Looking to get educated on what PrEP is and how is can work for you? Start here.
WHAT IS PrEP?
PrEP stands for pre-exposure prophylaxis.
[ pre = before exposure = exposure to HIV prophylaxis = prevention ]
PrEP is a regime of medication taken by HIV-negative people to protect them from HIV transmission.
The way we currently use PrEP is with the daily oral medication Truvada, or generic versions of Truvada.
In the USA a second drug called Descovy has been approved for use as PrEP. Descovy isn’t widely available in Australia, but might be suitable for some people who Truvada doesn;t work for. More on Descovy here.
Does PrEP Really Work?
YES! Truvada is made up of two amazing medications (it’s a two-in-one punch against HIV).
Emtricitabine and tenofovir are two powerful anti-retroviral medications. They have been used for years in combination with other medications by HIV-positive people to keep the levels of HIV in their blood to undetectable levels, and keeping them healthy. Thirsty for more? Get the Undetectable 101’s
Knowing the Truvada was very powerful as an HIV treatment, clinical studies were run to determine if it could be used to protect people at risk of HIV infection. From these studies we know that PrEP is incredibly effective. In the real world, PrEP is 99% percent effective. This doesn’t mean you will contract HIV from 1% of encounters, it means your current risk of HIV will be reduced by 99%.
You can take PrEP every day for all-round protection, and some folks can take PrEP ‘On Demand’ - carefully timed doses of PrEP just around times you need it.
IS IT SAFE?
Truvada as PrEP is very safe. HIV-positive people have been taking this medication daily in combination (and separately) for years and have been very well tolerated.
As with many medications, there can be side effects however they are often minor, short-lived, and reversible.
Some people when starting PrEP experience some mild stomach upsets and or nausea, mild headaches, insomnia,
These side effects occur in a small percentage of people who take PrEP, and as your body get’s familiar with the medication they generally settle down very quickly. If you start PrEP and you are concerned about ongoing side effects, book back in to see your GP – but try not to be concerned too much about a few extra trips to the loo or a mild headache here or there in your first couple of weeks.
Long term effects?
One of the medications in Truvada has been shown in some people to have a minor reduction in kidney function, and in some people a very minor reduction in bone density. Both these things have been shown to reverse completely when stopping PrEP and for most people they don’t cause any issue. If you have low bone density, or reduced kidney function discuss this with your GP before starting PrEP. This likely won’t exclude you from starting PrEP but they may run some more frequent testing to make sure everything is being tolerated well.
Where Can I Get IT?
PrEP is easier to get in Australia than ever before. Depending on your location, or circumstances one of the following may be suitable for you to look into access PrEP. In all instances below, you need to frst find a PrEP knowledgable GP who can do all your tests, and then write you a prescription
Low cost PrEP can be found for purchase online, and is often the cheapest way to access PrEP because of the low cost of generic medications overseas. At around $22 per month for the cheapest option, this is how many people have accessed PrEP for years. for more check out our guide on how to Buy PrEP Online and selecting a supplier to purchase from.
PrEP is now subsidised on the Pharmaceutical Benefits Scheme (PBS). This is convenient, and will cost $40.30 for most people… but that may not be the cheapest option depending on your circumstances. Our PrEP on the PBS guide will help you weigh up that option.
PrEP is cheaper than ever before – however both importing and buying PrEP locally can be prohibitively expensive for some, especially those without access to Medicare. with this in mind, PAN offers free PrEP coupons for anyone unable to access PrEP at a price point within their budget. Check out how to apply for coupons at the Assistance Scheme page
If you don’t have Medicare and you live in NSW you can access 12 months of free PrEP via MI-EPIC, which is an extension of the EPIC PrEP study. This study is only for people who cannot access Medicare.
WHAT ABOUT OTHER STIS?
If you decide to reduce or stop using condoms when you start PrEP you need to be aware of other STIs. But, even if you’re using condoms 100% of the time guess what… you need to be aware of STIs.
Condoms don’t protect against ALL STIs. Herpes, crabs, and other bugs can spread from person to person even if you’re using condoms – and using the consistently.
The STIs condoms can protect against don’t always do that either. If you enjoy oral sex you’ll probably never have used a condom or other barrier method when getting orally fixated.
Recent evidence also shows that gonorrhoea can be spread by smacking tonsils, so no matter what your chosen method of protection is – you’re bound to get an STI along the road at some stage.
PrEP users are required to test at least every three months in order to get a script fo their next batch of medication. Gay men in the wider community only test around 1.5 times a year. This means PrEP users are picking up those STIs and getting treatment sooner, rather than passing on those STIs to their partners. Often a person with an STI won’t show symptoms – guys with Chlamydia only present with symptoms around 1/2 the time, and women even less. This is why regular testing is a crucial part of protecting your sexual health.
WHAT ABOUT OTHER STIS?
That’s up to you. Deciding to start PrEP is a personal decision for you, and in doing so you need to think about your own risk and be honest with yourself – sometimes that’s tricky in itself.
Different countries and states have different guidelines for who might want or need to consider PrEP. If you think you might be at risk for HIV - talk to your doctor about PrEP.
We would encourage and recommend all trans and gender diverse people assess their risk and consult with a trans-friendly GP or sexual health clinic about their HIV prevention tools.
I'm Trans, Is PrEP for me?
PrEP is for all of us. PrEP works for trans and gender diverse folks too!
Truvada has no known contraindications with any transition-related hormones. It is an HIV medication that many trans people living with HIV have used for treatment over many years. If you’re concerned - you can check out interactions with the drugs in Truvada at HIV using this great checker tool
Currently, there is only evidence to support trans people using Daily PrEP. On Demand PrEP doesn’t provide enough coverage for people with a vagina/front-hole, and we don’t have evidence that supports trans women using PrEP On Demand. If you’re trans - Daily PrEP will provide excellent protection.
Our friends over at PASH.tm have developed a wonderful resource for gay, bi and queer trans men called GRUNT which is well worth a look into – and you can follow up on HIV treatment for trans men specifically there.
Need a trans-friendly GP? Contact your state AIDS Organisation for advice on where to get the care and support that’s right for you.
WHAT IF I’M a young person?
The Australian guidelines now recommend PrEP for people under 18, so long as they weigh 35kg or more.
Unfortunately, to get a prescription for PrEP on the PBS you need to be over 18, because of the way the medication is registered. Never fear though! If you are under 18 you can get a prescription form your doctor and import generic PrEP drugs from overseas. It’s the same exact drug, and for most people its actually even cheaper than buying it at the pharmacy.
If you need advice on buying PrEP online, feel free to get in touch!
WHAT IF I’M FIRST NATIONS?
First Nations people (Aboriginal and Torres Strait Island people) can access certain medications at reduced cost under the Closing The Gap scheme to improve health and wellbeing outcomes. If you are an ATSI person accessing PrEP on a clinical study where it would cost money to access the medication, it may be at reduced cost or even free.
Once PrEP is listed on the PBS this will mean that ATSI community members will likely be able to access further reduced cost PrEP to prevent HIV.
If you’re a prescriber – get up to speed on Closing The Gap