Pre-Exposure Prophylaxis, or PrEP, is medication you can take if you think you may be at risk for contracting HIV. If you are planning on having unprotected sex, PrEP reduces your chance of transmission down by 99%, and it is available on the NHS.
We don’t recommend having unprotected sex with anyone, especially if you do not know their HIV status. Even if you are on PrEP, you should continue to get tested every three months or with every new sexual partner, as it does not reduce transmission of other STI's.
PrEP is for individuals who are at higher risk of contracting HIV. This is decided based on a number of factors; if you are HIV negative, if you have anal, vaginal or frontal sex in a variety of situations where condoms are not always used, or you want to protect yourself from HIV.
PrEP is predominantly used by men who have sex with men (MSM) but it is also used by women. According to PrEPWatch, there is an estimated 61,000 people using PrEP in England alone.
Data shows that the interest from the community regarding PrEP is incredibly high, massively overtaking the predictions for each year that the distributors initially laid out. This is line with data which suggests that Men who have Sex with Men (MSM) are highly engaged in preventing the transmission of the virus.
Unfortunately, this comes with a downside. The NHS is struggling to keep up with demand for PrEP, and there are many people resorting to accessing PrEP via non-clinical routes, such as borrowing from friends or ordering it online. This means that data is less accurate.
A recent report conducted by National AIDS Trust, Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network has revealed the bleak situation of PrEP in the UK. The 'Not PrEPared' report has revealed only one third of people who want to access PrEP are able to do so, and people trying to access PrEP for the first time faced the biggest hurdles (68% reported access issues).
This data was collected prior to the outbreak of the Monkeypox virus, so its fair to assume wait times are longer, and resources are more thinly stretched now as Sexual Health Clinics are managing the outbreak.
PrEP works by preventing HIV from replicating in the body. PrEP acts as a catalyst that helps the body produce antibodies, which help diseases causing germs and viruses. After contact with the virus, the tenofovir and emtricitabine block the enzyme needed by the virus to replicate. Used correctly, PrEP eliminates the risk of contracting the virus after exposure to it. This is different from PEP, which is an emergency treatment that kills HIV cells in the body after recent exposure.
There are two ways to take PrEP. One tablet per day, everyday at the same time. A patient needs to take it for seven days before it is fully effective in the body. Alternatively, patients can take PrEP “on-demand,” that is, a double dose around 2-24 hours before having planned sex and a single dose 24 hours post-sex and another 48 hours post-sex. Please remember to consult a medical specialist before taking any medication.
Taking PrEP is safe for most people, but there is a risk that it will impact kidney function in some people. There is early data to suggest that daily PrEP is slightly better for renal safety, but studies note that the overall safety of PrEP is still very high.
Before starting the PrEP medication, you need to have an HIV test. If the patient has HIV, taking PrEP actually has the opposite effect on the body, making HIV treatments less effective against cells. This makes the HIV treatment program less effective.
