What is PrEP?
PrEP stands for Pre-Exposure Prophylaxis. It involves a person who doesn’t have HIV, regularly taking a pill to reduce their risk of HIV infection. Each pill is a combination of medications.
LGBT Foundation believes PrEP should be available to anyone who might be at higher risk of HIV infection regardless of their gender identity or sexual orientation.
PrEPster is a great resource for learning more about PrEP and whether it might be something for you or someone you know.
Where can I get PrEP?
NHS England are about to begin recruiting patients for a 3 year, 10,000 place PrEP Trial. The first patients should start recieving PrEP in September. The NHS England announcement is here. We will update this page with info on how to enroll when details are announced.
The Scottish Health Service in Scotland have announced that PrEP is available to those most at risk of HIV exposure for free (you need to be over 16). If you live in Scotland, visit your local sexual health (GUM) clinic to discuss your options. You can find out more at https://prep.scot/ (Scotland).
The NHS in Wales have recently committed to funding a 3 year PrEP trial through All Wales Medicines Strategy Group.
PrEP is not currently available through the NHS in Northern Ireland.
If you're not currently able to access PrEP where you live you can purchase a course of PrEP (28 days of medication) from a website called iWantPrEPNow.com from £37.
LGBT Foundation advocates for self-prescribing where treatment is not accessible from the public health service. It's important that you have access to medication guidance and work with your healthcare provider (a sexual health clinic, GP or hospital) to regularly assess how the medication is affecting your health.
Know your status
Before taking PrEP you need to ensure that you're HIV negative by having a HIV test. If you've had risky sex within the last 3 months and think you might have been exposed to HIV you need to test after 3 months after the sexual encounter (this is the window period for accuracy for most HIV tests).
It's really important that you're sure you're HIV negative before starting PrEP. If somebody who is HIV+ but unaware of their status begins a course of PrEP the virus could develop resistance to the anti-HIV medication that is used for PrEP. This could lead to potentially serious treatment complications in the future.
Whilst you're testing for HIV it's recommended you have a full sexual health screening for other STIs. It's important to also test your blood for immunity levels, particularly for Hepatitis B. This is because there's a risk of exposure of STIs during sex.
Medication and dosage
It takes some time for the right levels of PrEP to be in your system and this needs to be maintained, particularly if you think you might have more riskier sex encounters.
If you have intend to have vaginal sex, you need to take PrEP every day for 2-3 weeks. You'll need to continue to take it several days after sex. The medication takes longer for PrEP to be absorbed in to vaginal tissue in comparison to the rectum.
If you intend on having anal sex there are two ways to take PrEP: daily or on-demand.
For most people taking PrEP daily allows them peace of mind that they'll have enough of the medication in their system to prevent HIV exposure even if they miss a dose. However, some people may prefer to take PrEP ahead of a riskier sex session rather than daily, because it costs less money and you might not be having regular riskier sex. This is sometimes referred to as 'event based dosing' or 'on-demand dosing'.
It's important you continue to regularly test for HIV and STIs whilst you're taking PrEP. It's recommended you do so every 3 months (within exposure window periods) to give you peace of mind.
It is vital that you get a quarterly urine 'dip-stick' test to check that your kidneys have no problems relating to PrEP usage. Additionally every 12 months you should ask for a blood test to check how your kidneys and liver are functioning. These tests should be available for free at NHS sexual health clinics - if you have any trouble accessing these essential tests please refer to this guide from Prepster (PDF).
Why do we need PrEP?
There are now over 101,000 people living with HIV in the UK. There is higher prevalence (more people living with HIV) in particular places in the UK including Manchester. This means there might be a higher risk of people contracting HIV, particularly if they're having riskier sex. Some factors that might contribute to you being at higher risk are:
- A recent STI
- Use of PEP (post-exposure prophylaxis)
- Engaging in ChemSex (using drugs such as crystal meth, mephedrone or GHB during sex)
We can have safer sex by using condoms, but not everyone likes to use condoms or they might feel pressured not to use them. PrEP gives people another option to prevent contracting HIV.
How effective is PrEP?
Results from separate studies of PrEP in the UK and France both show that PrEP greatly reduces HIV infections among gay men by 86% PrEP has also proven effective for heterosexual couples in which one partner is HIV positive and is not taking HIV treatment.
PrEP does not prevent other STIs (sexually transmitted infections) or pregnancy.
Does PrEP have side-effects?
Any medicine can have side-effects, so taking PrEP is a serious decision. The drugs in PrEP have been used as part of HIV treatment for many years and treatment has developed over time to have much fewer side effects. Most people taking PrEP don’t report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away.
If you are experiencing issues with medication it's important that you speak to your GP. Healthcare professionals have a duty of care to ensure that you're healthy and well. This includes accessing renal function testing (kidney) at a hospital to assess whether the medication is having any negative impacts on your immune system.
Dealing with PrEP shaming
Unfortunately some people don't advocate for PrEP and in turn shame people who want to access PrEP. If you're accessing PrEP you're taking control of your sexual health and helping to fight the onward transmission of HIV. We're proud to support people taking PrEP because it improves sexual health and wellbeing.
Some people claim that using PrEP means people take more risks in their sex lives. However, in 2 studies it was found that there was no difference in the number of men diagnosed with other STIs between those on PrEP and those not on PrEP. At LGBT Foundation we're sex positive and believe that people should have the opportunity to have fantastic sex with their partners without shame and discrimination from other people.
If you would like to chat to us in confidence about the sex you're having/want to have, advocating for safer sex, or about your sexual health and wellbeing 'Let's talk about sex' might be the service for you.
In 2015, Nicholas Feustel produced the video documentary on the PROUD Study which showed how highly effective PrEP is in gay men in the UK. Two years later he spoke with ordinary PrEP users – outside of the PROUD Study – to learn about their experiences and motivations. He also talked with PrEP activists and clinicians to find out what impact PrEP has already had in the UK, but also to find out what is still missing for a proper implementation.
Campaigning for PrEP
Although PrEP trials are being implementing by the NHS in England and Wales, we are calling for earlier access to PrEP - sign the statement at www.prepaccess.org.uk.
The NHS must speed up its evaluation process and make PrEP available as soon as possible. Furthermore, we call for interim arrangements to be agreed now for provision of PrEP to those at the highest risk of acquiring HIV.
PrEP trials and studies
Two European studies of pre-exposure prophylaxis (PrEP), PROUD and IPERGAY, reported results in February 2015. The two studies of PrEP in gay men and trans women have demonstrated that the availability of PrEP reduced the rate of infection by 86%. This amounts to the highest effectiveness yet seen for PrEP and is superior to most other HIV prevention interventions. Extraordinarily, two separate studies which provided PrEP in very different ways found exactly the same level of effectiveness.
In light of this news, together with data on continued high rates of new HIV diagnoses, the NHS urgently needs to make PrEP available.