01 May 20

Ending HIV

Should I continue or stop taking PrEP during COVID-19?

We’re all pretty aware of the physical-distancing restrictions that have been put in place in response to COVID-19. Due to the nature of how the coronavirus is spread, it makes sense to hold off from casual hook-ups for the time being. In fact, it’s a strong recommendation from many community organisations to avoid it altogether.

So, if you’re one of the thousands of PrEP users, you might be asking yourself – what should I do about my PrEP? Do you continue taking PrEP, alter how you take it or stop it for now? And if you do stop or change how you’ve been taking PrEP, what’s the best way to go about it?

Continuing PrEP daily

Everyone takes PrEP for different reasons and for many, it provides reassurance for when those random, casual hook-ups occur. At a time like this where people are putting off having casual sex, it’s fair to question if continuing to take PrEP daily is necessary or not.

Sure, while our daily routines may have gone through some big changes of late, you may find that continuing to take PrEP daily provides a sense of normality – and if that’s the case, that’s totally fine.

This way, when the situation changes and you can go back to having sex more freely you’ll be prepared and confident that you’re still protected from HIV.

Switching to PrEP on-demand (for those it’s recommended for)

You may have heard of some PrEP users taking it at intervals rather than daily. Most people call it PrEP on-demand and it involves taking PrEP tablets at time-specific intervals prior to and after sex. As the name suggests, many use this method on-demand and for when they know they’re going to have sex.

There’s clinical evidence to support PrEP on-demand as being as effective as daily dosing, however, it’s important to note that the research currently only supports PrEP on-demand as being suitable for cisgender men who have sex with men. If you aren’t a cisgender man who has sex with men, there isn’t enough research to date to safely say it is effective.

For cisgender men who have sex with men, switching to PrEP on-demand could be a good alternative to daily PrEP when sexual encounters may be few and far between or if you had trouble taking PrEP every day.

To take PrEP on-demand you need to follow a carefully timed dosing schedule:

• Take two PrEP pills in one go (a double dose) between two and 24 hours before you have sex; then
• Take one more PrEP pill 24 hours after your first dose; then
• Take one final pill 24 hours after the second dose

Sticking to this schedule is very important so if it helps, set reminders in your phone and ensure that your PrEP is always within arm’s reach.

Given the nature of the dosing schedule, over time you may take less pills than if it were daily dosing, which means less medication in your body. So if side effects were ever a concern, this may also put you at ease.

Stopping daily PrEP

Using daily PrEP gives you around the clock protection from HIV. By stopping PrEP, be sure that you’re still keeping yourself safe by other means – such as condoms or relying on a HIV positive partner’s undetectable viral load – in the event you do have sex while off PrEP.

For cisgender guys who have sex with guys

Previously, the advice for stopping PrEP involved having to take PrEP daily for 28 days after the last possible exposure to HIV. New evidence now supports a faster stopping method in cisgender men who have sex with men only.

To stop using daily PrEP safely, keep taking PrEP once a day for two consecutive days (24 and 48 hours) after the last time you have sex or your last possible exposure to HIV. If you haven’t had any sex in the last two days you are OK to stop PrEP immediately.

For everyone else

For trans and gender diverse people, cisgender women and heterosexual men, stopping PrEP is different.

To stop using daily PrEP safely, keep taking PrEP once a day for 28 days after your last possible exposure to HIV. If you haven’t had any sex in the last 28 days you can stop using PrEP immediately.

Restarting daily PrEP

If you’ve had a period of time without taking PrEP and want to start again, you’ll need to be sure you’re still HIV negative prior to restarting PrEP. Using PrEP after acquiring HIV may limit your treatment options down the track. So if you’ve had any possible exposure to HIV since you stopped using PrEP, before restarting PrEP you should get tested first.

For cisgender guys who have sex with guys

Similar to initiating PrEP on-demand, to restart daily PrEP, take two PrEP pills (a double dose) in one go between (no less than) two and (no more than) 24 hours before you have sex. Then continue taking one PrEP pill every day.

For everyone else

For trans and gender diverse, cisgender women and heterosexual men, restarting daily PrEP is a bit different.

To restart daily PrEP, take one PrEP pill every day for seven consecutive days before you have sex. Then you can continue taking one PrEP pill every day.