What is PrEP?
“PrEP” stands for preexposure prophylaxis, and it’s the use of anti-HIV medication that keeps HIV negative people from becoming infected. This is done by taking a single pill that contains 2 HIV medications ONCE DAILY. PrEP has been shown to be safe and effective, it is highly effective against HIV when taken every day. The medication interferes with HIV’s ability to copy itself in your body after you’ve been exposed. This prevents it from establishing an infection and making you sick.
WHY TAKE PrEP?
The HIV epidemic in Thailand is growing. About 20,000 people get infected with HIV each year. More of these infections are happening in some groups of people and some areas of the country than in others. Taking PrEP could help prevent HIV infection.
SHOULD I CONSIDER TAKING PrEP?
PrEP is not for everyone. PrEP is for those who have a high risk of coming in contact with HIV by not using a condom when they have sex with a person who has HIV infection.
You should consider PrEP if you are a man or woman who sometimes has sex without using a condom, especially if you have a sex partner who you know has HIV infection, if you don’t know whether your partner has HIV infection but you know that your partner is at risk (for example, your partner inject drugs or is having sex with other people in addition to you) or if you have recently been told by a health care provider that you had a sexually transmitted infection. If your partner has HIV infection, PrEP could be an option to help protect you from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.
Rates of side effects while on PrEP are low. Mild symptoms such as mild stomach cramps, headaches and loss of appetite may appear the first few weeks.
HOW LONG SHOULD A PERSON TAKE PrEP?
PrEP is appropriate for periods of time when people have greater risk for contracting HIV. Those periods may be short or long or recurrent, depending on the individual. The CDC also recommends that before people discontinue PrEP, we would do ongoing HIV risk-reduction counseling and support. For people who have hepatitis B, we should also discuss whether to continue treatment as a means to control their hepatitis.
If I'm in a relationship. Do I need PrEP?
In the Australia around 25% of people who acquire HIV are in relationships. So, if you’re in a relationship we’d recommend you consider it. It's a personal choice but the safest option is to use PrEP and then it's a matter of trusting yourself and not needing to rely on others.
Is PrEP for both tops and bottoms?
Yes, even though there is more risk bottoming, tops can also acquire HIV. Uncircumcised tops have a slightly greater chance again. It's very true that tops can also experience anxiety about acquiring HIV. Being on PrEP certainly helps with that.
Are there long term effects from taking PrEP?
Truvada (the PrEP pill's brand name that is produced by Gilead in the USA) was approved in 2004, so it’s been around for more than a decade. Before it was used as PrEP, it was used as treatment for people infected with HIV or exposed to HIV (it contains molecules that are used in HIV drugs). The worst side effects that have been reported are one percent bone mineral density loss and reduced kidney function. Is it safe? Yes. To put it into perspective, they can't tell if it's any worse than just getting older. People in the USA have been taking it for years.
Your doctor will check your liver and kidney function as well as a HIV/STI screening every three months to make sure you're ok. It's a normal part of getting your updated script each time. If you are concerned about any effect from taking PrEP then chat with your doctor.
Someone told me PrEP could cause HIV to mutate?
That's not true. PrEP works by stopping the virus penetrating the cell. If it can't get into the cell then it can't multiply. Mutations occur when the virus reproduces. So essentially no infection means no mutation. It's important that you are not already HIV positive when you start PrEP. If the virus is already reproducing in your body then taking PrEP may cause some inconvenient problems with resistance and your doctor may have to try other medications. Your doctor will test to make sure you're not HIV positive before you start.
Should I tell people I’m taking PrEP?
It’s totally your decision to disclose if you’re taking PrEP. Some people are proud to say they are taking PrEP and in doing so they are helping beak down stereotypes and showing that taking PrEP is a choice to look after their own health. Telling people that you are on PrEP also lets them know that protecting yourself against HIV is important to you. You're not legally or morally required to tell anyone. It's important to respect where other people are at on their safe sex journey so if your partners prefer to use a condom then that's their right. They don't have to take your word for it that you are safe. Of course they could take PrEP themselves and then their safety is completely in their hands.
Can I get PrEP as an extra protection even though I consistently use condoms?
Yes. If you are anxious about situations like condoms breaking, slipping off, not being applied correctly or doing head jobs without a condom then PrEP is still good for reducing your fear and anxiety. Some people just want an extra layer of protection and that's fine. Some medical professionals also use PrEP to stop HIV infection if they get a needle stick injury. PrEP is incredibly effective and reliable. PrEP users report that they are letting go of fear they didn't even know they carried.
What if I miss a PrEP dose?
Current studies are showing that PrEP works well even if you miss a dose. It was shown that users who took PrEP at least 4 days out of 7 hadn't acquired HIV. We strongly, and I mean STRONGLY, recommend that you stick to one pill a day though. That gives maximum protection. If you're not consistent then that's where you can miscalculate and undo all your good work. So one pill a day keeps everybody happy, secure and safe.