At Melbourne Sexual Health Centre and Alfred Health, PrEP is also known as HIV Integrated treatment Prevention or HIP
What is PrEP?
PrEP is "pre-exposure prophylaxis" for HIV. The goal of PrEP is to bio-medically prevent HIV infection if you are exposed to the virus. This is done by taking a pill every day, called Truvada®, that contains two HIV medications. These are the same medicines used to stop the virus from growing in people who are already infected. Taking a daily dose of Truvada® has been approved by the Food and Drug Administration in the United States since July 2012 for reducing the chance of getting HIV infection in people who don't have HIV. Condoms provide the most effective barrier to HIV and are also the best way of reducing your chances of picking up or passing on HIV and other sexually transmissible infections (STIs)
Is PrEP for me?
PrEP suits a person who has an ongoing high risk of HIV infection and you are interested in taking PrEP medication. You may consider PrEP if for example
- if you are a man who has sex with other men and sometimes has sex without using a condom. This is especially important if you have a sex partner whom you know has HIV infection or is at high risk of HIV, whether you have male or female partners. Another example might be if your partner injects drugs or is having sex with not only you, but other people, or
- If you have been recently told by a health care provider that you had a sexually transmitted infection.
Is PrEP covered under Medicare?
No. Truvada® is currently not licensed by the Medicare Pharmaceutical Benefits Scheme for use as PrEP in Australia and is therefore not available at a subsidised price. However, prescriptions for Truvada® may still be issued for the purposes of PrEP.
Is PrEP effective?
Several studies have shown that PrEP reduced the risk of getting HIV infection. Men who have sex with men and who were given PrEP medication were 44 percent overall less likely to get HIV infection compared to those who took no PrEP medication. Those who took the pill more regularly had a reduced risk of HIV infection by 73 percent or more, up to 92 percent for some. More information on the details of the studies can be found at www.cdc.gov/hiv/prep
Is PrEP safe? What are the side effects?
The clinical trials also provided safety information on PrEP. Some people in the trials had early side-effects such as an upset stomach loss of appetite but these were mild and usually went away within the first month. Some people also had a mild headache. No serious side-effects were observed. You should tell your doctor if these or other symptoms become severe or do not go away. A small proportion of people taking Truvada® develop kidney damage so it is very important you have kidney tests every three months.
What do I have to do?
If you are interested in PrEP, speak to your doctor to see if you are suitable. If you are assessed to likely benefit from PrEP and are agreeable, blood tests to assess your kidney and liver function, in addition to an HIV test, will be done. You will then be given an appointment at our PrEP clinic where a detailed assessment of your suitability and whether you might benefit from PrEP will be done, and your tests to ensure the PrEP is safe for you will be reviewed. Once you have met the eligibility criteria and want to start PrEP, you will be given a prescription. Details on how to obtain the medication are given at the end of this information sheet.
Taking PrEP medicines will require you to follow up regularly with your doctor. You will have blood tests for HIV and tests to see if your body is reacting well to the medication. You will also receive counselling to reduce the risk of acquiring HIV. You should take your medicine every day as prescribed, and your doctor will advise you about ways to help you take it regularly so that it stands the best chance to help you avoid HIV infection. Tell your doctor if you are having trouble remembering to take your medicine or if you want to stop PrEP.
Does PrEP protect me against other Sexually Transmitted Infections (STIs)?
No, PrEP does not protect you against other STIs like syphilis or gonorrhoea. If you have started taking PrEP, it is important for you to return for regular STI screening. Condoms provide the most effective barrier to HIV and are also the best way of reducing your chances of picking up or passing on other sexually transmitted infections (STIs).
I have heard about taking PrEP "as needed" instead of daily - will that be as effective?
Results from the IPERGAY study, where PrEP was only taken for short periods just before and after having sex, do not conclusively recommend taking PrEP on an "as needed" basis. Daily dose of PrEP medication is the best way to protect yourself.
How long do I need to be on PrEP?
You should discuss this with your doctor. There are several reasons that people stop taking PrEP. If your risk of getting HIV infections becomes low because of changes that occur in your life, you may want to stop taking PrEP. If you find that you don't want to take a pill every day or often forget to take your pills, other way of protecting yourself from HIV infection may work better for you. If you have side effects from the medication that are interfering with your life, or if blood tests show that your body is reacting to PrEP in unsafe ways, your doctor may stop prescribing PrEP for you.
Are there any alternatives to PrEP?
Depending on your risk factors, you may be more suitable for other HIV prevention methods like NPEP (Non-occupational Post Exposure Prophylaxis) or safer sex strategies. Your doctor can best advise you which is most suitable, after your consultation.
How do I get the PrEP medication?
Information on how to obtain PrEP has been prepared by ACON (ACON Health, formerly the AIDS Council of New South Wales) and ASHM (the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) and is contained in the information sheet "PrEP Access Options" available at: endinghiv.org.au or at: pan.org.au
This fact sheet is designed to provide you with information on PrEP. It is not intended to replace the need for a consultation with your doctor. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. Every effort has been taken to ensure that the information in this pamphlet is correct at the time of printing.Last Updated April 2016