The generation of people born after the HIV crisis of the eighties have reached sexual maturity, and there has been a corresponding decline in the use of condoms.
Regular condom use has been in steady decline in Australia since 2004, with 30 per cent of men who have sex with men using protection, and 50 per cent of heterosexual couples, according to the Centre for Social Research In Health.
In 2012, Australia recorded its highest HIV infection rate in 20 years with 1,253 new cases.
For gay men aged 25 years and younger, the rate of newly acquired HIV infection tripled from 2011 to 2012. As of 2014, it’s estimated that there are currently 26,800 people in Australia living with HIV.
“It’s important to remind Australians that HIV is still out there,” Edwina Wright, the project leader of a PrEP trial in Victoria, said.
"It’s ironic because here we are in a wealthy country with Medicare, subsidised medications, good communication strategies, no censorship on our internet, why is this happening?”
'It’s a fantastic outcome because in a sense it empowers people'
PrEP or Pre-Exposure Prophylaxis is when an individual who is HIV negative takes an antiretroviral drug to prevent themselves from receiving transmission. The drug is currently taken once daily as an oral pill.
Ms Wright said it has the potential to drive down HIV transmissions, and could lead the way to eliminating HIV infections in this country.
There are three trials underway in Australia with participants selected from high risk groups; men who have recently had unprotected sex with a partner of unknown status, men who have had unprotected sex with a positive partner, and magnetic (positive/negative) couples seeking to conceive.
The drug is dispensed at three month intervals, at which the participants are tested to see if they’ve acquired HIV, and for the concentration of the drug in the bloodstream.
The trial so far as indicated that there is a 44 per cent risk of reduction in gay men and a 70 to 75 per cent reduction for heterosexual couples. Ms Wright said that participants who adhere perfectly to the daily dose experienced a 90 per cent reduced risk.
“It’s a fantastic outcome because in a sense it empowers people,” she said.
“They can say, ‘I’m opting in to protect myself from HIV’. It’s a positive health approach. People have control of their lives.”
'There is a certain anxiety that is very much unique to the gay community associated with their sexual health'
In 2013, only three per cent of gay men in Australia had reported awareness of PrEP as an effective HIV prevention strategy.
Mardi Gras attendee Ryan said he wasn't "really a fan" of taking prescription medicine.
"But if it was something that would significantly improve my sexual health there would probably be a good chance that I would take it,” he said.
“It’s just at this stage, I don’t know. I’d have to see some very good studies to know it was 100 per cent safe and 100 per cent effective.”
Daniel first accessed PrEP in the United States and has been using it for seven months. He would like to see more awareness and availability of the drug in Australia.
“When I learnt that there was potentially going to be a trial here in Melbourne I almost became obsessed," he said.
“There is a certain anxiety that is very much unique to the gay community associated with their sexual health. There’s no other demographic that I can think of who have this anxiety that they have potentially infected themselves with a lifelong illness, the morning after, every time they have sex.
“Truvada and PrEP represents an opportunity for me to take responsibility for myself. No longer does the other person’s status matter to me, because I’ve taken responsibility for myself.
'PrEP has caused a lot of rethinking about 'What is HIV prevention?'
“The most surprising thing that I’ve experienced since starting PrEP has actually been the psychological journey that I’ve been on more so than the physical side effects.
“You’re undoing years and years of conditioning. That’s not to say that I have sex without a condom all the time now, but the idea that I protected without them is a big, that’s a big thing. It’s taken me six months to really get comfortable with that.”
Dean Murphy, an HIV education officer and social researcher, acknowledged that Truvada faces some resistance.
“PrEP is controversial in some ways because it challenges an existing norm about using condoms to prevent HIV, and a lot of people are very attached to that history of safe sex," he said.
"So PrEP has caused a lot of rethinking about “What is HIV prevention?”
Dan faces these issues while discussing his use of Truvada with potential partners.
“Those conversations have been difficult," he said.
"They represent something that is inherently scary for those people, and the general response is I don’t know what you’re talking about and I don’t like it.”
Truvada is also currently prohibitively expensive for many, costing $13,500 per year, and many men would prefer to continue using non-pharmaceutical protection.
The drug is still in the trial phase, so not all side effects are known at this point.
“In the first couple of weeks, quite a proportion of people might feel nauseated, or have a tommy upset or headaches or tiredness but very quickly they pass,” Ms Wright said.
“We know that individuals taking this drug over a longer period – for one to two years, a very small but significant reduction in the health of the kidney function occurs.”
“Importantly, we need to acknowledge that for longer term use, if somebody stays on PrEP for three, four or five years, we don’t yet know what the longer term toxicities are. That needs to be studied.”
'Imagine someone saying “we only had seatbelts in the 1950s, I really want to argue strongly against airbags.'
Ms Wright emphasises the need to broaden the options for prevention.
“In America, there was some really ugly stigma that came out largely from within the gay community,” she said.
“There was some shaming around men saying 'you just want to use it as a party drug. You’re going be a Truvada whore'. People were suggesting that it was all about selfishness and not about responsibility.”
“Imagine someone saying 'we only had seatbelts in the 1950s, I really want to argue strongly against airbags'. It’s foolish. The more choices people have the likelier it is that a strategy is going to work because people have choice.”
“There’s going to be a revolution, the same way that when contraceptive pills were put on the market,” Dan said.
“Educate yourselves, find out what it is, talk to your doctors about it, find out the facts and make your decision and if it’s right for you it will change your life, absolutely.”