PrEP (Pre Exposure Prophylaxis) is a new HIV prevention strategy that involves HIV-negative people taking antiretroviral drugs (ARVs) to reduce the risk of becoming infected with HIV if sexually exposed to the virus.
Research is showing that PrEP is highly effective in preventing the sexual transmission of HIV as long as the medication is taken regularly and as directed. The PROUD study in the UK reported that PrEP reduced the risk of HIV infection by 86% for men who have sex with men (MSM). Read more about this study at www.proud.mrc.ac.uk.
Currently (July 2017), PrEP is not available in Ireland, but access is expanding globally. The World Health Organisation (WHO) recommends that in all countries, PrEP should be available to MSM, alongside other HIV prevention interventions. The European Centre for Disease Prevention and Control (ECDC) advises European countries to consider integrating PrEP into their existing HIV prevention package for those most at-risk of HIV infection, starting with MSM.
Keep up to date about access to PrEP at www.prepwatch.org.
PrEP does not prevent other STIs. Condoms, when used consistently and correctly, are the best way to prevent the transmission of HIV and other STIs.
What is PrEP?
PrEP is a course of HIV drugs taken by HIV negative people before and after sex to reduce the chance of getting HIV. Results in trials have been very successful, with PrEP significantly lowering the risk of becoming HIV positive and without major side effects. The medication used for PrEP is a tablet which contains tenofovir and emtricitabine (sometimes known as Truvada).
How does PrEP work?
Taking PrEP before and after being exposed to HIV means there is enough drug inside you to block HIV if it gets into your body – before it has the chance to infect you.
How do I get PrEP?
At the moment PrEP is not available in Ireland. In Ireland, it is against the law to supply prescription medication by mail order, including over the internet. The Health Products Regulation Authority (HPRA) provides information for the public in relation to sourcing medication over the internet. View/download the HPRA information leaflet ‘The dangers of buying prescription medicines online‘.
PrEP has recently been made available in Scotland. For more information about PrEP we recommend you check out the prep.scot website.
Update on sourcing PrEP online
(information supplied by the Gay Health Network)
The Health Products Regulation Authority (HPRA) have increased surveillance of PrEP orders coming in to Ireland. Reports have been received of orders being intercepted by the HPRA and PrEP medicine being confiscated.
In addition to this, the HPRA have expressed particular concern about the legitimacy of the source of a recently seized supply of generic PrEP. The HPRA are also examining the websites people use to source PrEP.
There have been no reports from the HPRA or any other appropriate bodies stating that the medicine being sourced online is not effective as PrEP. However, sourcing medicine online does carry a level of risk and so we encourage caution if you intend to do so.
- If you are sourcing PrEP by any means, engage with your local sexual health service for testing and monitoring. Clinics want to see people who are taking PrEP so that they can look after them in the best possible way.
- If the HPRA intercepts a PrEP order it will be confiscated. Under no circumstances will the PrEP drug be released to you. Any amounts spent on purchasing the drug will be lost.
- If the HPRA contacts you about having placed an order for PrEP online – you are not in any trouble. If they ask you for information on how you ordered PrEP, you are under no obligation to respond. However, the role of the HPRA is to protect the public from illegitimate drugs and their suppliers – any information supplied by you will be used to better understand the circumstances around supply of medicines and protect the public from bogus suppliers.
Advice before taking PrEP
Talk to a health advisor, nurse or doctor at the clinic. They can help you if you are planning to take, or are already taking PrEP. It is important to have an HIV test before you start. PrEP can only be used if you are HIV negative. If you are already HIV positive and don’t know it, you could develop resistance to drugs that you will need for treatment.
Ask for a ‘4th generation’ HIV blood test. This is also called a ‘combined antigen/antibody’ test. This test can tell you your HIV status approximately four weeks ago. Most finger prick tests are currently ‘3rd generation’. They tell you your HIV status approximately three months ago. So don’t rely on a finger prick test alone before you start PrEP.
If you are just starting PrEP and had a risk exposure to HIV in the last four weeks, have another 4th generation HIV blood test four weeks after starting, just to be sure an early infection was not missed. If you have flu-like symptoms and a recent HIV risk exposure it is advisable not to start PrEP. This is to check that these symptoms are not related to a recent HIV infection.
If you are starting PrEP after PEP, it is best to start immediately if you have ongoing risks. Ideally you should have an HIV blood test around the time you finish PEP/start PrEP plus another HIV blood test four weeks into PrEP.
Remember that unprotected sex while taking PrEP will reduce your risk of HIV but not other STIs. Use condoms to reduce your risk of other STIs and get tested regularly.
You will also need to have your kidney function checked. Kidney monitoring just involves a blood test for creatinine and a urine test for protein. These should ideally be done just before or on the day you start PrEP.
Advice while taking PrEP
Once you have started PrEP, health monitoring is really important.
Every 3-4 months:
- Have a ‘4th generation’ HIV blood test.
- Have a full screen for other STIs.
- Have a urine dipstick test for protein when you have your STI check up; if there is more than a trace, an additional blood or urine test can be sent off for kidney function.
Every 12 months:
- Have a blood test to check your kidney function.