HIV Basics

PrEP

PrEP (pre-exposure prophylaxis) is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV.

This section answers some of the most common questions about PrEP.

What is PrEP?

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PrEP (pre-exposure prophylaxis) is an internationally recommended HIV prevention method, in which people who do not have HIV take the HIV medication emtricitabine and tenofovir disoproxil fumarate every day, to prevent getting HIV. When taken daily PrEP is 99% effective at preventing HIV. In New Zealand we use the generic form of PrEP which is a single pill taken once daily.

How effective is PrEP?

PrEP is highly effective for preventing HIV.
  • PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
  • Although there is less information about how effective PrEP is among people who inject drugs, we do know that PrEP reduces the risk of getting HIV by at least 74% when taken as prescribed.
  • PrEP is much less effective when it is not taken as prescribed.

Is PrEP safe?

  • PrEP is safe but some people experience side effects like diarrhea, nausea, headache, fatigue, and stomach pain. These side effects usually go away over time.
  • Tell your health care provider about any side effects that are severe or do not go away.

How long do I have to take PrEP before I am protected?

Current evidence suggests that for both rectal and vaginal exposure, high protection is achieved after 7 days of daily dosing. Women need to maintain high adherence to daily dosing of PrEP to maintain adequate drug levels in vaginal/cervical tissues. No data are yet available to inform considerations of protection for male insertive sex partners. Limited data exist for transgender and gender-diverse people therefore extra attention to daily dosing is recommended.

WHO recommends that because MSM achieve highly protective levels of PrEP medications with a single loading dose of two PrEP tablets they can take this PrEP loading dose whether they intend to commence daily PrEP, or PrEP211. High protection is achieved 2 hours after the loading dose.
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Is PrEP right for me?

PrEP may be right for you if you test negative for HIV, and any of the following apply to you:
You have had anal or vaginal sex in the past 6 months and you
  • have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load),
  • have not consistently used a condom, or
  • have been diagnosed with an STD in the past 6 months.
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You inject drugs and you
  • have an injection partner with HIV, or
  • share needles, syringes, or other equipment to inject drugs (for example, cookers).
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You have been prescribed PEP (post-exposure prophylaxis) and you
  • report continued risk behaviour, or
  • have used multiple courses of PEP.
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If you are a woman and have a partner with HIV and are considering getting pregnant, talk to your doctor about PrEP if you’re not already taking it. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.
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How do I get PrEP?

Currently emtricitabine and tenofovir disoproxil fumarate are approved for use as PrEP by Medsafe in New Zealand, so your GP can prescribe it for you - checkout the provider section, if you want information to give your GP, or to find someone that is already prescribing.

Pharmac has approved PrEP for funding (1st March 2018) if you meet certain criteria. If you are eligible, you can get PrEP locally from your pharmacist for the co-pay amount (which ranges from $5 to free).

How do I know if I’m eligible to be prescribed funded PrEP?

To be eligible for funded PrEP you must meet the following criteria:
You have tested HIV negative
and either:
ALL of the following:
  • You are male or transgender; and
  • You have had sex with men; and
  • You are likely to have multiple episodes of condomless anal intercourse in the next 3 months
As well as ANY of the following:
  • You have had at least one episode of condomless receptive anal intercourse with one or more casual male partners in the last 3 months; or
  • You have had a diagnosis of rectal chlamydia, rectal gonorrhoea, or infectious syphilis within the last 3 months; or
  • You have used methamphetamine in the last three months
or
or
ALL of the following:
  • You have a regular partner who has HIV infection; and
  • Your HIV positive partner is either not on treatment yet or has a detectable viral load; and
  • You do not always use condoms

Importing PrEP from Overseas

If you don’t qualify for subsidised PrEP but still want the extra protection provided by PrEP, you can purchase it locally from your pharmacist or you can import it by purchasing it online. You can purchase PrEP from your local pharmacy for $85 for 30 pills. If you are importing, it's best if your script is for the scientific name of the drugs rather than a brand name which may be different depending on the manufacturer So, ensure the script is for 'Tenofovir DF 300mg once daily plus Emtricitabine 200mg once daily' and indicates it is 'For personal importation'. Otherwise customs may hold it for clarification before releasing, which can take up to 6 weeks. Currently it is around $40 per month to import the generic version of PrEP.

