Pre Exposure Prophylaxis (PrEP)
PrEP is medication for people who are HIV negative, but at high risk of becoming infected, to take before sex to reduce the chance of becoming infected with HIV. PrEP is a combination of two different drugs (Tenofovoir and Emtricitabine) in a single tablet (Truvada™) which has been used for many years as a treatment for people who are living with HIV.
What does taking PrEP involve?
Taking a pill, usually daily, and regularly getting tested for HIV and other sexually transmitted infections. Before starting PrEP, it’s important that you know your HIV status.
How does it work?
PrEP if taken consistently can significantly lower the risk of becoming infected with HIV (studies have shown up to a 92 percent reduction in risk). Once PrEP reaches protective levels in the body, it prevents HIV from staying in the body. It takes seven days to reach protective levels in rectal tissue and 20 days to reach protective levels in vaginal tissue.
Who is PrEP for?
If you are HIV negative but have a high risk of being exposed, you should consider taking PrEP. This includes men who have sex with men or transgender women who have had anal sex without a condom or have been diagnosed with a rectal sexually transmitted infection in the past twelve months. In addition, taking PrEP may be beneficial for heterosexual men or women who do not regularly use condoms during sex with a partner who is HIV positive and not on treatment.
PrEP is not suitable for everyone, and you should only take it if you feel it is right for you, and have discussed its suitability for you with a health professional.
In Scotland, the following criteria have been agreed by all the health boards for prescribing PrEP:
- Aged 16 or over.
- Test HIV negative in a 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 and with a detectable viral load.
- Gay and bisexual men, other men who have sex with men*, and transgender women with a documented bacterial rectal STI in the last 12 months.
- Gay and bisexual men, 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.
*This includes transgender men who have male sexual partners
Does PrEP mean I can stop using condoms?
PrEP does not prevent transmission of other sexually transmitted infections therefore it is important to continue using condoms. PrEP is not intended as a replacement for condoms and they are still an integral part of the HIV and sexual health response.
Can I get PrEP on the NHS?
PrEP has now been approved to be provided by the NHS in Scotland for people who reside in Scotland and it is therefore free.
Where can I get PrEP in Tayside?
PrEP is only available from sexual health and MOT clinics in Tayside. You must be seen by a nurse (at a walk-in or MOT clinic – click here for opening times) for a pre-PrEP consultation and then an appointment will be made for you at a PrEP clinic to see a consultant. A decision and treatment plan will be made by the consultant together with you once they have reviewed all the results from your assessment with the nurse.
What’s the difference between PrEP and PEP?
While PrEP is taken before possible exposure to HIV, PEP (post-exposure prophylaxis) is given to people in an emergency after someone has had a likely exposure to HIV. PEP requires individuals to access the drug within 72 hours of the exposure (ideally within the first 24 hours) and adhere to a regime for a month which can have significant side effects.
I’m not eligible for PrEP on the NHS, what are my options?
If you don’t meet the criteria for PrEP on the NHS, then it might not be a good idea to take it. Taking PrEP means taking a drug daily and you probably don’t want it in your body if experts think you don’t need it. The best thing to do is to keep talking to your healthcare provider because HIV risk changes over your lifetime.
PrEP can be purchased online from generic suppliers. If you get, or intend to get your PrEP online, talk to your healthcare provider about it. Stay connected to your sexual health clinic as well, because you still need to be regularly monitored and tested.
Where can I get more information?
Tayside Sexual and Reproductive Health Service – 01382 425542
You can also get more information in our leaflet or by visiting www.prep.scot
If you want to make some changes to your chemsex use, you can work your way through this care plan.