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PREP BASICS
PrEP is short for Pre Exposure Prophylaxis.
PrEP is one form of HIV prevention used by people who don’t have HIV and are at risk of acquiring HIV. When people have penetrative sex with others, passing on HIV can happen.
Taking PrEP can be as simple as taking one oral pill a day, and it only takes about a week to provide maximum protection from HIV. Consult with your doctor though because waiting times for PrEP to become effective in preventing HIV may vary depending on your body. Current studies show that PrEP can offer you very high levels of protection from HIV, when taken as prescribed by your doctor. For anyone who has sex, ensuring informed choices are made about their sexual health is important.
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PrEP is prescription medicine.
PrEP is combination therapy which includes two drugs; emtricitabine and tenofovir disoproxil fumarate.
For HIV positive people, PrEP is used alongside other anti-HIV treatments to treat HIV-1. PrEP alone isn’t a complete treatment for people living with HIV.
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• PrEP works by blocking an enzyme called HIV reverse transcriptase.
• By blocking this enzyme, it prevents HIV from making more copies of itself.
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• Take PrEP (TD*/FTC) for seven days BEFORE potential exposure to HIV.
• Continue to take one tablet every day.
Ask your doctor for recommended waiting times to ensure you have achieved maximum protection before having sex.
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• People in serodiscordant relationships (one negative partner and one positive partner) where the negative partner shares responsibility.
• People who find it difficult to negotiate HIV prevention with their sexual partners.
• Anyone who wants to feel confident in managing their own HIV sexual health.
• People who prefer to engage in condomless sex (bare backing).
• People who have sex while inhibited by drugs or alcohol.
• People who have difficulties maintaining an erection while using condoms.
• Anyone who engages in Blood Play.
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HIV stands for Human Immunodeficiency Virus.
HIV can enter your body via unprotected anal, oral or vaginal sex and through sharing used needles. HIV is a virus which once established in the body, attacks the immune system and the protective cells called CD4 cells. Once HIV enters these protective cells, HIV multiplies quickly and releases more HIV into the blood infecting other CD4 cells within the body. Once HIV is established in the body, you become HIV positive. Once HIV positive, you remain HIV positive for life. Without treatment HIV can cause serious health problems and can potentially lead to death through secondary AIDS related illnesses.
Currently there is no cure for HIV.
Often people who are HIV positive will show no obvious symptoms so regular HIV testing is recommended.
DOSING METHODS
There are two common ways to take PrEP (TDF/FTC), and both methods provide similar protection, if taken as prescribed.
Chat to your clinician about which dosing method suits you, and if/when you choose to change dosing methods.
1. Daily-Prep
2. On-Demand PrEP
Daily-PrEP
Daily PrEP is highly effective at preventing HIV transmission for Cisgendered men who have sex with men, Transgender men and women, Heterosexuals, and people who inject drugs (PrEP Guidelines)
Credit: Thorne Harbour Health
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Daily-PrEP is as simple as taking one pill a day, every day.
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There are 2 ways to start taking Daily-PrEP;
OPTION A
• Take PrEP for seven days, each day BEFORE having sex (one pill a day).
• Take PrEP every day for at least 7 days before having condomless sex.
• You are fully protected after the 7 days of continuous daily PrEP.
• Ensure that you protect yourself with other methods (e.g. condoms) if having sex before the 7 day period. Ask your clinician for some free condoms.
• Continue to take one tablet every day.
OPTION B
If you are a Cisgender man, you can commence daily PrEP by taking a double dose (2 pills at the same time), 2 to 24 hours before sex, then followed by a daily pill.
Continue to take one tablet every day.
IMPORTANT (Option B for commencing PrEP is not recommended for Transgender men, as there isn’t sufficient research to confirm its efficacy in preventing HIV).
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If Daily-Prep isn’t for you, you may consider On-Demand PrEP
Before stopping PrEP, make sure to consult your prescribing doctor. You might need to continue taking it for a certain period to ensure ongoing protection from HIV.
On-Demand PrEP
"On-Demand PrEP is effective in preventing HIV."
2+1+1
Credit: Ending HIV
Credit: Thorne Harbour Health
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On-Demand PrEP can be used for short periods of time, or around single events of sexual activity. It is more suited to people who don’t have sex regularly and who have the ability to plan when they have sex (E.G., an upcoming festival, dance party, overseas travel, or before going to a sex sauna).
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2+1+1 is a simple way to remember how to take On-Demand PrEP.
• Day 1 - Take 2 pill together (double dose) a minimum of 2 to 24 hours before sex.
• Day 2 - Take a 3rd pill 24 hours after the first two tablets.
• Day 3 - Take a 4th pill 24 hours after the third tablet.
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Continue taking 1 pill every 24 hours for as long as you are having sex, to keep protected.
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Following the last day you have sex, continue to take 1 pill a day for 2 consecutive days (1+1). Only after 2 consecutive days of taking PrEP with no sex, is it safe to stop taking PrEP.
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For On-Demand PrEP, it's important you don't miss any tablets. It's recommended you take your pills at the same time everyday.
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• PrEP on-Demand is suited for Cisgender Gay, Bi and men who have sex with other men.
• Assigned male at birth Non-Binary folk, who aren’t taking gender affirming hormones and having anal sex.
This is the current recommendation, as feminising hormones may reduce the levels of PrEP in your body. Although PrEP levels may not be sufficiently reduced, taking On-Demand PrEP with feminising hormones may not be appropriate until more research is conducted. Speak to your clinician for further advice. Learn more HERE.
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• Currently On-Demand PrEP is NOT RECOMMENDED for Trans and Gender Diverse people, Heterosexual males and females, and people who inject drugs. This is simply due to lack of efficacy data for these populations.
• For front hole or vaginal sex, only Daily-PrEP is recommended.
• On-Demand PrEP is NOT RECOMMENDED for people living with chronic Hepatitis B infection.
The good news is, Daily-PrEP can work for most people. Please consult a clinician who specialises in sexual health to see what dosing method suits you.
Always consult your clinician before commencing or ceasing PrEP, and when changing from Daily-PrEP to On-Demand PrEP, or vice versa.
