Now that biomedical HIV prevention strategies dominate the social dialogue, we look at the increasingly broad selection of sexual health strategies available without losing sight of traditional methods that have undoubtedly helped reduce the impact of the HIV epidemic.
The biomedical HIV prevention tool, PrEP, is remarkably effective and increasingly popular. And now we know that people living with HIV who maintain an undetectable viral load cannot transmit the virus.
But today, not everybody across Australia is aware, willing or able to embrace biomedical HIV prevention options. Most importantly, everyone should feel confident in choosing options that work for them — ultimately, taking action and choosing one or more sexual health strategies is better than choosing none at all.
And let’s be clear. Thinking about the benefits of different strategies is important. But choosing to protect yourself and other people is what really prevents new HIV transmissions from occurring. So here’s some information to help you decide how you can be part of the solution.
In this article:
PrEP
Type: Biomedical HIV prevention strategy
Description: PrEP stands for Pre-Exposure Prophylaxis. PrEP involves using prescription medicine that, when used as advised, is highly effective at preventing someone who does not have HIV from acquiring HIV.
Introduced: VicPrEP was the first demonstration project in Australia to offer PrEP to more than 100 Melbourne residents in 2014. Large-scale studies in Victoria, New South Wales, Queensland and most other states and territories began enrolling participants from around March 2016. The Australian Therapeutic Goods Administration (TGA) approved PrEP for preventing HIV in May 2016. Even prior to TGA approval, some doctors were prescribing PrEP to people who could benefit from it.
Can be used by: Only people who are HIV negative.
Combination approach: PrEP can be safely used in conjunction with condoms to maximise protection against HIV and help reduce the chance of acquiring STIs — this is important as PrEP does not protect against other STIs.
Sexual health tests: Part of a managed PrEP program includes comprehensive sexual health testing at least once every three months.
Frequency and duration of use: There are three different ways to use PrEP. Daily PrEP involves taking one pill every day. Periodic PrEP is the same as daily but with an end date in mind. On-demand PrEP involves using PrEP according to a carefully timed dosing schedule for shorter periods of time. Use our PrEP Selector tool to find out which option could suit your needs. PrEP can be used as an ongoing strategy for as long as someone chooses.
Usage trends and population uptake: As of October 2024, 80,000+ people have been prescribed PrEP at least once in Australia.
“… taking action and choosing one or more sexual health strategies is better than choosing none at all”
Accessibility: Prescriptions are available from doctors across Australia. Although any doctor can prescribe PrEP as part of a managed sexual health program, not all doctors may be aware of it.
Personal cost: From April 1, 2018, PrEP is available on the PBS (Pharmaceutical Benefits Scheme — the list of government subsidised medicines available to people with Medicare). This means that anyone who has a valid script for PrEP will be able to buy it in any Australian pharmacy for no more than $31.60 per month, or $7.70 with a concession. Community organisations PrEP’D For Change and PAN (PrEPaccessNOW) provide support and information on how to access PrEP across the country. For people with or without Medicare, personal importation options to buy PrEP online with a prescription from a doctor start from around $20 per month. For anyone in financial hardship, free PrEP is available through community schemes.
Considerations: When used as advised, PrEP offers extremely high levels of protection against HIV. PrEP does not protect against other STIs. Most STIs are easy to detect and straightforward to cure. This is why three-monthly testing and, if necessary, treatment of other STIs is recommended while using PrEP. Although increasingly popular, PrEP may not be suitable or desirable for everyone. To discover which PrEP option could be right for you, use our interactive PrEP Selector tool.
Special mention: Australia and other countries that have introduced large-scale access to PrEP have observed significant reductions in new HIV diagnoses.
More information: Contact your doctor, local HIV/AIDS organisation, sexual health clinic or community groups like PrEP’D For Change and PAN (PrEPaccessNOW) for support and further information. Emen8 also provides a series of articles on how to get PrEP in Australia — click your state/territory below to read:
Condoms
Type: Physical barrier device used as an HIV and/or STI prevention strategy.
Description: A condom is a physical sheath-shaped device used to cover the penis during sex. Using a condom can help prevent HIV and other STIs.
Introduced: Condoms were first acknowledged to prevent the transmission of HIV close to the start of the HIV epidemic in the early 1980s. It took a few years to understand that the virus was transmitted through particular bodily fluids. As a result, gay and bi+ guys quickly adopted them and were pioneering community activists in promoting condom use as the only known way to protect against HIV at the time. Throughout most of the 1980s, before treatments became available, acquiring HIV was likely to result in premature death, so using a condom was directly associated with staying safe and alive. Despite the prevalence of other STIs long before the HIV epidemic, condoms weren’t typically used for sex between men as they were predominantly used for preventing pregnancy.
Can be used by: Anyone, regardless of their HIV status. As condoms are only used to cover the penis, they are only worn by the insertive partner — the top.
Combination approach: Condoms can be safely used in conjunction with PrEP to maximise protection against HIV and other STIs. Although using HIV treatment medicine to maintain an undetectable viral load means there is no risk of transmitting HIV, condoms can still be used if preferred. Condoms also help protect against most STIs.
