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Promoting ‘Equitable Access’ to PrEP in Australia: Taking Account of Stakeholder Perspectives

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Abstract

As evidence of the safety and effectiveness of HIV pre-exposure prophylaxis (PrEP) has grown, so has attention to the views of prospective users and providers. However, far less attention has been paid to understanding the perspectives of other stakeholders in the rollout of PrEP access programs. We conducted 21 semi-structured qualitative interviews in 2017 with key stakeholders working across the policy, advocacy, research and/or clinical dimensions of the Australian HIV response, before federal support for a subsidised access scheme was achieved. Our analysis explored three areas of shared concern: who is a suitable candidate for PrEP; why are disparities in PrEP access important; and how can disparities be addressed? In examining how this diverse group of professionals grappled with the challenges of promoting ‘equitable access’ to PrEP in an increasingly resource rationed health system, we can see how the principles believed to underpin the Australian response to HIV were both reaffirmed and challenged through this period of significant change.

Resumen

Últimamente, viene acumulando evidencia para la seguridad y eficacia de la profilaxis pre-exposición al VIH (PrEP, siglas en inglés). Junto con esto, también se ha aumentado atención a las opiniones de los posibles usuarios y proveedores. Sin embargo, todavía sabemos muy poco sobre las perspectivas de otras personas interesadas, aunque tal vez menos directamente involucradas, en el despliegue de los programas de acceso a PrEP. En 2017, llevamos a cabo 21 entrevistas cualitativas semiestructuradas con “informantes claves” de la respuesta australiana al VIH, o sea, gente que trabaja en las dimensiones políticas, de abogacia, investigación y/o clínicas de la epidemia en el país. Las entrevistas fueron hechas antes de que se lograra el apoyo federal para un esquema de acceso subsidiado. Nuestro análisis exploró tres áreas de preocupación compartida: ¿Quién es un candidato apropiado para PrEP? ¿Por qué son importantes las disparidades en el acceso a PrEP? y ¿Cómo se puede abordar estas disparidades? Examinamos en particular la manera en que este grupo diverso de profesionales lidió con los desafíos de promover el “acceso equitativo” a PrEP, en un sistema de salud cada vez más racionado. Por esa óptica queda claro que, en este período de transformación significativa, los principios vistos como bases fundamentales de la respuesta australiana al VIH fueron tanto reafirmados como desafiados.

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Notes

  1. The most comprehensive overview of international PrEP availability is available at: https://www.prepwatch.org/country-updates/.

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Acknowledgements

Many thanks to all of our participants who made room in their very busy working lives to speak with us about this topic.

Funding

This work was supported by the Centre for Social Research in Health, which receives funding from the Australian Government Department of Health and UNSW Arts and Social Sciences. Small grants were provided by Arts and Social Sciences at UNSW Sydney to support the development of a collaboration with our colleagues at UCSF CAPS, including a Faculty Collaborative Research Scheme Grant.

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Authors and Affiliations

  1. Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia

    Christy Newman, Asha Persson & Martin Holt

  2. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Shana Hughes & Hong-Ha M. Truong

Authors
  1. Christy Newman
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  2. Shana Hughes
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  3. Asha Persson
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  4. Hong-Ha M. Truong
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  5. Martin Holt
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Correspondence to Christy Newman.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Newman, C., Hughes, S., Persson, A. et al. Promoting ‘Equitable Access’ to PrEP in Australia: Taking Account of Stakeholder Perspectives. AIDS Behav 23, 1846–1857 (2019). https://doi.org/10.1007/s10461-018-2311-2

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