PrEP For HIV Prevention
The pill that keeps you HIV negative
PrEP is an exciting HIV prevention option that is already playing a vital role in our efforts to end HIV, and since being listed on the PBS (Pharmaceutical Benefits Scheme) in April 2018, just about anyone can now get it!
What is PrEP?
PrEP is an acronym that stands for pre-exposure prophylaxis. It involves HIV negative people taking antiretroviral medication to protect them and prevent HIV infection. When used as prescribed, PrEP is highly effective at preventing HIV infection.
Unlike PEP (post-exposure prophylaxis), which is taken after a potential exposure to HIV, at least the first dose of PrEP needs to be taken before a potential HIV exposure.
To take PrEP, you must be HIV negative, so a HIV test should always be performed before you start taking PrEP. You should also test for other STIs (sexually transmitted infections), such as chlamydia, gonorrhoea and syphilis, and have your kidney health assessed. Your PrEP prescriber will go through this with you at your first appointment. Following that, you’ll need to have a check-up every three months.
Importantly, while PrEP is effective at protecting you from HIV, it does not protect you from other STIs. If you are concerned about STIs, consider using other prevention methods, like condoms.
Who is PrEP for?
PrEP is recommended for people who are considered at risk of getting HIV. You may be at risk if you:
- Are a man (cis or trans) or transgender woman who has anal sex with men and does not always use a condom
- If your sexual partners include men who have anal sex with men
- If you’ve had chemsex, or had sex when parting with any drugs and alcohol with former or current partners
- Have a heterosexual partner who has HIV, and you want to have a baby
- Have a partner who is HIV positive but has not achieved an undetectable viral load, and you don’t always use a condom
- Are a person who injects drugs
Daily, On-demand or Periodic – how should I take PrEP?
When PrEP was first introduced, everyone was recommended to take it daily. Since then, research has found new ways to take PrEP that are just as effective as daily dosing.
Today, PrEP can be taken daily, on-demand or periodically. Same pill – just a different way of taking it. Check out our PrEP dosing frequency tool to see which option could work best for you!
Daily PrEP
Taking PrEP daily is an option that anyone can use. It’s simple – you take 1 pill every day for lasting protection.
Daily PrEP can suit people for a range of reasons. If you want to be protected from HIV without having to anticipate when your next sexual encounter may be, if you have a generally busy sex life or if you prefer the structure of routine dosing, daily PrEP can work for you.
Taking daily PrEP safely will vary depending on how you identify.
For cis guys who have sex with guys, to start:
- Take 2 pills (double dose) at least 2 hours before sex, then
- Take 1 pill every 24 hours after the double dose
Then to stop, after your last hook-up:
- Take 1 pill daily for 2 days. If you have sex during this period, this resets the 2 days.
For everyone else such as trans people who have sex with gay, bisexual or queer guys, to start:
- Take 1 pill daily for a full 7 days before sex
Then to stop, after your last hook-up:
- Take 1 pill daily for 28 days. If you have sex during this period, this resets the 28 days.
On-demand PrEP
Currently, on-demand PrEP is only recommended for cis men who have sex with other men, as there is not enough research to support its efficacy in other groups.
On-demand PrEP can suit guys who infrequently have sex or who can plan or delay sex (by at least 2 hours). If the amount of sex you are having doesn’t warrant taking daily medication or if you are concerned about side effects, then on-demand PrEP could be good for you.
For on-demand PrEP, the timing for taking your doses is extremely important.
To take PrEP on-demand, use the 2-1-1 dosing schedule:
- Take 2 pills (double dose) between 2-24 hours before sex, then
- Take 1 pill 24 hours after the double dose, then
- Take 1 pill another 24 hours after that
If you continue to have sex, then keep taking 1 pill daily until two days after your last hook-up.
If you are considering PrEP on-demand, discuss it with your prescribing doctor and make sure you understand the timing of the pills.
Periodic PrEP
If you don’t want or need to take PrEP long-term, then periodic PrEP could be a good alternative. With Periodic PrEP, you take one pill once a day over a period of time when you want to protect yourself from HIV. It can be however long or short that works for you – usually when you think you might be having lots of sex.
