What is PrEP?

What is it?

“PrEP” stands for Pre-Exposure Prophylaxis. PrEP is a way for people who don’t have HIV, but who are at very high risk of getting it, to prevent HIV infection. This is by taking a pill containing two medicines, that are also used to treat HIV, every day at periods of high risk. If you take PrEP and are exposed to HIV through sex, these medicines can work to keep the virus from taking hold in the body.

Where can I get it?

Whilst on holiday in San Francisco earlier this year I was amazed that PrEP could be purchased over the bar on the gay scene, it was openly advertised and people were able to buy it as easily as buying a beverage. Coming back to the UK I found that PrEP has only been made available in the UK to people enrolled in research trials and by private prescription from some GPs or sexual health clinics. PrEP is already available in other countries including France, Israel, Kenya and U.S.A.  Some people are buying PrEP over the Internet as the drugs are much cheaper when they are imported from developing countries but there is always the added risk of buying drugs that aren’t what they state they are. If you engage in Chemsex you may have considered using PrEP but remember how effective, it is for preventing HIV infection from injection is unclear. It’s also important to remember that taking PrEP will not prevent you from getting other sexually transmitted infections (STI’s) such as syphilis, gonorrhea, chlamydia, or other STI’s. PrEP will also not protect you from getting hepatitis. PrEP should only be used for people who are at ongoing substantial risk of HIV infection. For people who need to prevent HIV after a single high-risk event of potential HIV exposure—such as sex without a condom, needle-sharing injecting drug use, or sexual assault—there is another option called Post Exposure Prophylaxis, or PEP. PEP must begin within 72 hours of exposure.

In my opinion, I feel that we should be doing as much as we can to protect people and if that means providing PrEP then we should be able to provide it.

How do I take it?

There are two proven ways of using PrEP when the risk is from anal sex.  One is to take it all the time during periods of risk (the PROUD study) and the other (the IPERGAY study) is to take a double dose 2-24 hours before you know you are going to have risky sex and then daily until 48 hours after you stop having risky sex. Both methods have been proven to work but there is more research to support the PROUD method of daily use. For vaginal sex only the daily method has been proven to work.  People who use PrEP must be proven to be HIV negative and must commit to taking the drugs properly. They need regular HIV and STI testing and need checking that the drugs have no serious side effects with blood and urine tests to make sure that the medicine are not affecting your kidneys.  This is because if PrEP is used after HIV infection it can make treatment more complicated.

Will it work?

In 2 recent studies (PROUD and IPERGAY) PrEP has been shown to significantly reduce the risk of HIV infection in people who are at high risk from anal sex by as much as 86%, overall.  It is thought that the infections that did occur were in people who did not take their medication properly.  There has been a report of someone on PrEP who became infected by someone with antiviral resistant virus.

PrEP is much less effective if it is not taken properly PrEP can be even more effective if it is combined with other ways to prevent new HIV infections such as condom use, drug treatment, and adherence to treatment for people living with HIV to further reduce the chance of HIV being passed on.