Pre-exposure prophylaxis (PrEP) for HIV prevention

What is PrEP (pre-exposure prophylaxis)?

PrEP (pre-exposure prophylaxis) is an oral medication taken by HIV-negative people to protect them from contracting HIV.

When taken daily, or on-demand under the advice of a doctor, PrEP is up to 99% effective at preventing HIV.

Video courtesy Thorne Harbour Health

When to take PrEP (pre-exposure prophylaxis)

Currently approved PrEP is a single tablet that contains 2 HIV antiretroviral (ART) medications used to treat HIV. It is usually taken daily.

PrEP can also be taken when you need it (known as PrEP on-demand). It is important to see a GP for guidance on how to follow the strict dosage instructions for protection against HIV.

Remember, PrEP isn’t for everyone and there are other HIV prevention options available.

What PrEP (pre-exposure prophylaxis) is used for

PrEP is for HIV-negative people at risk of HIV infection. This includes:

• Men who have sex with men without using a condom.
• Having a sexual partner who has HIV and is not on treatment, or are at high risk of getting HIV.
• People who are sexually active and inconsistently use condoms.

Your circumstances and your risk of being exposed to HIV should all play a role in deciding whether PrEP is right for you.

Speak with your doctor to see if PrEP is your best option to prevent HIV.

Where to get PrEP (pre-exposure prophylaxis)

PrEP medication is on the Pharmaceutical Benefits Scheme (PBS).

All GPs (doctors) in Australia can prescribe PrEP. If you have a Medicare card, it can be purchased at a subsidised cost from pharmacies, with a valid prescription. (Some pharmacies may need to order the medication in, which may take a few days.)

If you do not have a Medicare card, or cannot afford the subsidised cost, PrEP can be imported through online pharmacies. More information is available from PAN (PrEP Access Now) or the Victorian PrEP Service at the Alfred Hospital (PrEPME Clinic) on 1800 889 887.

If your doctor is unfamiliar with PrEP or what’s involved in prescribing it, they can call the Victorian PrEP Service at Alfred Hospital, on 1800 889 887.

PrEP (pre-exposure prophylaxis) effectiveness

Studies show that PrEP is highly effective in preventing HIV when taken consistently as prescribed. It can reduce the risk of getting HIV by up to 99%.

Possible PrEP (pre-exposure prophylaxis) side effects

Most people who take PrEP don’t experience side effects. Some may have mild effects that usually usually disappear within the first month. These include:

• nausea
• loss of appetite
• headaches.

A small proportion of people on PrEP may develop kidney damage. So it is very important to have kidney tests every 6 months when taking PrEP.

If you have any concerns about side effects, see your doctor.

Important things to know about PrEP (pre-exposure prophylaxis)

At your first appointment and before starting PrEP, your doctor will check your health and organise some tests including:

• an HIV test
• a full sexually transmissible infection (STI) test
• kidney and liver function tests.

You will also receive information about how to reduce your risk of HIV infection.

PrEP must be taken as prescribed for maximum effective protection.

Visit your doctor every 3 months while on PrEP (pre-exposure prophylaxis)

See your GP every 3 months for repeat HIV and STI tests and for a new PrEP prescription.

PrEP can have some side effects, so work with your doctor to monitor your general health.

PrEP does not protect against other sexually transmissible infections (STIs) such as – syphilis, gonorrhoea and chlamydia.

Condoms and lubricant can provide protection against and reduce the risk of spreading an STI.

It is important to have a sexual health test every 3 months while on PrEP, even if you have no symptoms.

PrEP Access Now has more information on where to get PrEP and how much it costs.

How long to take PrEP (pre-exposure prophylaxis)

The length of time people need to be on PrEP medication depends on their personal circumstances.

People may stop taking PrEP if:

• Their risk of HIV infection becomes low because of lifestyle changes.
• They don't want to take medication every day or often forget to take their medication. Other ways of preventing HIV infection may work better for you.
• Medication side effects are interfering with their life.
• Blood tests show the body is reacting to PrEP medication in unsafe ways.

Your doctor may decide there are other options.

Stopping PrEP (pre-exposure prophylaxis)

Talk with your doctor if you are having trouble remembering to take your medication or if you want to stop PrEP.

It is important to make sure that you continue taking PrEP for 28 days after your last potential exposure to HIV before ceasing it.

Other HIV prevention options

There are many easy and effective ways to prevent HIV. Other than PrEP, HIV transmission can also be prevented by:

• Using condoms (including female or internal condoms) with water or silicone-based lubricant during anal or vaginal sex.
• Although there is a low risk of HIV transmission during oral sex, using external condoms on penises or dental dams on vulvas and anuses. This can also help to reduce the risk of other STIs from being passed on.
• Using clean, sterile injecting equipment.
• Achieving and maintaining “undetectable” HIV viral loads (U=U) if you have HIV by taking HIV antiretroviral treatment (ART) as prescribed.
• Getting regular sexual health checks.
• Taking post-exposure prophylaxis (PEP) – if you think you have been exposed to HIV.

Depending on your risk factors and lifestyle, you may be more suited to other HIV prevention methods. It is important to find the right prevention method (or combination of methods) that works for you and your sexual partners.

Speak to your GP or sexual health clinician for more information.

Thorne Harbour Health (formerly the Victorian AIDS Council) and PrEP Access Now has more information on PrEP.

Where to get help

• Your GP (doctor)
• Your local community health service
• PAN (PrEP Access Now)
• Victorian PrEP and NPEP Service, Alfred Health – information line Tel 1800 889 887 (Monday-Friday 9am-5pm)
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Get PEP If you believe you may have been exposed to HIV. Tel. 1800 889 887
• Living Positive Victoria Tel. (03) 9863 8733
• Positive Women Victoria Tel. (03) 9863 8747
• Victorian HIV Service, Alfred Health Tel. 1800 889 887
• Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795 (for country callers)
• Multicultural Health and Support Service, Centre for Culture, Ethnicity and Health Tel. (03) 9418 9929
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Equinox Gender Diverse Health Centre Tel. (03) 9416 2889
• PRONTO! Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 Or (03) 5448 1600
• Gateway Health Clinic 35, Wodonga Tel. (02) 6022 8888 or 1800 657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
• Women's sexual and reproductive health hubs (throughout Victoria)