PrEP or Pre-Exposure Prophylaxis is a prescription medication which is a combination of two different drugs, and is taken once daily by people in order to prevent them from becoming infected with HIV. It must be started 7 days before exposure and continued for 28 days after exposure.
Who is PrEP for?
PrEP is for people who are HIV negative and are at higher risk of becoming infected with HIV through their sexual or injecting practices. This includes some sexually active gay and bisexual men, transgender people, heterosexual people, and those people who have a HIV positive partner whose viral load is detectable or unknown, as well as some people who inject drugs in an unsafe manner (such as sharing injecting equipment). If you think that you are at higher risk of HIV infection make an appointment to discuss this with a doctor.
How does it work?
PrEP works by preventing HIV replicating within the body, therefore preventing infection. PrEP needs to be taken for at least 7 days before it can be relied upon to prevent HIV infection. It should be continued for at least 28 days after the exposure, and can be taken continuously in those people who remain at risk. Safe sex and condom use are still recommended to further reduce the risk of transmission of HIV and other Sexually Transmissible Infections (STIs).
How effective is it?
Clinical trials have shown that PrEP is very effective in preventing HIV infection when taken as prescribed. Effectiveness depends on your ability to continue to take the medication every day, as failure to do so may reduce its effectiveness. Using condoms will also decrease your risk of acquiring HIV.
Are there any side effects?
Side effects are not uncommon when starting PrEP. These can include nausea, headaches, and fatigue. Not everyone experiences these side effects, and if they do occur, they usually go away after a few weeks. If side effects persist it is important to discuss this with your doctor. Long term use of the PrEP medication may be associated with bone and kidney changes, and ongoing monitoring will be recommended in those people who are using PrEP long term.
Do I still need to use a condom?
Yes - PrEP is only effective in reducing the risk of HIV infection and use of condoms is still very important to protect you from other STIs such as chlamydia, gonorrhoea, and syphilis.
How do I get PrEP?
PrEP can be prescribed by a GP for anyone who is at higher risk of HIV infection and who has a Medicare card. A total of 3 months (28 tablets, with two repeats) can be prescribed at a time. The prescription is then taken to a pharmacy to have the medication dispensed, just like any other prescription. Most pharmacies will need to order the medication in for you, so there may be a delay of a day or two before it can be dispensed. For the repeat prescription, remember that the pharmacy needs to be reminded a few days before you run out, so you can continue on the medication without missing any doses.
For people who do not hold a Medicare card PrEP is available by private importation. In this case you will still need to see a doctor to get a prescription and you can then import PrEP under the Personal Importation Act.
What happens at my first appointment?
The doctor will have a discussion with you about your eligibility for PrEP, your past medical history, and the advantages and disadvantages of using PrEP. You will be asked to have some blood tests and an STI screen. Once you have had these tests you can be given your first prescription.
What is the cost of PrEP?
PrEP is currently $40 a month, and $6.40 for Health Care Card Holders, at time of printing. The cost of importation is similar.
Do I need to continue to see my doctor while I am on PrEP?
Yes, you will need to see your doctor one month after your first appointment to see how you are managing and for re-screening. You will also require a follow-up visit before your first prescription is finished (about 10 weeks after you start).
From then on you will need to see your doctor every three months for a review, which will include STI screening and a new prescription. It is important to time follow-up appointments so that you don’t run out of medication. If you have symptoms or signs of an STI, you should always have a check-up before the three-month follow-up.
To avoid drug interactions, you should advise other doctors who are prescribing new medication for you that you are taking PREP.