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PrEP to prevent HIV

Overview

PrEP stands for pre-exposure prophylaxis. PrEP is taken by HIV negative people before having sex (pre-exposure) and after sex, to prevent HIV (this is called prophylaxis).

PrEP has been shown in many studies to be safe and highly effective at preventing HIV. When taken correctly PrEP has been found to be about 99% effective.

PrEP is the newest HIV prevention tool available and is best used in combination with other HIV prevention measures.

If you decide to use PrEP, it is important to do this with support from a healthcare professional.

Benefits of PrEP

If you are HIV negative and don’t always use condoms, then PrEP could reduce your risk of HIV. 

You may have a higher risk of HIV if you:

• are having sex with HIV-positive partners who are not on treatment or whose treatment may not be working.

• had a recent sexually transmitted infection (STI), especially a rectal infection or syphilis.

• have used PEP (post-exposure prophylaxis) in the past year.

• are using recreational drugs for sex, also known as chemsex.

PrEP and other sexually transmitted infections (STIs)

PrEP does not protect against other STIs. For example, syphilis, chlamydia, gonorrhoea, and hepatitis C.

PrEP users can combine condoms and PrEP to reduce the risk of contracting other STIs.

Regular STI testing at least every 3 months is recommended for people taking PrEP.

Vaccination against hepatitis A and B is recommended for all gay, bisexual, and other men who have sex with men (MSM) and people who inject drugs.

HPV vaccination is recommended for MSM up to and including 45 years of age to protect against genital warts and HPV-associated cancers.

How to get PrEP

If you are HIV negative and don’t always use condoms, then you may be at risk of getting HIV. Taking PrEP can prevent HIV.

You may be eligible to get PrEP for free. You need to attend an approved PrEP service provider to access free PrEP.

If you are eligible for free PrEP, you also need to have a medical card or Drug Payment Scheme (DPS) card. There is no means test for a DPS card but you do need a PPS number.

Who is eligible for free PrEP?

To get PrEP for free through the HSE you need to:

• test negative for HIV.

• be able to attend a check-up at least once every 3 months.

• meet at least 1 of the following criteria for free PrEP.

  1. You are having sex without condoms with HIV-positive partners who:

• are not on HIV treatment, or

• are on treatment but not virally suppressed (do not have an ‘undetectable’ viral load)

2. You are a man who has sex with men. This includes transgender men who have sex with men or a transgender woman who has sex with men, who meet the following:

• had anal sex without a condom with more than 1 partner in the last 6 months

• had an STI in the last year.

• used HIV post-exposure prophylaxis (PEP) in the last year.

• used recreational drugs for sex (also known as chemsex) in the last 6 months.

3. You are a heterosexual man or woman who is considered by a specialist STI doctor, to be at a large risk of contracting HIV through sex.

If you are not eligible for PrEP

If you do not meet the criteria for free PrEP you can decide to pay for PrEP.

You can buy PrEP through community pharmacies with a prescription.

Who should not take PrEP?

PrEP should not be used if you are HIV positive.

You may not need PrEP if you are:

• using condoms consistently and happy to continue using them

• only having sex with HIV-positive partners who are on treatment and have an undetectable viral load

An undetectable viral load is when the virus exists in such small amounts that it can’t be detected by standard blood tests. It means the level of HIV in your body is so low, that it can’t be passed on. This needs to be monitored regularly by a healthcare professional.

Buying PrEP online

It is possible to buy generic PrEP products over the internet.

In Ireland, it is illegal for a person to source prescription medication without a prescription.

The Health Products Regulation Authority (HPRA) have information on the risks of buying medicines online.

Before you start PrEP

PrEP should not be used if you are HIV positive.

You may not need PrEP if you are:

• using condoms consistently and happy to continue using them

• only having sex with HIV-positive partners who are on treatment and have an undetectable viral load

An undetectable viral load is when the virus exists in such small amounts that it can’t be detected by standard blood tests. It means the level of HIV in your body is so low, that it can’t be passed on. This needs to be monitored regularly by a healthcare professional.

Tests you need before you start PrEP

If you decide to start taking PrEP, there are a few tests that you will need first.

HIV test

You must have a 4th generation HIV test before or as you start PrEP. A blood sample will be taken, usually from your arm, and sent to a laboratory. This test has a window period of around 4 weeks.

The window period is the time between when you may have been exposed to HIV, and the point when the test will give an accurate result. During the window period, you can be infected with HIV but still have a negative HIV test.

If there is a chance that you have been exposed to HIV in the last 4 weeks, tell your healthcare provider. You may need more blood tests and a repeat HIV test 4 weeks after starting. This is to make sure that an early infection is not missed.

If you have had a recent HIV risk and have developed flu-like symptoms, this may be a sign of HIV seroconversion. This is when the immune system produces antibodies in response to a recent HIV infection. In this situation it may not be safe to start PrEP until the result of your HIV test is back from the laboratory and HIV has been ruled out.

If you are starting PrEP after PEP, it is best to start immediately after you finish the course of PEP. There is no need to delay starting PrEP after PEP. Ideally, you should have a 4th generation HIV blood test around the time you finish PEP/start PrEP. You should have another HIV blood test 4 weeks after starting PrEP.

Sometimes a rapid HIV test is done in addition to the laboratory HIV test. If the rapid test is negative it may be possible to start PrEP on the day you are first seen regarding PrEP. This will be discussed with you in greater detail by your healthcare provider.

Hepatitis B test

You must have a test for hepatitis B. This is because PrEP medicines are active against both HIV and hepatitis B. Taking PrEP if you have undiagnosed Hepatitis B could be harmful to you.

You can still use PrEP if you have hepatitis B, but it needs to be used more carefully.

If you have hepatitis B, you need to take daily PrEP with medical advice and monitoring, especially if you want to stop. Event-based dosing (EBD) is not suitable if you have hepatitis B or if you don’t know your hepatitis B status.

This is a good time to be vaccinated or to boost a previous vaccine.

Hepatitis A and B vaccination is recommended for gay, bisexual and other men who have sex with men (MSM) and people who inject drugs (PWID).

Kidney tests

Kidney monitoring involves a blood test for creatinine, and sometimes a urine test for protein. These should ideally be done just before or on the day you start PrEP.

Sexually transmitted infections (STIs) tests

You should have STI testing, which includes testing for:

• Syphilis

• Chlamydia

• Gonorrhoea

• Hepatitis C

HPV vaccination is recommended for gay, bisexual and other men who have sex with men (MSM) up to 45 years of age. HPV vaccination protects against genital warts and HPV-associated cancers.

Pregnancy test

If there is a chance that you may be pregnant, you should have a pregnancy test before starting PrEP.

For more information please go to https://www.sexualwellbeing.ie/sexual-health/prep/