A landmark HIV medication trial in Australia could be paving a path for other high-income nations to reduce new HIV infections, according to researchers. The trial reduced new HIV infections 25 percent over a year, through state funded distribution of free preventive medication for high-risk, HIV-negative individuals, says a report from The Guardian.

The New South Wales government distributed the preventative HIV medication PrEP to 9,714 HIV-negative individuals considered at high-risk for exposure. The drug is nearly 100 percent effective in preventing infection when taken daily.

Researchers, led by Professor Andrew Grulich of the University of New South Wales, then tracked over 3,000 gay and bisexual men involved in the initial trial. Over the course of a year, they were tested for HIV every three months. Only two men tested positive for HIV, and both had not taken PrEP as prescribed.

The groundbreaking findings were published in the journal The Lancet HIV.

Overall, new HIV infections in the state fell by a third, from 149 infections annually to just 102. According to Grulich, such a reduction achieved in such a short time frame is unprecedented.

The drug is available in the UK and US as well. In the US, the high cost of the drug is often out of reach for those without health insurance, although subsidies are now aimed at increasing access to the drug. In the UK, the NHS has said it will distribute PrEP to high-risk individuals as part of a study, but is working on a slower timetable, with plans to provide PrEP to 10,000 individuals over three years.

“We think our results can be generalized to other countries with similar epidemics, and that’s high-income countries where a large proportion of HIV is in gay and bisexual men. We’ve shown you can quickly and substantially impact on HIV infections by introducing interventions at scale, targeting large proportions of people at risk,” Grulich said, speaking to The Guardian.

The plan used education and community outreach to create demand for the drug, instead of simply making it available.

“States that don’t invest in a community-based response will have more difficulty in achieving high-level uptake. We can’t expect all gay men to suddenly know about this drug and present to a doctor and ask for it.”

However, reductions were more modest in communities culturally or linguistically isolated, or outside of major cities, showing a blind spot in the community outreach efforts. The program is now working to make up lost ground in these areas.

The trial stopped enrollment in April, as the Pharmaceutical Benefits Scheme began subsidizing PrEP for the broader population. Grulich applauded these efforts at making the drug more accessible to low-income patients, but stressed the need for continuing targeted outreach and education to replicate the impressive reductions shown in the study.

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