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 two drugs, tenofovir (TDF) and emtricitabine (EM).
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 have recruiting patients for the 3 year, 10,000 place PrEP 'Impact Trial'. To check which sites (clinics) have started recruitment, visit https://www.prepimpacttrial.org.uk/join-the-trial. You will then need to contact the clinics directly to see if they have places or a waiting list. You must be eligible to take part in the trial. The criteria is:
- Men who have sex with men (MSM)
- Trans men and trans women
- HIV-negative people who have HIV positive partners that are not on effective treatment
- Heterosexual people who are considered to be at high risk of HIV acquisition
You may be able to take part if:
- You are HIV negative
- You are over the age of 16
- You are considered to be at high risk of HIV
- You are willing to adhere to the recommended PrEP regimen and re-attend the clinic every 3 months
You may not be able to take part if:
- You have an illness that could be due to HIV, you would need to wait until it has been confirmed that you don’t have HIV
- You are taking any medication that wouldn’t react well with PrEP
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). Current eligibility criteria for PrEP on the NHS in Scotland are:
- Aged 16 or over.
- Have a confirmed HIV negative test in a sexual health clinic.
- Able to attend for regular 3 month reviews.
- Willing to stop taking PrEP when no longer eligible.
- Resident in Scotland.
Plus, one or more of the following criteria:
- Current sexual partners, irrespective of gender, of people who are HIV positive who have a detectable viral load.
- Cis and transgender gay and bisexual men, other men who have sex with men, and transgender women with a documented bacterial rectal sexually transmitted infection in the last 12 months.
- Cis and transgender gay, bisexual men and other men who have sex with men, and transgender women reporting condomless penetrative anal sex with two or more partners in the last 12 months and likely to do so again in the next three months.
- Individuals, irrespective of gender, at an equivalent highest risk of HIV acquisition, as agreed with another specialist clinician.
The NHS in Wales have recently committed to funding a 3 year PrEP 'PrEPARED trial' through All Wales Medicines Strategy Group. The eligibility criteria will likely include:
- Must be over 16 to take part
- Resident in Wales
- Cis-and transgender men who have sex with men, and
- Transgender women, who are HIV negative, report sex without condoms in the past 3 months, and consider that they will do so again in the next 3 months
- The HIV negative partner of an HIV positive person when the positive partner is not known to be virally suppressed (i.e. has a detectable viral load), and sex without condoms is anticipated
- Other populations, not in the groups above, including those having heterosexual sex, who are clinically assessed and considered to be at similar high risk of HIV acquisition. This includes sex workers and women
Anyone prescribed PrEP will need to visit a sexual health clinic four times a year for as long as they are participating in the project, in addition to an initial assessment/consultation.
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 £19.
If you are not currently on a trial, need to access PrEP but
can’t afford it, Terrence Higgins Trust (THT) have just set up the Mags Portman
PrEP Access Fund to support HIV negative people to get the medication they
need. The fund is open to people who live in England and Northern Ireland who
have no income other than benefits. Through the fund you receive voucher codes
to buy PrEP free online. For more information and for how to apply see: https://www.tht.org.uk/our-services/online-services/mags-portman-prep-access-fund
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.
You can also get a private prescription for PrEP. Branded PrEP (Truvada) can be obtained from a doctor on private prescription for around £400 for 30 tablets.
Know your HIV and Hepatitis B 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.
You also need to be tested for the Hepatitis B virus to rule out an active Hepatitis B infection. You can still use PrEP if you have Hepatitis B infection but you must get advice from a health professional.
PrEP can cause a decline in kidney function though this isn’t common. It is important to have a kidney function test before you start to use PrEP and at regular intervals so that any problems can be identified. PrEP might not be suitable for you if you have problems with your kidneys.
Whilst you're testing for HIV it's recommended you have a full sexual health screening for other STIs. This is because there's a risk of exposure of STIs during sex. You can find out more about how you can test for HIV and STIs on our testing page, including our sexual health clinics for men who have sex with men.
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 receptive vaginal sex, you need to take PrEP every day for 1 week before and 1 week 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 recptive 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 advisable to have both a blood test (that tests for creatinine and eGFR in the blood) and a dipstick urine test (that tests for protein in the urine) before starting PrEP, or as soon after starting as possible. 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).
Here's Greg Owen, from IWantPrenow.com explaining what to do before starting and while taking PrEP:
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.
Want more information about PrEP?
I Want PrEP Now
iBASE UK Guide to PrEP
PROUD study results (24th February 2015)
IPERGAY study results summary
Summary of PROUD study results at aidsmap.com
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