The Doctor Will See You Now: Auckland GP Torrance Merkle Discusses PrEP
Torrance Merkle is a GP at Hobsonville Family Doctors in Auckland and one of 20 doctors, sexual health clinics and centres listed by Ending HIV for their expertise in HIV and sexual health, and their knowledge about PrEP. He’s 28, gay, has been a GP for three years after growing up in Auckland and training at Auckland Medical School, and thinks, in an ideal world, PrEP should be more freely available and fully funded in New Zealand. He shares his professional – and some personal – experiences and opinions around PrEP.
As a general practitioner, do you think New Zealanders have good access to the drugs they need, and – in the case of PrEP – why do you think it is so important?
TM: I think New Zealand is quite far behind with the funding of much needed medications - and although PHARMAC does a pretty good job, there are a few medications available that would make a big difference to many people.
New Zealand has recently had a huge increase in new HIV diagnoses - and with the recent availability of PrEP we have another powerful tool to reduce the amount of transmissions. It’s fantastic to see the latest figures showing a significant drop in new HIV diagnoses in NSW, Australia, after PrEP was made more widely available.
I’m really pleased that New Zealand has finally removed previous archaic funding restrictions on when people with HIV could start on anti-viral medications - it’s another step in the right direction. People newly diagnosed with HIV can now go straight onto anti-viral treatment, and many will become undetectable [+U], which has an extremely low chance of transmission.
How do you see the use of PrEP changing condom use?
TM: Syphilis, chlamydia and gonorrhoea are on the rise – but they were on the increase before PrEP as well. Condoms don’t suit everyone all the time - some people feel they reduce intimacy, some people find they make sex more painful, and sometimes they do break. With PrEP, a broken condom or other accident means no more worrying about getting HIV (it can take up to a month for HIV to be detectable on a blood test - which can feel like forever).
It’s really important for people to remember that PrEP doesn’t replace condoms - but compared to other STIs which are (currently) treatable, HIV is a long-term condition.
Part of the PrEP programme is also about looking after yourself and your sexual health by getting three-monthly check ups - which again is a hugely important part of reducing the spread of syphilis, chlamydia and gonorrhoea.
At the moment, without funding, a month-long course of Truvada prescribed in New Zealand is around $850, while those looking to overseas suppliers can access generic versions of PrEP for between $50 and $80. Are you looking for an “ideal world” answer in which it would be freely available and fully funded in New Zealand?
TM: That would be amazing, but there’s only so much money in the health budget. People who are “high risk” should be able to access it free but there are other social, financial and cultural barriers. People taking PrEP have to see their GP every three months at their own cost, which isn’t always cheap. It would be good to fund at least low income and high-risk groups as a start and, for those who could afford it, have them self-fund it for around $50-80 a month. Once the NZ PrEP trial in Auckland finishes, it would be good if there could be some funding through the sexual health clinics for the people that need it most.
(Editor’s note: the NZ PrEP trial is still recruiting participants.)
And do you think GPs are suitably clued up on PrEP to be able to explain and prescribe it?
When I went to a PrEP interest group, it was heartening to hear that many people were getting it through their regular GP and they were learning together as they went. I would love to see more resources and information so that if people ask their doctor about PrEP, their GP would already have that information at hand – much better than just a few GPs prescribing it.
When I saw Ending HIV’s list of GPs and that there were only a small handful of GPs on the list - I knew I had to put my hand up.
I don’t think many GPs know about it at all – it’s not yet in the conferences or other continuing medical education that keeps us up to date. I think there’s barely any awareness with GPs that there’s something that they can offer.
It would be excellent to have everything set up as a nice package and made available through the NZAF or other similar organisations, so that once GPs have done the online learning – which takes around 30 minutes, everything can be streamlined to prescribe and monitor those on PrEP. This would make one less barrier for doctors to prescribe it, and for people to access it.
You can find out more about PrEP, take part in the interactive quiz to see whether it is right for you, apply to take part in the NZ PrEP study or find out how to access PrEP via prescription in New Zealand or online here. For all other queries email us at [email protected].