PrEP (Pre Exposure Prophylaxis)
What is PrEP?
PrEP is a medication taken by HIV-negative people to reduce the chance of getting HIV from having sex without a condom and from sharing needles or equipment to inject or use drugs. The medication used for PrEP is a tablet which contains tenofovir and emtricitabine (sometimes known as Truvada).
How does PrEP work?
PrEP has been shown in many studies to be safe and highly effective at preventing HIV. PrEP stops HIV from establishing itself inside the body. When taken correctly PrEP has been found to be about 99% effective.
Is PrEP available in Ireland?
Yes. You can only get PrEP with a prescription. You can get a prescription from one of the approved PrEP services in Ireland.
Do I have to pay for PrEP?
From 4th November 2019, PrEP is available free of charge to those who meet the clinical eligibility criteria for PrEP.
If you are eligible for PrEP, to get it free of charge you will need:
(1) a PPS number.
(2) a Drug Payment Scheme (DPS) card or a medical card.
A DPS card is available to anyone who is ‘ordinarily resident’ in Ireland. The €80 monthly limit will not apply once you have a prescription from an approved clinic. There is no means test for a Drug Payment Scheme card but you do need a PPS number.
Can I still get PrEP free if I can’t get a DPS card?
Yes, you can. Some people may not be eligible for a DPS card because they are not ‘ordinarily resident’ in Ireland (e.g. students from non EU countries).
If you are not eligible for a DPS card and have been refused one, you can still get PrEP for free once you have been prescribed PrEP from an approved clinic.
When you are prescribed PrEP from an approved clinic, you are registered with the HSE PCRS, or Primary Care Reimbursement Service. This is the system that allows the HSE to make payments to pharmacists (and other healthcare professionals) for the free service they provide to the public.
The pharmacy will need to call PCRS (Pharmacy Function) on 01 864 7100 extension 7231 to confirm that you are registered with PCRS and to confirm that you have been clinically approved for PrEP. Once confirmed, the pharmacy can dispense the prescription and will be reimbursed.
While efforts have been made to ensure that all pharmacies are aware of these ‘exceptional circumstances’, some pharmacies may not be fully aware. If you have been prescribed PrEP from an approved clinic, but do not have a DPS card, bring this information with you to the pharmacy.
Note: this information also applies to people who are eligible for a DPS card, but are waiting on approval or have yet to send in their application. The pharmacy can issue an emergency DPS number to you, giving you time to apply for one or get approval, and can dispense the prescription on the same day.
Am I eligible to get PrEP?
To get PrEP for free through the HSE you need to:
- test negative for HIV
- be aged 17 years and older
- be able to attend for a check-up at least once every 3 months
- meet at least one of the following criteria for free PrEP:
(1) You are having sex without condoms with HIV-positive partners who:
- are not on HIV treatment, or
- are on treatment but not virally suppressed (do not have an ‘undetectable’ viral load)
(2) You are a man who has sex with men, a trans man who has sex with men, or a trans woman who has sex with men, and you meet any one of the following:
- had anal sex without condoms with at least two partners in the last 6 months
- likely to have anal sex without condoms in the next 3 months
- had an STI in the last 12 months
- used HIV PEP (post-exposure prophylaxis) in the last 12 months
- used recreational drugs for sex (also known as chemsex) in the last 6 months
(3) Other individuals considered by a specialist HIV/STI doctor to be at significant risk of acquiring HIV through sex.
Where do I get a prescription for PrEP?
View a list of approved PrEP services in Ireland. These services can prescribe free PrEP to those who meet the clinical eligibility criteria, and are considered to be at risk of acquiring HIV through sex.
What if I am not eligible for free PrEP?
If you do not meet the criteria for free PrEP you can decide to pay for PrEP. You can buy PrEP through community pharmacies with a prescription.
What pharmacies are stocking PrEP?
PrEP is available in pharmacies nationwide. If you encounter a pharmacy that does not have PrEP, they can order it and it will usually be delivered the next day, and sometimes on the same day, depending on the time the order is placed.
What happens at the PrEP service?
As PrEP can only be used if you are HIV-negative, you will need to have a few tests before you start PrEP:
- A (4th generation) HIV blood test.
- A test for hepatitis B (because PrEP is active against both HIV and hepatitis B).
- A test for hepatitis A and for hepatitis C.
- Tests for syphilis, chlamydia and gonorrhoea.
- A kidney function blood test (because a small number of people taking PrEP have developed reduced kidney function).
