Pre Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is the use of medication to prevent HIV. By taking PrEP, people who are HIV-negative (meaning they do not have HIV) can reduce the risk of getting HIV by almost 100%. Several studies have confirmed that using PrEP is incredibly effective at preventing HIV.

PrEP is for HIV-negative people who may be at risk of HIV. Many things influence risk, including:

• 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 can take the medication as prescribed. Your 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, you do not need to take it for the rest of your life. There are ways to safely stop using PrEP at any time. Speak with a doctor about what’s best for your circumstances.

When a person not on PrEP 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.

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 HIV can enter into the cells within the body.

PrEP is one of the most effective HIV prevention tools that we have.

PrEP is more than 99% effective when taken as prescribed in preventing HIV. There are over 660,000 people on PrEP worldwide, and less than a handful of cases where someone contracted HIV while taking PrEP. For more information on the research around PrEP's efficacy, head to www.prepfacts.org

Remember, PrEP is only effective in preventing HIV and does not provide any protection against other STIs. Keeping condoms in the mix helps avoid most STIs. Regular sexual health testing is a key part of the PrEP program and managing your sexual health.

Very few people experience side effects from using PrEP. For those who do, side effects may include headaches, nausea, or fatigue. Most side effects are usually mild and tend to pass quickly.

In a handful of people with 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 you must visit your doctor every three months to have your levels checked. If your bone density and kidney function are affected, these levels return to normal after discontinuing PrEP.

If you experience any side effects you are concerned about, speak with your doctor before stopping PrEP.

Australian guidelines for taking PrEP have been created by experts in the field of HIV prevention. Currently, only two ways of taking PrEP are recommended; daily PrEP and on-demand PrEP.

Daily PrEP

Daily PrEP involves taking a PrEP pill every day and is the most common way that PrEP is taken.

If you miss a dose when taking daily PrEP, take it as soon as possible. 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 doses a week, you should speak with your GP or use these simple tips to help remind you to take it daily. You can use a pillbox, keep them next to your bedside table or next to your toothbrush as a daily reminder, take the pill at the same time every day to start a routine or set a smart phone reminder.

On-Demand PrEP

On-demand PrEP is a different way of taking PrEP and is extremely effective in preventing HIV. It involves taking two pills 2 to 24 hours before sex, a single pill 24 hours after the double dose, and then another single pill 48 hours after the double dose.

If you have sex over several days, simply extend your on-demand PrEP by taking one PrEP pill a day until you have two sex-free days where you have taken PrEP.

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 miss or are unable to take any of the pills involved, get access to PEP within 72 hours of sex.

At this stage, there is only clear evidence to support on-demand PrEP for cis-gendered men who have sex with men. If you are a woman (cis or trans), trans man, or heterosexual male, there is no evidence that using on-demand PrEP is effective at preventing HIV. Therefore, it is recommended that you take daily PrEP.

No matter how you take PrEP, checking in with a doctor every three months for routine tests is part of the PrEP program.

PrEP has been available on the Pharmaceutical Benefits Scheme (PBS) since April 2018. This means anyone in Australia with a Medicare card can get PrEP with a prescription from a doctor for the standard PBS co-payment price per month – currently $41 for a 30-day supply or $6.60 with a concession card.

If you are unable to afford PrEP on the PBS, there are more affordable ways to access it.

• You can import PrEP with your prescription from overseas, where the same generic medication is a lot cheaper.
• Prepped Smart and Healthy is a charity set up to support people accessing PrEP. All HealthSmart Pharmacies provide people with PrEP for a third of the price. Simply provide your valid PrEP prescription and your Medicare card and you’ll receive three months’ supply of PrEP for the cost of one month. HealthSmart Pharmacies are dotted around Melbourne, or you can order online/via phone and have it delivered anywhere in Australia.

For information on buying PrEP head to pan.org.au or prepdforchange.com

If you do not have Medicare, there are still affordable ways to access PrEP. You can import PrEP from overseas with your prescription, where the same generic medication is a lot cheaper, around $20 per month.

If you can travel to the Alfred Hospital and do not have Medicare, you can visit the new PrEPMe clinic. PrEPMe offers free PrEP testing and prescription and allows you to pick up your medication at a nearby pharmacy for just $50 a month. Alternatively, you can use your PrEPMe script to access a free PrEP coupon through PAN.

For information on buying PrEP head to pan.org.au or prepdforchange.com