What is PrEP?
PrEP (Pre-Exposure Prophylaxis) is a HIV prevention program that makes use of medication and regular sexual health testing to prevent HIV. By taking PrEP, people who are HIV-negative (meaning they do not have HIV) can reduce the chance of getting HIV by up to 99%. The drugs used in PrEP are also often used in treating HIV.
In 2009, a large study showed not only were these drugs effective at treating HIV, but also at preventing HIV when taken every day. Since then, several studies have confirmed that it is incredibly effective at preventing HIV.
How do I take PrEP? Daily or on-demand PrEP?
There are many ways that people can take PrEP, and the Australian guidelines for taking PrEP have been created by experts in the field of HIV prevention. Currently only two ways of taking PrEP have been recommended and these are; daily PrEP and on-demand PrEP.
Daily PrEP involves taking a PrEP pill every day and is shown to be the most effective way to prevent HIV (when taking PrEP as a prevention strategy) as it has been examined in various large scale research projects around the world.
If you accidentally miss a dose when taking daily PrEP then take it as soon as you possibly can. However, if you’re close to taking your next regular dose, it’s fine to wait. There is no need to take two pills to make up for the missed dose. If you miss more than two non-consecutive doses a week, then it would be advisable to speak with your GP about things you might do to help you take PrEP regularly.
See the video at the top of the page for more information on how daily PrEP works and what you need to consider.
On-Demand PrEP is also extremely effective in preventing HIV and has been studied in one research trial of men who have sex with men. It involves taking two pills 2-24 hours before sex, and then a pill each 24 hours after sex for the next two days. It is important that when using on-demand PrEP that you adhere strictly to the dosing regimen to provide the greatest level of protection against HIV.
If you are a trans-man, cis-gendered female or heterosexual male, there is no evidence that using on-demand PrEP is effective at preventing HIV and therefore it is recommended that you take daily PrEP.
Also, it is recommended that you have a sexual health check every 3 months regardless of the way in which you take PrEP.
Is PrEP for me?
Pre-Exposure Prophylaxis (PrEP) is for HIV-negative people who may be at risk of HIV. Many factors can impact on your own personal level of risk. Factors to consider whether PrEP may be right for you include:
- Whether and how often you use condoms;
- Whether you know the HIV status of your sexual partners;
- Whether your HIV-positive partners are undetectable;
- Whether you are having sex with casual partners;
- The types of sex you have (anal, vaginal, oral, front hole etc);
- Whether you inject drugs, or use methamphetamines during sex.
It is important to understand what is involved in taking PrEP and to make sure that you are able to take the medication as prescribed. Your individual circumstances and your risk of being exposed to HIV should all play a role in deciding whether PrEP is right for you.
If you decide to take PrEP this does not mean that you are committed to taking it for the rest of your life. PrEP can be stopped at any time, and if you decide to stop using it then you should speak with your doctor about the right way to do so.
How does PrEP Work?
Normally when a person is exposed to HIV, the virus attaches itself to immune cells and uses them to make more HIV. The newly made HIV then spreads and attaches to more immune cells until they can no longer fight off illnesses and infections. PrEP stops this process before it starts, preventing HIV from making more copies of itself and therefore preventing HIV infection.
In order to be effective, there has to be enough PrEP in your body to prevent HIV. If there isn’t enough of the drug in your body then there’s a chance that your level of protection is not maximised, and HIV can enter into the cells within the body.
Is PrEP Effective?
PrEP is one of the most effective HIV prevention tools that we have. PrEP is more than 99% effective when taken as prescribed and is more effective than condoms in preventing HIV. Many different figures have been thrown around about how effective PrEP is. There are over 460,000 people on PrEP worldwide and less than a handful of cases where someone contracted HIV whilst taking PrEP. For more information on the research demonstrating how effective PrEP is, head to www.prepfacts.org
It should be noted that PrEP is only effective in preventing HIV, it does not provide any protection against other STIs and as such condoms should be kept in consideration in addition to regular sexual health check-ups.
What are the side effects?
PrEP has very few side effects, and very few people experience them. The most reported side effects can include headaches, nausea or fatigue however these side effects are usually mild and tend to pass quickly.
In a handful of people, who typically have pre-existing medical conditions, PrEP may lead to a loss of mineral bone density or a decrease in kidney function. These side effects are not problematic in and of themselves, but it is important that you visit your doctor every 3 months to have these levels checked. If your bone density and kidney function are affected, when you decide to stop taking PrEP, these levels return to normal.
If you are experiencing any side effects as a result of taking PrEP that you are concerned about then you should speak with your doctor before stopping PrEP
What is the difference between PEP and PrEP?
Where PrEP is taken before you’re potentially exposed to HIV, PEP is taken after a suspected exposure. PEP stands for post-exposure prophylaxis, and is taken only if someone thinks they have already been exposed to HIV, either through sex without condoms, injection drug use, or needlestick injury. PEP must be started within 72 hours of the exposure, and is taken for 28 days.
Does PrEP prevent other STI's?
PrEP does not prevent any STIs other than HIV. The best way to prevent other STIs is by going in for regular sexual health checks at least every three months and by using condoms.
Do I still need to use condoms if I am using PrEP?
Because PrEP does not prevent or protect against other STIs, condoms are still a very good idea. When used properly and regularly condoms are the most effective method for preventing STIs like gonorrhoea, chlamydia, syphilis, hepatitis, and herpes.
How do I get PrEP?
PrEP can be prescribed by any doctor or sexual health nurse practitioner in Australia. Your doctor does not need to undertake any specialist training in order to prescribe you PrEP. However, if they have never heard of or prescribed PrEP before then they may not be confident in providing you with advice that you need or a prescription. You can advise that they look at websites such as PAN (PrEP Access Now) or refer them to the PrEP video above or to ASHM who are the body governing the best practice medical guidelines for GPs when it comes to prescribing PrEP. You can also take this letter (www.pan.org.au/s/PrEP-letter.pdf) along to your appointment explaining to your doctor about PrEP.
Alternatively, you can get into contact with PAN yourself and locate a GP who has registered themselves as a PrEP prescriber using PAN’s find a doctor service. This way you can ensure that your new PrEP doctor will know the ins and outs of prescribing and taking PrEP.
Once you have a script you can get PrEP from your local pharmacy. PrEP will cost you roughly $40 per month and about $7 if you have a concession card.
What’s the difference between the generic and name brand drugs used for prep?
There is no difference between name-brand Truvada and its generic versions other than their manufacturer. Both contain the same ingredients and both are effective at preventing HIV.
Truvada, the drug used as PrEP, is manufactured by Gilead Sciences. Gilead has given permission to other companies in India and South Africa to manufacture generic versions, but with the exact same composition, mainly so they can provide affordable and low cost drugs to the people living there. These generics have been tested for safety and effectiveness by several agencies, including the US Food and Drug Administration, the World Health Organisation, and the South African Medicines Control Council.
Where can I go for more information or to talk to people who are on PrEP?
If you are looking for more information on PrEP you can head to any of the following websites:
- Information and Importation: www.pan.org.au
- Information and Importation: www.prepdforchange.com
- Information for trans-men: www.grunt.org.au
- Additional Information: www.what-works.org
- Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine