What is PrEP and how can I get it? Everything you need to know about HIV-preventing drugs
A new trial has launched in England for HIV-preventing drugs.
Should you be taking them? Where are they available? Here’s what you need to know.
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 through sexual activity.
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 England, PrEP is now available on the NHS to at-risk groups including gay men for free as part of a three-year trial.
Patients will be able to join the trial via participating sexual health clinics from September this year. There is no current list of participating clinics, so you may have to enquire if your clinic is involved.
Sexual health clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be amongst the first to start enrolling people in the trial from early September.
More clinics will join in October, with full implementation across England by April 2018 at the latest, with a trial also launching in Wales.
Scotland’s health regulator has already given the green light to the provision of PrEP on the NHS.
Due to high demand for PrEP from people concerned about the risk of HIV infection prior to the trial, 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?
NHS England is investing £10 million in the three-year PrEP trial. Privately, generic PrEP drugs are available for as little as £39 a month.
The cost of a public PrEP scheme is currently higher than buying the drugs privately, as Gilead still holds patents covering the provision. Branded Truvada costs £350 a month, and the cost of public PrEP schemes are projected to plummet once Gilead’s patents expire.
HIV researchers believe 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.
