by Daniel Storer | Community Engagement and Policy Analyst, Australian Federation of AIDS Organisations

On 1 April 2018, Pre-Exposure Prophylaxis (PrEP) became available through Australia’s Pharmaceutical Benefits Scheme (PBS). This allowed people who could most benefit from PrEP to access it through Government subsidy. While this access is one of the best in the world, there are still people that could benefit greatly from PrEP that are not able to access it including young people under the age of 18.

Although there is evidence to support the use of PrEP by people under the age of 18, all forms of brand name and generic PrEP in Australia explicitly prohibit administration  of the medication for people under the age of 18. While the number of people that would be eligible for PrEP in Australia under the age of 18 would be small, the reduced risk of HIV acquisition would be of great benefit.

Currently, a doctor in Australia is able apply for the use of PrEP for a person under the age of 18 through the Therapeutic Goods Administration’s (TGA) Special Access Scheme (SAS) Category B. The process presents obstacles for both the young person, who needs to be comfortable, confident and knowledgeable enough to raise the issue with their doctor, and the doctor, who needs to be open to the conversation, willing to investigate the SAS process and know where to find evidence to support the SAS application. The SAS requires a doctor to complete an application with supporting documentation outlining why the person under 18 requires PrEP and submit evidence such as safety and efficacy data to support the case. If the application was made and approved, the script provided would not be a PBS script and therefore not subsidised.

Without subsidised access to PrEP people under the age of 18 will either have to secure funds to pay the full retail price for PrEP if purchased in Australia, or be able to navigate the TGA’s Personal Importation Scheme, have access to a credit card and purchase the medication from a reputable online pharmacy. This level of health system navigation could exclude many people under 18 at medium to high risk of HIV from accessing it.

Considering the U.S. Food and Drug Administration (FDA) approved the use of PrEP ‘to include adolescents weighing at least 35 kg who are at risk of [HIV] acquisition’, it would be timely for Australia to remove the contraindication currently on brand name and generic forms of PrEP to increase access for people under the age of 18.

If Australia is to reach the full potential that PrEP can provide in reducing HIV transmissions then providing equitable access to all that can benefit from it, including people under the age of 18, is a must.