, A., Prestage, G., Zablotska, I., de Wit, J., Holt, M. (2014). Gay Community Periodic Survey: Queensland 2013. CSRH, UNSW Australia, Sydney.

4 Lee, E., Hull, P., Mao, L., Comfort, J., Chanmugam, M., Laing., S., Fragomeni, S., Prestage, G., Zablotska, I., de Wit, J., Holt, M. (2014). Gay Community Periodic Survey: Perth 2014. CSRH, UNSW Australia, Sydney.

5 Lee, E., Mao, L., von Doussa, H., Batrouney, C., West, M., Prestage, G., et al. (2014). Gay Community Periodic Survey: Melbourne 2014. CSRH, UNSW Australia, Sydney.

6 Hull, P., Mao, L., Rossteuscher, K., Marion- Landais, S.,Prestage, G., Zablotska, I., et al. (2014). Gay Community Periodic Survey: Canberra 2013. CSRH, UNSW Australia, Sydney.

7 Lee, E., Mao, L., Skene, H., Cannon, R., Narciso, L., Prestage, G., et al. (2013). Gay Community Periodic Survey: Adelaide 2012. CSRH, UNSW Australia, Sydney.

8 Down, I. (2014). What can data from the Seroconversion Study about PEP use tell us about how PrEP may be used? Presentation delivered at the AFAO National Gay Men’s HIV Health Promotion Conference 2014, Sydney.

9 Hull, P., Mao, L., Kolstee, J., et al. (2014). op cit.

10 Lee, E., Mao, L., Watts, P., et al. (2014). op cit.

11 Lee, E., Hull, P., Mao, L., et al. (2014). op cit.

12 Lee, E., Mao, L., von Doussa, H., et al. (2014). op cit.

13 Hull, P., Mao, L., Rossteuscher, K., et al. (2014). op cit.

14 Lee, E., Mao, L., Skene, H., et al. (2013). op cit.

15 Down, I. (2014). op cit.

Ben Wilcock is an HIV Health Promotion Officer at AFAO.