- A pregnancy test.
- It is also a good time to get vaccinated against hepatitis A and B and HPV or boost previous vaccinations if necessary.
- If HIV PEP is required, arrangements will be made to start PrEP at the end of the course of PEP.
How do I take PrEP?
PrEP is a tablet that you take orally. There are different dosing regimens but the best and most effectively proven regimen is taking one pill a day, every day. This is the only recommended regimen for people who inject drugs or who have hepatitis B. Talk to someone at your prescribing clinic about what dosing regimen will work best for you.
When you start taking PrEP you also have to get the drug levels high enough in your body to protect you:
- for anal sex, you will need to take at least two tablets 24 hours before sex, and then continue to take one every day.
- for vaginal sex, you will need to take PrEP for 7 days before sex and then continue to take one every day.
Find out more about how to take PrEP here.
So I’ve started taking PrEP! Now what?
Once you have started PrEP, you will need to go for a check-up every 3 months. This is to check for HIV and STIs and kidney function. Although side effects are rare with PrEP, the clinic monitoring will help to identify any potential problems at an early stage.
Every 3 months you should have the following tests:
- A ‘4th generation’ HIV blood test.
- A full screen for other STIs.
- A blood test to check your kidney function (this will happen at your first 3-month appointment after starting PrEP and thereafter as recommended by your clinic).
Every 12 months: you should have a hepatitis C test. (This may need to be done more frequently).
What do I do if I miss a pill?
If you miss one or two pills, don’t stop. Just continue once you remember. There is likely to be enough drug in your body to protect you against HIV.
If you are missing several doses a week, you are not going to be protected against HIV if you are exposed to it. You can access PEP up to 72 hours after a potential exposure to HIV.
If you are taking PrEP, try to pick a regular time each day to take it. You don’t have to take the tablet at the exact same time every day, but if you could link it to a daily task such as having your breakfast or brushing your teeth, it could help you remember.
Once I start, can I stop?
Yes you can. It is always best to discuss your decision to stop with your doctor, and before you stop follow this advice:
- If you’ve been taking PrEP to stop HIV through anal sex, don’t stop until 48 hours after the last time you had sex.
- If you’ve been taking PREP to stop HIV through vaginal sex, don’t stop taking it until 7 days after the last time you had sex.
- If you’re at risk of HIV through injecting or slamming drugs, don’t stop taking it until 7 days after the last risk for HIV.
Read more about ‘Stopping PrEP’ here.
Are there side effects?
Like all medicines, PrEP can cause side some effects. This can include mild nausea, diarrhoea, bloating and headaches. Less than 1 in 10 people taking PrEP experience these side effects and they usually stop within the first month. Most people taking PrEP do not report any major side effects. Occasionally PrEP can cause more serious side effects.
- Kidney function: Taking PrEP can affect your kidneys. This is is why monitoring your kidneys is so important.
- Bone density: PrEP can reduce bone density by between 1% and 2%, causing slight thinning of the bones. This loss reverses after PrEP is stopped.
- Interactions with other medications: Tenofovir and emtricitabine do not interact with many other medicines. One important consideration is between tenofovir and non-steroidal anti-inflammatory drugs (NSAIDs). This is especially true with diclofenac, which together can cause kidney problems. Other medicines in this class include ibuprofen and naproxen. Avoid using these medicines if you are taking PrEP, or let your GP know if you need to take them.
- For transgender people taking PrEP, there is no reason to expect PrEP will change the effectiveness of hormone therapy. There is some evidence that feminising hormones can affect the levels of PrEP in your system. It is advised that transgender women who are using hormone therapy use daily PrEP only, and not event based dosing.
Read more at ‘Side effects of PrEP’ here.
What about other STIs?
PrEP does not stop you from getting other sexually transmitted infection (STIs), so PrEP is not a replacement for condoms. Using condoms every time you have sex is the best way to prevent you from getting or passing on STIs. Find out where you can get free condoms.
More information about PrEP
HIV PrEP in Ireland: Information booklet for people who are taking PrEP or are considering taking PrEP to prevent HIV (published by HSE Sexual Health and Crisis Pregnancy Programme, October 2019).
Research has shown 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.
In what countries is PrEP available?
Access to PrEP 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.
Sourcing/Buying PrEP online:
It is possible to buy generic PrEP products over the internet. In Ireland, it is illegal to source prescription medication without a prescription. 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‘.
- 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.
Updated 21st July 2022