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What is PrEP?
PrEP 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.

You can read about other ways to reduce your risk here.
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.

For more details on how PrEP211 works as well as examples, click here.

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.
How long after I start taking the pills do they become effective?
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.

This advice is adapted from the Australasian Society of HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) PrEP Guidelines Update. Prevent HIV by Prescribing PrEP. Sydney, 2019.
Do I need PrEP if my partner is living with HIV?
If you are in a steady relationship with an HIV-positive partner, you should discuss with your doctor whether PrEP is a good idea for you.

Studies have shown that there is no risk of HIV transmission when the HIV-positive partner is on treatment and maintained an undetectable viral load for more than 6 months. PrEP can help bridge the period where the HIV-positive partner has a detectable viral load.

More information on what it means to be Undetectable can be found here.
What are the side effects?
Many people who take PrEP, say they haven’t had any side effects, but as with any drug, there are some reported side effects to consider.

Short Term: Approximately 10% of people taking PrEP initially experience mild side effects, such as nausea, diarrhoea and headaches. These tend to go away quickly. It's recommended to take PrEP with food to minimise the tummy issues.

Long Term: A small number of people taking PrEP may experience changes in their kidney function and in their bone density. These side effects are not common.

Emtricitabine and tenofovir disoproxil fumarate have been used for a long time for the treatment of HIV, so it’s a very well-known drug and is highly tolerable.
How do I get it?
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).
Importing PrEP from Overseas
UPDATE: As of 1 July 2022, the retail price of unsubsidised PrEP will drop from approx. $85 to only $25 per bottle of 30 pills (one months supply). This now means that importing PrEP from overseas is no longer cheaper than purchasing it locally from your pharmacist.
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 $25 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.
How do I know if I’m eligible to be prescribed funded PrEP?
To be eligible for funded PrEP your GP will simply need to confirm you are HIV negative and that they consider you at elevated risk of HIV exposure and that use of PrEP is clinically appropriate.

Funded PrEP is available to anyone, regardless of gender or sexual orientation.
How much does it cost?
PrEP can be purchased locally at your pharmacist. To purchase it unsubsidised the cost is around $25 for 30 pills (as of 1 July 2022). If you are eligible for subsidised PrEP, you will only pay the co-pay amount ranging from $5 for 3 months to free if you go to a discount pharmacy (e.g. at the supermarket).
What About PEP?
PEP (Post exposure Prophylaxis) is where you take an HIV medication after an incident to prevent getting HIV. It's an effective solution if you are using condoms, but have an instance where you had a slip-up for whatever reason (maybe the condom broke), and are concerned about your vulnerability.

You take PEP for 28 days following the exposure to prevent getting HIV. You access PEP through the Emergency Department and it must be started within 72 hours to be effective.
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
Who can prescribe PrEP for me?
Starting PrEP

Your first prescription for PrEP can be provided by any general practitioner or sexual health specialist.

Continuing on PrEP

You can renew your prescription for PrEP every 3 months.

PrEP can be renewed by any general practitioners or sexual health specialist. You'll need to have certain blood tests and other tests before your prescription is renewed. If you are following the PrEP211 dosing schedule you should still have a PrEP checkup with your GP every 3 months to check for other STI’s.
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