PrEP (Pre Exposure Prophylaxis) helps people reduce their risk of getting HIV when used as prescribed before sex. The PROUD study carried out in 13 sexual health clinics across the UK, showed that when high risk groups took PrEP daily, their risk of getting HIV was effectively reduced by up to 86%.
The two antiretroviral drugs in PrEP are part of the combination of medicines used to treat HIV infection. Although they do not cure HIV, they work by entering the immune cells of the body and preventing any HIV pathogen that enters, after exposure, from multiplying and invading other cells in the body.
When used properly, PrEP is over 90% effective at preventing HIV infections. It is important to always follow your doctor’s advice when taking PrEP. Taking more PrEP pills will not lower your risk of contracting HIV, but may increase your risk of experiencing side effects.
It’s important to be aware that PrEP does not reduce the risk of contracting other sexually transmitted infections (STIs), such as chlamydia or gonorrhoea. To reduce your risk of contracting other STIs, you should use condoms every time you have sex.
How is PrEP taken?
The PrEP trials that have been done so far have mainly used two methods of taking the drugs, which have both been effective at reducing the risk of getting HIV.
Firstly, PrEP can be taken regularly as one tablet per day preferably with food at the same time every day. The other method is referred to as ‘event-based’ or ‘on-demand’ dosing, where two PrEP tablets are taken 2 to 24 hours before sex, and afterwards, one tablet daily for up to 48hours.
Before deciding to start PrEP, it is best to see your GP or a sexual health advisor who will be able to help you assess your risk and frequency of exposure, which will determine which method will be most suitable for you to take PrEP.
Who can take PrEP?
PrEP can be taken by HIV negative persons who are at an increased risk of contracting the HIV virus. If you want to find out if you should consider PrEP, you can use this online PrEP tool.
The main groups of people who are at a heightened risk of contracting HIV include:
- Men who have unprotected sex with men
- People from countries with a high prevalence of HIV
- Women who have unprotected sex with men who have sex with men
- People who inject drugs
- People who have unprotected sex with people who inject drugs
- People who have other sexually transmitted infections
If any of the above conditions apply to you, you should speak to your doctor about PrEP to determine whether it would be beneficial for you.
Who should not take PrEP?
People either have a lower or higher risk of getting HIV, depending on which country they live in and their social lifestyle habits. Although you do not need to take PrEP if you have a low risk of getting HIV, it is advisable to use condoms during sex.
If you have a higher risk of getting HIV and if any of the following apply to you, you should visit your GP first before starting PrEP:
- you are HIV positive or not sure if you have HIV
- under 18 years or over 65 years of age
- have liver disease
- have kidney disease
- have an allergy to any of the ingredients in PrEP medicines
- are taking any other type of antiviral medication
- are taking a regular high dose of painkillers
- have lactose intolerance
- pregnant, breastfeeding, or trying to conceive
It is important to make sure you have tested HIV negative first before starting PrEP.
Are there any side effects of PrEP?
As with all medications, some people may experience side effects while taking PrEP. If they do not reduce or become unbearable over time, you should consider visiting your GP.
Some common side effects of taking PrEP are:
- Feeling sick and vomiting
- Feeling weak
- Pain in the stomach and feeling bloated
- Weight loss
- Back pain
If you experience any of the following less common but serious side effects, you should visit the nearest emergency department immediately:
- Kidney problems
- Yellow and itchy eyes which could be symptoms of liver problems
- Pain in the bones and joint stiffness
- A serious condition called lactic acidosis where lactic acid builds up in the body causing breathing difficulty and loss of consciousness
PrEP can be very effective if used as instructed before having sex. If you experience side effects which become unbearable while taking PrEP, you should always discuss with your doctor before deciding to stop PrEP.
Where can I get PrEP?
As of February 2020, PrEP is not available on the NHS in England. Wales and Northern Ireland offer PrEP from a selection of sexual health and GUM clinics. PrEP is accessible on the NHS from Scotland.
In order to get PrEP on the NHS, you will need to meet a certain criteria. The criteria may be different for certain countries within the United Kingdom, so it’s best to speak to your doctor.
If you can’t get access to PrEP on the NHS, or you don’t feel comfortable speaking to your doctor about getting access to PrEP, you can order PrEP online from a reputable UK pharmacy.
When buying PrEP online, you will need to answer some questions about your health and lifestyle so that the medicine can be dispensed safely. Moreover, you may be required to provide evidence regarding your HIV status. Some services, such as Prescription Doctor, allow you to buy a testing kit via their online service before buying PrEP.