Questions and Answers about PrEP

What is PrEP?

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but are at risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are also used in combination with other medicines to treat someone who has HIV. When someone who does not have HIV is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing itself in the body and causing infection.

Why take PrEP?

According to the data we collect each year to track HIV in Australia, which is published in the Annual Surveillance Report, there have been 1,236 new HIV diagnoses in Australia in 2013 alone (401 in NSW). About 80% of these new infections are among gay and bisexual men. There is still no cure or vaccine available, therefore prevention against HIV remains very important. Most effective prevention strategies available for HIV negative people are condoms and PrEP, in combination with regular HIV testing and safer sex practices.

How well does PrEP work?

Previous research has shown that the chances of getting HIV through sex can be substantially reduced by taking PrEP. How well PrEP works depends on how good people are at taking PrEP pills every day.

Overall, studies in other countries have shown that taking PrEP lowers the risk of getting HIV through sex by about 44 percent in men who have sex with men and by 62%-75% in heterosexual men and women, while the risk of HIV infection through injecting drugs was lowered by 49%. This means that some people in these research studies still got infected with HIV even though they were taking PrEP. However, when researchers looked specifically at people who were taking PrEP every day, they found that the risk of getting HIV was substantially lower. In the iPrEx study which followed 2499 men who have sex with men, those who took their PrEP pill every day had their risk of getting HIV lowered by at least 92 percent. In contrary, the risk of HIV infection was higher in people who did not take their tablets as was recommended daily.

These estimates of how well PrEP works come from studies where people who were taking PrEP pills were encouraged to keep using condoms. These studies also provided information on how to use condoms correctly. Therefore, it is still recommended that PrEP is used in combination with condoms, as well as any other risk reduction approach that is already being used.

Is PrEP for you?

PrEP is recommended for people who are HIV negative and are at high and ongoing risk of HIV infection. These can be:

  • gay or bisexual men; or
  • heterosexual men and women who have an HIV positive partner

In NSW, the NSW interim guidelines for PrEP specify the criteria to determine if someone is at high and ongoing risk of HIV infection. The PRELUDE project will be guided by these criteria for enrolment of study participants.

How can you start PrEP?

If you think you may be at substantial risk for HIV, you can contact one of the study clinics. There, you will be offered a screen to determine if you are at substantial ongoing risk of HIV infection, a general physical assessment and a test for HIV and other sexually transmitted diseases.

If you do take PrEP, you will need to follow up regularly with the same clinic at one-month, 3 months, and every 3 months thereafter. You will have blood tests for HIV infection and sexually transmitted infections, and to check for any side effects of Truvada. You will also receive counselling on how to minimize your risks of HIV infection.

It is important to take PrEP every day as prescribed. You will receive advice about ways to help you take it regularly so that it has the best chance to help you avoid HIV infection. Tell your doctor or nurse if you are having trouble remembering to take your medicine or if you want to stop PrEP.

Questions to ask your doctor if you are considering PrEP

  • Is PrEP a good prevention strategy for me?
  • If not, what other options can help me reduce my risk of getting HIV infection?
  • How effective would PrEP be at reducing my risk of HIV infection?
  • What are the side effects of the PrEP pills?
  • How often will I have to be tested for HIV and other STDs?
  • I have Hepatitis B (or C)? Can I take PrEP for HIV?
  • In the last few days, I have had unprotected sex with someone who is HIV positive (or you do not know what their HIV status was), can I start taking PrEP pills?
  • I am not feeling well today. Can you please check me out because I want to start taking PrEP?

Additional questions for women:

  • Can PrEP help me to get pregnant safely if my partner has HIV?
  • Can I take PrEP if I am pregnant or breastfeeding?

If I take PrEP, is it OK to stop using condoms?
PrEP offers a lot of protection from HIV, but it is still not 100% effective in reducing your risk of getting the virus. PrEP medicines don’t give you any protection from other infections you can get during sex (like gonorrhea, chlamydia, and hepatitis), but condoms do. Therefore, you should continue using condoms while taking PrEP.

Condoms also offer a lot of protection against HIV infection if they are used correctly every time you have sex, but not 100%. So if you want to maximize your protection from HIV and other sexually transmitted diseases take PrEP pills consistently and use condoms during sex.

For how long can I take PrEP?
There is no limit to how long you can be on PrEP as long as you are still at high and on-going risk of HIV infection. You should discuss this with your doctor. The PRELUDE study will provide up to 12 months of PrEP.

If, after taking PrEP pills for some time, you find that one or more of the following applies to you, ask your doctor or nurse whether it is time for you to stop taking PrEP, and they will recommend you the safest way of stopping PrEP and maintaining protection from HIV:

  • Your risk of getting HIV infections becomes low because of changes in your life.
  • You don’t want to take a pill every day.
  • You often forget to take your pills or just cannot do it every day.
  • You have developed side effects from the medicine that are interfering with your life.

Your provider will be checking your health regularly, and if your tests show that your body is reacting to PrEP in unsafe ways, your provider may stop prescribing PrEP for you.

Can I stop and start taking PrEP?
Some people wonder if they can take PrEP only on occasions when they might be doing something that puts them at risk for getting HIV. There is no research evidence that PrEP is effective if taken in any way except every day. Therefore, PrEP should be taken every day to give the best protection against HIV.

Can I start PrEP if I have recently been exposed to HIV?
PrEP is only for people who are at ongoing 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 injection drug use, or sexual assault—there is another option called postexposure prophylaxis, or PEP. PEP must begin within 72 hours of exposure. If it is more than 72 hours but less than 30 days since you had an exposure, tell your provider so that you can be appropriately assessed.