I stopped taking PrEP – how do I get back into it?

As the COVID-19 situation improves here in NSW and the sense that things are feeling a bit more normal-ish again, the thought of a cheeky hook-up has probably crossed your mind. You’re not alone – you are human. You may have gone through what seems like aaages without some lovin’, so what better way to warm up these cold winter days than a bit of fun?

But it should be noted that as we’ve seen in other places, the situation can change quickly. So, for now, it’s still a good idea to hold off from having any casual hook-ups.

Understandably though, there are some who, for whatever reason, will jump back into it – and for those who are PrEP users who may have stopped taking their tablets during iso, before picking up that PrEP bottle again, there are some things to consider.

First things first – test

If you haven’t had sex for a while then you might be thinking ‘well, I’m still HIV negative so I can simply start taking PrEP again’, and you’re probably right. But regardless of if you did or didn’t have sex while in quarantine, before you restart PrEP, it’s a good idea to get tested. In fact, it’s recommended to do so.

PrEP works as a method to prevent you from getting HIV. If you happen to be HIV positive and then use PrEP, it could limit your HIV treatment options down the track, and that’s not an ideal scenario.

Who are you?

Depending on how you identify, starting PrEP and your options for how you continue to take PrEP will differ.

For cisgender guys who have sex with guys

To start or restart PrEP:

  • Take 2 pills (double dose) between 2-24 hours before sex.

You need this time to let the medication take effect, so your body is in fighting form. Yes, that time period is specific, but very important.

Then, depending on your situation, how you continue to take your PrEP will vary, with doses and intervals that are equally as important.

Daily PrEP

If you want ongoing protection, regardless of if you have sex or not in that 2-24-hour period:

  • Continue taking 1 pill every 24 hours after the double dose.

You can have peace of mind, knowing you’re protected around-the-clock for whenever sex might happen.

Eventually, if you think you won’t have sex for a while or want to stop taking PrEP:

  • After your last hook-up, take 1 pill daily for 2 days (keeping to the same 24-hour intervals as your doses).

On-demand PrEP

If you don’t want to take PrEP daily, there’s an alternative that’s just as effective. Many call it ‘on-demand PrEP’, and it can work for a lot of different situations. It’s a good option for those who can plan exactly when sex will happen, may not have sex as frequently, or who simply may not want to take PrEP daily for any other reason. Even if you think you might have sex but then don’t, it can be a good choice for you.

The basic protocol for on-demand PrEP revolves around having sex within the 2-24-hour period after taking the double dose.

If you have sex within that 2-24-hour period, your start-to-end schedule looks like:

  • Take 2 pills (double dose) between 2-24 hours before sex, then after your hook-up
  • Take 1 pill daily for 2 days (keeping to the same 24-hour intervals as the first dose).

But say you don’t have sex until after that 2-24-hour period – let’s be real, delays happen and guys online can be flaky (it’s Flakr, not Grindr, right?). Whether it remains as just a one-time session or you end up having more sex, you can stay protected by continuing to take one pill every 24 hours for at least two days after your last sexual encounter. In other words, you can safely stop using PrEP once you’ve had two sex-free days.

If you have sex after that 2-24-hour period, your start-to-end schedule looks like:

  • Take 2 pills (double dose) between 2-24 hours before sex, then
  • Take 1 pill every 24 hours after the double dose, then after your last hook-up
  • Take 1 pill daily for 2 days (keeping to the same 24-hour intervals as the first dose).

For trans guys who have sex with guys

Starting or restarting PrEP for trans and gender diverse people is a bit different. At the moment, daily PrEP is the only recommended method, and depending on the type of sex you’re having, your dosing schedule will vary.

If you only have anal sex with cis guys, to start and continue daily PrEP:

  • Take 2 pills (double dose) between 2-24 hours before sex, then
  • Take 1 pill every 24 hours after the double dose.

If you have all types of sex (such as frontal-sex) with cis guys, to start and continue daily PrEP:

  • Take 1 pill 7 days before you have sex, and
  • Continue taking 1 pill every 24 hours after that.

Eventually, if you think you won’t have sex for a while or want to stop taking PrEP:

  • Keep taking 1 pill daily for 28 days after your last hook-up (keeping to the same 24-hour intervals as your doses).

For everyone else

For everyone else, such as cisgender women and heterosexual men, it’s recommended to take PrEP daily.

To start and continue daily PrEP:

  • Take 1 pill 7 days before you have sex, and
  • Continue taking 1 pill every 24 hours after that.

Eventually, if you think you won’t have sex for a while or want to stop taking PrEP:

  • Keep taking 1 pill daily for 28 days after your last hook-up (keeping to the same 24-hour intervals as your doses).

PrEPARATION is key

For PrEP to work, regardless of if you take it daily or on-demand, it must be taken correctly.

It also goes without saying that a bit of forward-planning is required. After you take that first PrEP dose again, be sure to either abstain from sex or protect yourself by other forms of safe sex such as condoms or relying on a positive partner’s undetectable viral load.

And to ensure you keep on track with your schedule, consider setting reminders in your phone for when your next doses are, and keep your PrEP always within arm’s reach.

If you have any further questions, it’s best to speak with your PrEP prescriber. There are also online groups such as PrEP Access NOW and PrEP’D For Change that house community discussions around PrEP.