I just ran across this update from the New Zealand AIDS Foundation about a nascent PrEP Demonstration Project. Not much to tell—basically just “we’re working on it and we’ve got no money and we’re already quite busy”—but I couldn’t help raising an eyebrow at some of the language:
“We want to make PrEP available via sexual health doctors for those men who don’t wear condoms and put themselves and others at risk.”
Which echoes an earlier NZAF statement in response to the most recent WHO recommendations which noted that PrEP “has been shown to work for highly motivated individuals who resist other forms of safe sex.”
I wish them luck finding sponsors for the project, and I sincerely hope folks actually participating in this project will find the experience to be a little less, um, judgey in tone.
New Zealand’s neighbour, Australia, has a PrEP demonstration project already up and running. The VicPrEP study is looking at the feasibility and impact of providing PrEP in Victoria with a special focus on the reasons people choose to use or not use PrEP. Essentially I think they’re trying to figure out how they’re going to do it with a limited number of people before they scale up (which is I guess what a demonstration project is usually about, huh?).
Unfortunately they’re not accepting new participants, but there is this helpful site which provides a lot of answers about PrEP, how to use it safely, and (crucially) how to order it online from a reliable generic vendor.
Meanwhile over in Europe, there are two demonstration projects that are just getting under way.
One is in Amsterdam (which is in the Netherlands, do I even need to say that?) and it’s called AMPrEP, the other is in Antwerp, Belgium, the Be-PrEP-ared study. It’s worth noting that the Be-PrEP-ared study explicitly include transwomen as well as cis- gay and bisexual men, it’s not clear whether the AMPrEP study will (although most of the materials are in Dutch so I haven’t looked at them closely).
These are more than just “can we make this work here?” studies, though, both studies will compare two different PrEP regimens: daily Truvada and intermittent or “on-demand” Truvada. The daily regimen is what’s been used in most studies to date (and is proven to be very, very effective). Intermittent PrEP has only been tested in the IPERGAY trial, but it seemed to be as effective as daily Truvada on a population level at least.
I’m glad to see more work being done on the intermittent dosing regimen. I can see the appeal of both dosing regimens depending on one’s own preferences and circumstances, but it’ll be interesting to see the results of these studies, which protocol different folks favour when they have the choice.
Of course, intermittent PrEP is appealing not just for people who may not have sex often enough to need daily dosing, it’s also very appealing to European governments concerned about the cost of providing PrEP. Using it only when you’re actually having sex could mean a 30-pill supply could last several months instead of just one, dramatically reducing the cost. Knowing this method is safe and effective, and feasible to implement, could speed the roll out of PrEP in Europe considerably.