Sexual health tests: Testing every three months is important because condoms aren’t typically used for oral sex and they don’t always fully cover affected areas of skin, allowing the possibility of acquiring or transmitting syphilis. Testing for HIV and STIs at least four times a year is part of a good sexual health strategy.
Frequency and duration of use: One condom for every occurrence of sex. A fresh condom should be used with every sexual partner. Condoms can be used as an ongoing strategy to reduce transmission of HIV or other STIs.
Usage trends and population uptake: According to the Centre for Social Research in Health (CSRH) Annual Report of Trends in Behaviour, condoms continue to play an important role for many guys. They’re not leaving the HIV and STI prevention toolkit any time soon.
“Choosing to actively protect yourself and other people is what really prevents new HIV transmissions from occurring”
Accessibility: Condoms can be purchased in supermarkets, service stations, pharmacies, restroom vending machines or online. Some LGBTQ venues, sexual health services and HIV/AIDS organisations provide condoms and lube for free or at low cost.
Personal cost: Condoms vary in price between free to upwards from around $5 for a pack of 10. Some non-latex condoms, or custom-made condoms may cost more.
Considerations: When used correctly, condoms offer protection against HIV and help prevent most STIs. However, condoms don’t always cover affected areas of skin, there’s the possibility of them slipping or breaking, and they’re not typically used for oral sex. If a condom isn’t on, it can’t offer any protection against HIV or STIs. Condoms are only effective when used correctly every time. Although condoms are a useful tool, they might not always be to hand and not everyone enjoys using them.
Special mention: Condom use by gay and bisexual men has prevented millions of HIV transmissions and saved countless lives since the beginning of the HIV epidemic in the early 1980s.
More information: Contact your local sexual health service or HIV/AIDS organisation for further information on condoms.
Undetectable Viral Load (UVL)
Type: Biomedical HIV treatment program with additional benefits as a way of preventing HIV.
Description: Use of prescription medicine to manage the virus in people living with HIV. Starting and staying on an effective HIV treatment program is important to remain healthy. By using HIV treatment, people living with HIV can reduce the amount of virus — a measure known as ‘viral load’ — in their body so low that it is considered ‘undetectable’ in laboratory tests. This doesn’t mean they are cured or free of HIV; it simply means their treatment is working to suppress the virus from being harmful. People living with HIV who maintain an undetectable viral load cannot transmit the virus to sexual partners.
Introduced: Zidovudine (AZT) was the first effective antiretroviral medicine introduced in 1987. In 1996, HAART (highly active antiretroviral therapy) became the new standard for treating HIV using a combination of different classes of HIV medicines. Many HIV treatment medicines are now available for use in Australia, and new and improved medicines are constantly in development.
Can be used by: HIV treatment is only used by people who are living with HIV. However, people who are HIV-negative can rely on an HIV-positive partner’s undetectable viral load to avoid getting HIV.
Combination approach: Although using HIV treatment medicine to maintain an undetectable viral load means there is no risk of transmitting HIV, condoms can still be used if desired. Condoms also help protect against most STIs.
Sexual health tests: Part of a managed HIV treatment program includes sexual health testing at least every three months.
Frequency and duration of use: Treatment regimes involve taking one or more pills every day. New HIV treatment is now available as a long-acting injectable. HIV treatment must be used on an ongoing basis to ensure someone’s health and wellbeing is maintained. Regular monitoring of viral load from a specialist clinician helps ensure the treatment continues working to suppress the virus with no risk of onward transmission to other people.
Usage trends and population uptake: According to data from the Kirby Institute, it is estimated that there were 28,870 people living with HIV in Australia in 2022. Of these, 95 per cent were receiving antiretroviral therapy, and 98 per cent of those on treatment had an undetectable viral load.
“People living with HIV who maintain an undetectable viral load for six months or more do not transmit the virus”
Accessibility: Only doctors trained as specialist S100 prescribers under the Australian Government’s Highly Specialised Drugs program may prescribe HIV treatment medicine. Our interactive map of sexual health services lists all known S100 prescribers across all states and territories.
Personal cost: For people with Medicare, HIV treatment medicines are available on the Pharmaceutical Benefits Scheme (PBS) — the list of government-subsidised medicines. See our guide on accessing free HIV treatment in Australia, even without Medicare.
Considerations: Although various highly effective treatment options exist, there is currently no cure for HIV. Most people living with HIV who use HIV treatment will sustain an undetectable viral load; however, a very small number will not achieve this. Even in this small number of cases, the virus may still be suppressed to very low levels which will result in a greatly reduced risk of onward transmission of HIV to sexual partners compared to not being on treatment.
Special mention: HIV treatment is proven to extend and improve the quality of life for people diagnosed with HIV.
More information: Contact your doctor, local HIV/AIDS organisation, or community groups like The Institute of Many for support and further information. Information on how to access HIV care and treatment is available from the National Association of people with HIV Australia (NAPWHA).