What is PrEP?
PrEP stands for pre-exposure HIV prophylaxis. It’s a way of preventing HIV infection by taking a pill on an ongoing basis before sex and continued after sex. It’s taken by someone who doesn’t have HIV, to prevent them from getting HIV. The PrEP pill is an antiretroviral drug – the same type of pill taken by someone who already has HIV to treat HIV.
What does PrEP involve?
PrEP is most commonly taken as a once-a-day-pill. This pill is a combination of two drugs – tenofovir and emtricitabine. This is one of the same pills commonly taken by someone with HIV as an HIV treatment. Trials have shown that PrEP works best when it is taken regularly – this ensures that levels of drug in the blood are high enough to be protective against HIV.
Does PrEP have to be taken every day?
Recent trials have also explored if oral PrEP might work if taken less regularly, particularly before and soon after sex. This way of taking PrEP might be more popular for people who know in advance when they are going to have sex. Many HIV researchers think there are still questions to be answered about taking PrEP on a non-daily basis. Click here for more information on daily and non-daily use of PrEP.
How does PrEP work?
If a person taking PrEP is exposed to HIV, the PrEP drugs they have taken prevents HIV from entering their cells and from replicating. This stops HIV from establishing itself and stops the person taking PrEP from becoming infected with HIV.
How soon is it effective?
Research shows that PrEP needs to be taken daily for between 4 and 7 days for protective levels to be reached in the blood and the rectum. It takes longer for protective levels to be reached in the vagina and cervix – so people with a vagina or a cervix may need to take PrEP on a daily basis for three weeks before it becomes effective.
Does PrEP work?
The short answer is yes. Studies across the world have shown that daily oral PrEP is highly effective. The iPREX trial showed that it was most effective when taken every day. Aidsmap’s briefing paper provides an excellent overview of PrEP research.
Are there side effects?
Most people who take PrEP don’t experience side effects. When people do get them they tend to go away on their own within a few weeks. Side effects can include stomach problems, headaches or tiredness. In the PROUD study participants reported few side effects, and almost everyone who stopped PrEP because of side effects were able to start PrEP again.
Is PrEP different from PEP?
Is PrEP available in England?
Should I discuss PrEP with my doctor?
If you are considering starting PrEP, it is highly recommended that you discuss this with a doctor at a sexual health clinic. Medical staff will be able to help you decide if PrEP is right for you, and will be able to offer important tests before starting PrEP – such as kidney function tests. Most importantly, they will be able to provide the right kind of HIV test – PrEP should only be started if you know you are HIV negative for sure.
Under what circumstances might PrEP be prescribed on the NHS?
If PrEP becomes available on the NHS, it is likely to be mainly available from sexual health clinics. There will be guidelines about who will be able to receive it – such as individuals who are at greater risk of getting HIV. It will not be recommended for everyone.
What happened to the decision about PrEP?
In March 2016 NHS England released a statement on provision of PrEP in England that said that Local Authorities and not NHS England are responsible for funding PrEP. This was despite NHS England starting a formal process 18 months ago to decide if NHS should fund PrEP. In August and November 2016, NHS England was taken to court by National Aids Trust. The judges ruled that NHS England could lawfully commission PrEP.
What will happen next?
In December 2016, NHS England announced funding for a new trial that would provide PrEP to 10,000 people in England over 3 years. The IMPACT Trial enrolled its first place in October 2017. More details of the Trial are here.
What is PrEPster’s response to the trial?
PrEPster was deeply concerned by the actions taken by NHS England throughout 2016 and saw them as a U turn. Whilst we have been broadly supportive of the IMPACT Trial, we do not accept that further evidence is needed for PrEP to be made available through the NHS. PrEPster is working with other HIV prevention activists and organisations to push for PrEP at the earliest opportunity.
What is being done to access PrEP in other parts of the UK?
In Scotland, PrEP is now available for free on the Scottish health service for people 16 and over who live in Scotland. Find out more here. In Wales, PrEP is available on a limited basis through the PrEPARED project. PrEP is currently not available either through a trial or through health services in Northern Ireland.
What can be done to push for PrEP access now?
Take one of the 9 actions in the Take Action section of PrEPster!
What is PrEP access like in other parts of the world?
Information about global PrEP access can be found here.