PrEP 101

What is PrEP?

PrEP stands for pre-exposure prophylaxis.

pre = before exposureexposure to HIV prophylaxis = prevention ]

PrEP is a regime of medication taken by HIV-negative people to protect them from HIV transmission.

The way we currently use PrEP is with the daily oral medication Truvada, find or generic versions of Truvada.

As new medical advancements are achieved, pills we may use multiple different forms of PrEP to protect ourselves.

Does PrEP work?

YES! Truvada is made up of two amazing medications (it’s a two-in-one punch against HIV).

Emtricitabine and tenofovir are two powerful anti-retroviral medications. They have been used for years in combination with other medications by HIV-positive people to keep the levels of HIV in their blood to undetectable levels, ampoule and keeping them healthy. Thirsty for more? Get the TasP 101’s

Knowing the Truvada was very powerful as an HIV treatment, clinical studies were run to determine if it could be used to protect people at risk of HIV infection. From these studies we know that PrEP is incredibly effective. In the real world, PrEP is 99% percent effective. This doesn’t mean you will contract HIV from 1% of encounters, it means your current risk of HIV will be reduced by 99%.

Is it safe?

Truvada as PrEP is very safe. HIV-positive people have been taking this medication daily in combination (and separately)  for years and have been very well tolerated.

As with many medications, there can be side effects however they are often minor, short-lived, and reversible.

Some people when starting PrEP experience some mild stomach upsets and or nausea, mild headaches, insomnia,

These side effects occur in a small percentage of people who take PrEP, and as your body get’s familiar with the medication they generally settle down very quickly. If you start PrEP and you are concerned about ongoing side effects, book back in to see your GP – but try not to be concerned too much about a few extra trips to the loo or a mild headache here or there in your first couple of weeks.

Long term effects?

One of the medications in Truvada has been shown in some people to have a minor reduction in kidney function, and in some people a very minor reduction in bone density. Both these things have been shown to reverse completely when stopping PrEP and for most people they don’t cause any issue. If you have low bone density, or reduced kidney function discuss this with your GP before starting PrEP. This likely won’t exclude you from starting PrEP but they may run some more frequent testing to make sure everything is being tolerated well.

What about STIs?

If you decide to reduce or stop using condoms when you start PrEP you need to be aware of other STIs. But, even if you’re using condoms 100% of the time guess what… you need to be aware of STIs.

WAIT, WHAT?

Condoms don’t protect against ALL STIs. Herpes, crabs, and other bugs can spread from person to person even if you’re using condoms – and using the consistently.

The STIs condoms can protect against don’t always do that either. If you enjoy oral sex you’ll probably never have used a condom or other barrier method when getting orally fixated.

Recent evidence also shows that gonorrhoea can be spread by smacking tonsils, so no matter what your chosen method of protection is – you’re bound to get an STI along the road at some stage.

PrEP users are required to test at least every three months in order to get a script fo their next batch of medication. Gay men in the wider community only test around 1.5 times a year.  This means PrEP users are picking up those STIs and getting treatment sooner, rather than passing on those STIs to their partners. Often a person with an STI won’t show symptoms – guys with Chlamydia only present with symptoms around 1/2 the time, and women even less. This is why regular testing is a crucial part of protecting your sexual health.

Is PrEP right for me?

That’s up to you. Deciding to start PrEP is a personal decision for you, and in doing so you need to think about your own risk and be honest with yourself – sometimes that’s tricky in itself.

Different countries and states have different guidelines for who might want or need to consider PrEP. Some (but not all) of the things worth thinking about in making your decision, are you:

  • A man who has sex with men and doesn’t always use condoms (topping or bottoming).
  • Someone who has sex with men who have sex with other men.
  • The partner of an HIV-positive person who is not on treatment, or has a detectable viral load
  • Having regular receptive sex without a condom with people whose status you do not know (raw/bareback sex)

Have you had:

  • Rectal (in the butt) Gonorrhoea, rectal Chlamydia or infectious syphilis diagnosis during the last 3 months or at your last STI screening.
  • Any methamphetamine use within the last 3 months.
  • Any front hole (urethral) STI – if you’re a trans guy into guys
  • Any injecting drug use

We would encourage and recommend all trans and gender diverse people assess their risk and consult with a trans-friendly GP or sexual health clinic about their HIV prevention tools.

I’m trans. Is PrEP for me?

PrEP works for trans people too.

If you’re a person with a trans experience then it’s important to know your risk so you can make informed choices to protect your own sexual health – whether that is with condoms, TasP, PrEP or a combination. If you’re a HIV-negative trans person we would encourage you to consider PrEP. Globally, trans women who have sex with men shoulder a very heavy burden of HIV and trans men who have sex with other men are at the same risk as their cisgender gay brothers.

Truvada has no known contraindications with any transition-related hormones. It is an HIV medication that many trans people living with HIV have used for treatment over many years. You can check out any and all interactions with the drugs in Truvada at HIV using this great checker tool 

Truvada as PrEP offers everyone full protection after 7 days of daily use – that’s for anal and front hole sex.

Our friends over at PASH.tm have developed a wonderful resource for gay, bi and queer trans men called GRUNT which is well worth a look into – and you can follow up on HIV treatment for trans men specifically there.

Need a trans-friendly GP? Contact your state AIDS Organisation for advice on where to get the care and support that’s right for you.

What if I’m First Nations?

First Nations people (Aboriginal and Torres Strait Island people) can access certain medications at reduced cost under the Closing The Gap scheme to improve health and wellbeing outcomes. If you are an ATSI person accessing PrEP on a clinical study where it would cost money to access the medication, it may be at reduced cost or even free.

Once PrEP is listed on the PBS this will mean that ATSI community members will likely be able to access further reduced cost PrEP to prevent HIV.

If you’re a prescriber – get up to speed on Closing The Gap