What is PrEP?

Pre-Exposure Prophylaxis, or PrEP as it is known, is a pill that HIV-negative people can take before sex to help reduce the risk of HIV acquisition (catching HIV).

PrEP must be taken as directed by a healthcare professional. PrEP is different to PEP, a medicine that is taken after sex to help prevent the risk of developing HIV, in that you take it in preparation for sex, rather than afterwards as an emergency.

It is now available on the NHS in England following the completion of the IMPACT clinical trial. It is also available via the NHS in Scotland and via the PrEPARED project in Wales.

You can find lots more information about PrEP at PrepMyWay

Do I need it?

PrEP is recommended for people at higher risk of HIV acquisition. In the UK this is most likely to be MSM who have condomless anal sex. This is because HIV is most easily passed on through condomless  anal sex. However PrEP may also be suitable for some heterosexual men and women who have sex with partners who have a higher risk of having undiagnosed HIV (eg. sex with gay and bisexual men, sex with people from areas of the world where HIV is common).

The online PrEP tool from the Terrence Higgins Trust is a quick and easy way to know if PrEP would be of benefit for you. It is available here.

Condoms remain the primary way to prevent most STI’s. If you use condoms consistently, then we would not encourage you to swap them for PrEP. Condoms and PrEP should work in tandem to reduce your risk of acquiring all STIs.

I think I might need PrEP, where can I get it?

PrEP is now available in the clinic – please call us to discuss if you are interested. We will assess your eligibility for PrEP – this is to determine if your risk of acquiring HIV is high. We will also assess your suitability for PrEP – this is to check for the small number of reasons PrEP cannot be prescribed safely.

For patients already receiving PrEP from our Exeter service you can request your next follow up appointment by contacting us at: rduh.prepfollowupclinic@nhs.net. Please email us at least two weeks before your current meds run out, and ensure you include in the email your name and date of birth.

PrEP is also available to buy online here at iwantprepnow.co.uk, or via the PrEP shop at 56 Dean St. These websites provide good quality PrEP at affordable prices, and have really helped thousands of patients in previous years when PrEP has been difficult to access in England.

Some prescription or over the counter medicines cannot be taken alongside PrEP. Please speak to a doctor or nurse at the clinic, or your GP if you are taking, or are planning to take other medicines alongside PrEP. You can also check for drug-drug interactions here

How effective is PrEP?

The success of PrEP is measured by how well it reduces the risk of acquiring HIV. A wide range of results have been reported from PrEP studies, with some finding high effectiveness and some finding that PrEP made no difference.

For men who have sex with men (MSM) the two most significant studies to date (PROUD and IPERGAY) found PrEP reduced your acquisition risk by at least 86%. The findings of the PrEP IMPACT trial were very similar. Our experience in the clinic is that it is likely to be even more effective than that when taken reliably and correctly.

For women and heterosexual men the results are mixed. The key difference in results is linked to what we call adherence ie. how regularly you take the medication. We now know it takes longer to build up protective levels of PrEP in your body ready for vaginal sex, and also that it wears off quickly. This means heterosexuals have to take PrEP for a week or longer, and keep taking it daily, for it to be effective.

The PrEP Impact Trial, involving more than 24,000 participants between October 2017 and July 2020, found use of HIV PrEP reduced the chances of getting HIV by 86% and considerably reduced HIV acquisition in real-world settings across several years of use. Find out more here.

Did you know, PrEP can be taken two ways?

• DAILY dosing (taking it every single day, at the same time)

or, alternatively

• ON DEMAND or EVENT BASED DOSING (taking it before sex, and for 48hrs after)

Daily dosing can be taken by anybody. For MSM it will be working after you swallow your third tablet. For heterosexual men and women after you swallow your eight tablet.

Event based dosing can only be used by MSM. It has been a very useful strategy over the COVID lockdown when people have needed to take PrEP on and off.