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About PrEP (Post Exposure Prophylaxis)

“PrEP” stands for Pre-Exposure Prophylaxis. PrEP is a way for people who don’t have HIV, but who are at very high risk of getting it, to prevent HIV infection. This is by taking a pill containing two medicines, that are also used to treat HIV,  every day at periods of high risk. If you take PrEP and are exposed to HIV through sex, these medicines can work to keep the virus from taking hold in your body*.

PrEP can be combined with condoms and other prevention methods to provide even greater protection than when used alone.

There are two proven ways of using PrEP when the risk is from anal sex.  One is to take it all the time during periods of risk (the PROUD study)  and the other (the IPERGAY study) is to take a double dose 2-24 hours before you know you are going to have risky sex and then daily until 48 hours after you stop having risky sex. Both methods have been proven to work but there is more research to support the PROUD method of daily use. For vaginal sex only this daily method has been proven to work.  People who use PrEP must be proven to be HIV negative and must commit to taking the drugs properly. They need regular HIV and STI testing need checking that the drugs have no serious side effects with blood and urine tests to make sure that the medicine are not affecting your kidneys.  This is because if PrEP is used after HIV infection it can make treatment more complicated.

*Even though several studies have shown PrEP to be highly effective at reducing rates of new HIV infections by as much as 86%, and with high rates of new HIV infections being reported year on year, NHS England has not yet agreed to make PrEP available via the NHS. Birmingham LGBT feels that this is wrong and supports many other UK sexual health and HIV organisations in calling for PrEP to be available on the NHS urgently.

PrEP is not for everyone. The aim of PrEP is for it to be used for people who are HIV-negative and at high risk for HIV infection. This may include anyone who is in an ongoing relationship with an untreated HIV-positive partner as well as for people who are having risky unprotected sex who find it difficult to consistently use condoms as a prevention method.

PrEP is not available in the UK on NHS prescription. PrEP has only been made available in the UK to people enrolled in research trials and by private prescription from some GPs or sexual health clinics. PrEP is already available in other countries including, the USA, France, Israel, Kenya.  Some people are buying PrEP over the Internet as the drugs are much cheaper when they are imported from developing countries.

People who inject drugs or have shared needles might also consider using PrEP, for example if you engage in Chemsex but it will not protect you against Hepatitis C and how effective it is for preventing HIV infection from injection is unclear.

If you have a partner who is HIV-positive and are considering getting pregnant, talk to your doctor about PrEP. It may be an option to protect you and your baby.

PrEP involves taking medication daily during periods of high risk and regular visits to a GP or other clinic for U and E (Urine and Electrolyte) tests to monitor your kidney and liver health and regularly be screened for HIV infection.

PrEP should only be used for people who are at ongoing substantial risk of HIV infection. For people who need to prevent HIV after a single high-risk event of potential HIV exposure—such as sex without a condom, needle-sharing injecting drug use, or sexual assault—there is another option called Post Exposure Prophylaxis, or PEP. PEP must begin within 72 hours of exposure.

It’s also important to remember that taking PrEP will not prevent you from getting other sexually transmitted infections (STI’s) such as syphilis, gonorrhoea, chlamydia, or other STI’s, or from becoming pregnant. PrEP will also not protect you from getting hepatitis C.

In 2 recent studies (PROUD and IPERGAY) PrEP has been shown to significantly reduce the risk of HIV infection in people who are at high risk from anal sex by as much as 86%, overall.  It is thought that the infections that did occur were in people who did not take their medication properly.  There has been a report of someone on PrEP who became infected by someone with antiviral resistant virus.

PrEP is much less effective if it is not taken properly  PrEP can be even more effective if it is combined with other ways to prevent new HIV infections such as condom use, drug treatment, and adherence to treatment for people living with HIV to further reduce the chance of HIV being passed on.

Read more about PrEP and the PROUD and IPERGAY studies here:

http://www.aidsmap.com/PrEP/cat/1623/

http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/

http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/

http://www.proud.mrc.ac.uk

Some people in clinical studies of PrEP had early side effects such as an upset stomach or loss of appetite, headache, but these are usually mild and usually go away within the first month. Some people did have some kidney disturbance but this did not lead to serious long term kidney problems.

The medication used in PrEP has been used to treat people living with HIV for many years and has been shown to be low risk of serious side effects. However, if using PrEP and you are experiencing side effects, you should discuss this with with the GP or clinic where you are having your regular check ups.  Ideally you have a kidney function blood test and a urine test before you start and may need this repeating if you remain on PrEP

PrEP is not available on the NHS in the UK however many people choose to obtain PrEP via the internet. There are always risks in buying anything online, but we have included the following links for you to obtain more information if you are considering buying or acquiring PrEP:

Can I get PrEP privately in the UK?: http://i-base.info/qa/10696

Where can I but PrEP online and is it legal in the UK?: http://i-base.info/qa/10734

How can I check that PrEP I buy from the internet is genuine: http://i-base.info/qa/10695

How do I safely use PrEP if I buy it online?: http://i-base.info/qa/10528

Recommended reading if considering buying PrEP online: www.iwantprepnow.co.uk and http://prepster.info/

The pill used by people using PrEP for daily use who are at very high risk of getting HIV infection is called Truvada®.

Truvada® is a combination of two HIV medications (tenofovir and emtricitabine). In other parts of the world it is available as a cheaper generic (non patented) product.  Most commonly this is from an Indian company called Cipla.  These medicines work by blocking important pathways that HIV uses to set up an infection. If you take PrEP daily, the presence of the medicine in your bloodstream can often stop HIV from taking hold and infecting you with the virus.

Dosage is very important: If you do not take PrEP properly  there may not be enough medicine in your bloodstream to block the HIV virus. If you are infected you virus may then have some resistance to Truvada and may affect your later treatment.

Read more about PrEP and the PROUD and IPERGAY studies here:

http://www.aidsmap.com/PrEP/cat/1623/

http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/

http://www.proud.mrc.ac.uk

http://www.ipergaymtl.com/en/about-us.html

http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/

Pleas see the ‘Our Clinics’ page or click here

To read the Umbrella ‘How to take Pre-Exposure Prophylaxis (PrEP)’ leaflet click here.

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