PrEP was listed on the PBS (Pharmaceutical Benefits Scheme) from April 1 2018. It is classed as an S85 drug and can be prescribed GPs.
According to the ASHM guidelines on PrEP, the risk criteria for heterosexual people include:
- Having a partner who is HIV+ and not on treatment and/or with detectable viral load where the couple don’t use condoms regularly
- A person having receptive sex with a casual partner who is HIV+ and a person (woman) who is having sex with a gay or bisexual man whose HIV status is unknown
- A woman who is trying to conceive with a HIV+ partner
- People who share injecting equipment with a HIV+ person or with a gay or bisexual man of unknown HIV status
- Condomless sex with a person from a country with high HIV prevalence
- Trans and gender diverse people may identify as heterosexual. Their risk criteria include diagnosis with STIs, methamphetamine use, and insertive condomless anal intercourse
Ideally the prescriber will be able to ascertain when a person is an appropriate candidate for PrEP, which involves many important factors. A trusting relationship between patient and doctor helps to facilitate disclosure of personal information such as injecting and sexual practices. Adherence is important so a good relationship and regular monitoring of the patient is ideal. Some heterosexual men also have sex with men, so the guidelines may apply here, but appropriate prescribing also relies on patient knowledge of risk, and prescriber knowledge and skills.
Ongoing management and routine testing for HIV and STIs (sexually transmitted infections) is important. Condoms remain an effective way to prevent STIs. Sexually active people, particularly those taking PrEP, should be regularly tested for STIs and HIV to ensure optimum sexual health.