Depending on how you identify, how you take periodic PrEP will vary.
For cis guys who have sex with guys, to start:
- Take 2 pills (double dose) at least 2 hours before sex, then
- Take 1 pill every 24 hours after the double dose
Then to stop, after your last hook-up:
- Take 1 pill daily for 2 days. If you have sex during this period, this resets the 2 days.
For everyone else such as trans people who have sex with gay, bisexual or queer guys, to start:
- Take 1 pill daily for a full 7 days before sex
Then to stop, after your last hook-up:
- Take 1 pill daily for 28 days. If you have sex during this period, this resets the 28 days.
If you have questions about PrEP dosing or need specific advice, call the NSW Sexual Health Infolink (1800 451 624) or speak with your prescribing doctor.
Where and how can I access PrEP?
Access PrEP through the Australian Healthcare System
If you are an Australian resident with a current Medicare card, you can access PrEP through the PBS at a subsidised cost. This means any doctor or general practitioner can write a script for PrEP, which you can take to any pharmacy for dispensing (collection). You can also visit the PrEP Access Now website for other cost-effective options. Keep in mind that you may have to pay for your doctor’s visit if it’s not a bulk billing service.
Access PrEP through personal importation
If you cannot access PrEP through Medicare, purchasing a generic version of the medication from a reliable overseas supplier is another option. You still require a script from a doctor before ordering online. Multiple suppliers export PrEP into Australia at a range of costs. Visit the PrEP Access Now website for more information. You can buy a few months of PrEP at a time to save on shipping costs, and make sure to have a look at different websites to get a good price. There are many different medications available online, so be sure that the medication you order is the same one on the script the doctor has written for you.
How much does PrEP cost through the PBS?
Anyone with a Medicare card and a doctor’s script will have to make a PBS co-payment at the pharmacy when collecting their PrEP. The co-payment is the same for all other medications accessed via the PBS. Currently, the maximum cost per script is $31.60, while for concession holders, it is $7.70.
More Frequently Asked Questions about PrEP
How do I find a doctor who can prescribe PrEP?
Any doctor can now prescribe PrEP. When choosing a doctor, it is important that you find someone who you feel comfortable discussing your sexual history with, as this is required for the eligibility and ongoing screening for those who take PrEP.
If you’re searching for a doctor who can prescribe PrEP for you or want to talk to someone about PrEP before you see your doctor, you can call the NSW Sexual Health Info Link on 1800 451 624.
Can anyone get PrEP?
PrEP is available for people who are at risk of acquiring HIV.
For gay and bisexual men, the risk criteria can include having condomless sex with a partner who doesn’t know their HIV status, having a regular partner with HIV who is not on treatment, having a recent STI in your arse such as gonorrhoea or chlamydia or if you occasionally party and play.
Others may qualify if their sexual partners are gay, bisexual or queer men that have sex with men.
There may be cases where someone can be prescribed PrEP without meeting these criteria, but this will require a discussion with a doctor.
I am interested in taking PrEP, what do I need to do?
If you are thinking about starting PrEP, you will need to make an appointment with a doctor or sexual health clinic. During your first appointment, they will discuss your eligibility for PrEP, complete the required testing for HIV and STIs, and check your kidney function.
Once you have completed the required testing, you will be given a script that you can collect from a pharmacy. PrEP is more than just a pill; it is a program that requires regular doctor visits and HIV and STI testing every three months. You will also need to make a follow-up appointment in one month for another HIV test. After that, you will need an appointment every three months to keep getting your prescription.
I don’t have Medicare, what does that mean for me?
If you don’t have access to Medicare, while you will not be eligible to receive subsidised PrEP via the PBS, you can consider personal importation, which can be an affordable alternative. Many overseas importation options offer generic PrEP at a price comparable to subsidised PrEP through the PBS. You will still need a script from an Australian doctor, and a cost may be associated with your appointment or required testing. To access PrEP via personal importation, we recommend visiting the PrEP Access Now website.