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What is PrEP and how can I get it?

Nick Duffy May 26, 2017
PrEP Impact trial: Man holding a pill used for Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection

PrEP: Man holding a pill used for Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection

There has been a lot of talk in the media about new HIV-preventing drugs.

Should you be taking them? Where are they available? We’ve got you covered.

Disclaimer: This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or another qualified medical professional if you have questions about your health.

What is PrEP?

PrEP stands for ‘Pre-Exposure Prophylaxis’.

In simple terms, it means taking a drug before you come into contact with HIV (Pre-Exposure), in order to build up your body’s defences against it.

Research has shown that PrEP treatments can be very effective at lowering the risk of becoming infected with HIV.

Following extensive research, the World Health Organisation recommended PrEP for ‘at-risk’ groups, who are statistically likely to face exposure to HIV, due to the prevalence of HIV among certain demographics.

These groups include men who have sex with men, sex workers, transgender women, and people in Serodiscordant relationships (where one person has HIV and the other does not).

Can PrEP replace a condom?

No.

If you have sex without a condom PrEP will drastically lower your chances of getting HIV, but it will not protect you from any other sexually transmitted infection, such as gonorrhoea or chlamydia.

It is also not infallible. Though research suggests PrEP is up to 99% effective at preventing HIV transmission for people who take a daily pill, there is always some risk when it comes to unprotected sex.

The safest way to have sex is always to use a condom, and get full, regular sexual health screenings. Rather than replacing condoms, advocates see PrEP as another tool in the sexual health arsenal that can help reach the groups that are most at-risk.

What am I actually taking?

Though PrEP is a relatively new method of HIV prevention, the drugs involved have been used in HIV treatments for several years.

The most common form of PrEP involves the drug Emtricitabine/tenofovir, which is commonly used to treat people who are HIV-positive.

The form of the drug used in PrEP is sold under the brand name Truvada, sold by biopharmaceutical giant Gilead.

People on PrEP take the medicine as a daily pill.

Is it safe?

As we said, the same drugs used in PrEP treatment are taken by hundreds of thousands of people living with HIV across the world.

They are extremely safe, with few side effects. Some people may experience nausea, headaches or tiredness.

Long-term use can affect kidney function, but PrEP regimes include routine, precautionary kidney function tests.

Where can I get it?

The World Health Organisation strongly backed the use of PrEP as HIV prevention in 2014, but global provision remains patchy.

To date, PrEP has been approved for use by medical bodies in the United States and European Union, as well as in Norway, Australia, Israel, Canada, Kenya, South Africa and Taiwan.

In most countries where it has been approved, PrEP is still only available privately, though HIV researchers and activists support a wider rollout via public health initiatives.

In the UK, there has been substantial media debate about the provision of PrEP on the National Health Service (NHS), which would make it available free to the public on prescription.

Scotland’s health regulator has already given the green light to the provision of PrEP on the NHS, and it is due to be rolled out as soon as this summer.

The process in England has not been as smooth, as NHS England argued that devolved English healthcare laws actually place responsibility for interventions on cash-strapped local authorities.

However, after a legal battle NHS England agreed to launch a PrEP trial, meaning the drugs will become available in both England and Wales on a “trial basis” later this year.

It is understood that PrEP will be made available to at least 10,000 people in England and Wales across the multi-year trial.

Meanwhile, due to high demand for PrEP from people concerned about the risk of HIV infection, in many areas grey-market suppliers have sprung up to provide the drugs.

UK website IWantPrEPNow, which sells a supply of generic PrEP drugs, has surged in popularity, and many sexual health clinics provide support to people who want to use the treatment safely.

How is PrEP different from PEP?

Despite their similar names, it’s important not to confuse PrEP with PEP, which is the so-called ‘morning after pill’ for HIV.

Post-Exposure Prophylaxis (PEP) is available to people who believe they might have been exposed to HIV, such as people who have already had unprotected sex.

The time-sensitive, emergency treatment, which is ideally administered as soon as possible after exposure, uses a more aggressive drug cocktail than PrEP and is a lifeline that can prevent you from becoming HIV-positive.

Sexual health and HIV clinics can provide free emergency PEP, and it is also available from Accident & Emergency departments.

How much does PrEP cost… and should the public pay for it?

Generic PrEP drugs are available for as little as £39 a month.

The cost of a public PrEP scheme would currently be higher, as Gilead still holds patents covering the provision. Branded Truvada costs £350 a month, though the NHS may be able to secure a cheaper rate.

The cost of any scheme is projected to plummet once Gilead’s patents expire.

NHS England believes a PrEP scheme may come with a “cost of £10-20 million a year”, but HIV researchers say rolling out PrEP might actually be cost-effective in the long term.

As the lifetime cost of treating just one HIV infection can be up to £380,000, a PrEP scheme would only need to prevent a handful of transmissions in order to be cost-effective.

However you wrangle with the numbers, however, it’s pretty clear that some media coverage of the debate has been fundamentally inaccurate.

Right-wing newspaper coverage of England’s legal battle over PrEP branded it a “lifestyle drug” that would lead to slashed funding for vital cancer treatments.

The extraordinary claims led to admonishment from the National Union of Journalists, while activists accused the press of peddling old-fashioned HIV-stigma.

As Dr Chris van Tulleken points out in documentary ‘The Truth About HIV’, the NHS funds treatments for obesity and smoking-related-illnesses, both of which have a “lifestyle” factor.

Sexual health interventions are valid healthcare interventions, no matter what the Daily Mail tells you.

If you have more questions about HIV/AIDS, visit the Terrence Higgins Trust.

More: Gay, Health, LGBT, national health service, NHS, Pre-Exposure Prophylaxis, PrEP

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