Iwantperpnow.co.uk has done an amazing job at validating trusted sites for buying PrEP online, to help ease your stress. Popular online sources of PrEP that have been validated include greencrosspharmacy.online or Dynamix International. You are allowed to import 3 months (90 pills) worth of medication for personal use at one time.

The choice of PrEP Schedule: Daily PrEP vs PrEP211

Daily PrEP is when you take a PrEP tablet every single day. PrEP211 is when you take PrEP tablets only when you are going to have sex. For more details on how PrEP211 works, click here.

Daily PrEP is suitable for all people who are at risk of HIV. Daily PrEP is the only PrEP regimen that is recommended for cis-gender and transgender women, for transgender men who have vaginal sex, for men who have anal or vaginal sex with women, people who inject drugs and for people with chronic hepatitis B.

Only cis-gender gay/bi guys have a choice between daily PrEP and PrEP211. In this setting, daily PrEP would be preferential for those gay/bi guys who cannot predict when sex will occur, who cannot delay sex for more than 2 hours and for those whose potential exposure to HIV occurs more than twice a week. Daily PrEP is the only suitable regimen for anyone with chronic hepatitis B infection to maintain virological suppression, prevent drug resistance and hepatitis flares.

When should I take my PrEP Pills?

Daily PrEP

A daily PrEP regimen involves taking a single daily tablet at approximately the same time each day. Taking the tablet some hours earlier or later than usual will not adversely influence the levels of the drug. If you forget to take a tablet for one day, there is no need to take two tablets the next day.

PrEP211

The PrEP211 regimen, which is recommended for Gay/Bi Guys only, involves the person taking a loading dose of PrEP where two tablets of PrEP are taken together as early as 24 hours before sex, or as late as 2 hours before sex. After sex, another PrEP tablet is taken 24 hours after the loading dose and then a final PrEP tablet is taken 48 hours after the loading dose. This 2+1+1 method for the use of PrEP211 for an isolated act of sex is endorsed by WHO.

People who have more than one episode of at-risk sex over a period of days should keep taking a single PrEP tablet every day that they are having sex until the last day that at-risk sex occurs, then they should take a single daily PrEP tablet until they have had two sex free days.

Can I stop and start the pills?

Yes, if you want to take a break, you can.

Discontinuing PrEP in gay/bi guys
WHO recommends that gay/bi guys who take either daily PrEP or PrEP211 can safely cease PrEP by taking a dose of PrEP 24 and 48 hours after their last at-risk sexual exposure.

Discontinuing daily PrEP for other populations
PrEP should be continued for 28 days after the last at-risk sexual exposure

How often do I have to go to the clinic?

At your first visit your doctor will run some tests to ensure:
  • You don’t have HIV as PrEP on its own is not an effective treatment for HIV.
  • You don’t have Hepatitis B – A component of PrEP is a treatment for Hep B and you should get that sorted first. If you aren't vaccinated for Hep A and B you should ask your GP to do this. If you are under 27, ask about the HPV vaccine as well while you are there.
  • Check for other STI’s and get them treated.
  • Check your kidney function to make sure they are working well, as PrEP can be a bit stressful on your kidneys.
Once your tests are completed you will be provided with a prescription.

At 1 month it is wise to check your HIV status again to make sure you weren’t in the window period when you started.

At 3 months you will run tests again – renal function is checked annually. You will grab another script at this point and continue. Its good to plan ahead to ensure you don’t run out of pills.

If you are using the PrEP211 strategy your pills may last longer than 3 months. Adjust your clinic visit accordingly but it is wise to maintain a 3 month sexual health check.
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About HIV

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About HIV

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HIV Transmission

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HIV Transmission

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HIV Prevention

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HIV Prevention

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PrEP

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PrEP

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PEP

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PEP

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HIV Stigma

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HIV Stigma

Information contained in this section is a reproduction for New Zealand of content published on the CDC (Centers for Disease Control and Prevention) Website
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