PrEP For HIV Prevention
The pill that keeps you HIV negative
PrEP is an exciting biomedical development that is already playing a vital role in our efforts to ending 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 drugs to protect them and prevent HIV infection. When used as prescribed, PrEP is highly effective at preventing HIV infection.
Unlike post-exposure prophylaxis (PEP), which is taken after a potential exposure to HIV, PrEP is taken before a potential HIV exposure.
PrEP can be taken by anyone. For all people, it can be taken on an everyday, ongoing basis (daily dosing), or if you are a cisgender man how has sex with men, then you can also take it before and throughout a period where you know you are going to be having sex (on-demand).
To take PrEP you must be HIV negative and a HIV test should always be performed before you start taking PrEP. Your PrEP prescriber will go through this with you at your first appointment.
While PrEP is effective in protecting you from HIV, PrEP does not protect you from sexually transmitted infections (STIs). Anyone taking PrEP should test four times a year for STIs. Additional testing may be required if you start to show symptoms or a partner lets you know they’ve been diagnosed with an STI. A full screen should include chlamydia, gonorrhoea and syphilis, and can also be done when you visit your PrEP prescriber.
Who is PrEP for?
Daily 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) who has anal sex with other men and does not always use a condom
- 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
If you identify as trans or gender diverse, daily PrEP is the only dosing method that is recommended.
Currently, on-demand PrEP is only recommended for cisgender men who can predict when sex will occur or delay sex.
Should I take prep every day or use on-demand dosing?
Taking PrEP every day is a great option if you want to be protected from HIV without having to anticipate when your next sexual encounter may be. Sex is sometimes spontaneous! So if you take PrEP every day, you are always protected. Daily PrEP is also great if you know you are going to be having a lot of sex, or just have a generally busy sex life.
Currently, on-demand PrEP is only recommended for cisgender men as there is not enough research to support its efficacy in other groups. On-demand PrEP can suit people who infrequently have sex without condoms, or plan to have sex without condoms for a short period of time (a night out, dance or sex party). 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.
Either way, both daily and on-demand PrEP are highly effective at preventing HIV.
For on-demand PrEP, the timing for taking your doses is extremely important. Particularly the loading dose of two PrEP pills, at least 2 hours before sex (however, earlier is better).
To use on-demand PrEP use this specific dosing strategy:
- Take two PrEP pills at once (a double dose) between 2-24 hours before you have sex
- Take one more PrEP pill 24 hours after your first dose
- Take one final pill 24 hours after the second dose, and if you continue to have sex, then continue to take one pill a further 24 hours and another pill 48 hours after your last hook-up.
If you are using this strategy, first discuss it with your prescribing GP, and make sure you understand the timing of the pills.
If you can’t predict when you’ll have sex, can’t delay sex by at least 2 hours or find it difficult to stick to a carefully timed dosing schedule that PrEP on-demand requires, then this method may not be right for you. In which case, taking PrEP every day might be a more suitable option.
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). Keep in mind you may have to pay for your doctor’s visit if it’s not a bulk billing service.
Access PrEP through the MI-EPIC Study
The MI-EPIC Study is a follow-on study from the EPIC-NSW Study (a NSW PrEP trial) which will provide participants with up to 12 months of free daily PrEP. MI-EPIC aims to assist overseas-born individuals who are Medicare-ineligible and are wanting to maximise their HIV prevention options by commencing PrEP. Find out more about MI-EPIC and how to join the study here.
Access PrEP through personal importation
If you are not able to access PrEP through Medicare and are ineligible to join MI-EPIC, another option is to purchase a generic version of the drug from a reliable overseas supplier. You still require a script from a doctor before ordering online. There are multiple suppliers who export PrEP into Australia at a range of costs. Visit the ‘PrEP Access Now’ website for more information.
How much does PrEP cost through the PBS?
Anyone with a Medicare card and a script from their GP will have to make a PBS co-payment at the pharmacy when collecting their PrEP, which is the same for all other medications accessed via the PBS. From 1 January 2020 the maximum cost per script increased from $40.30 to $41.00, while for concessional patients the cost increased from $6.50 to $6.60 per script.
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 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 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.
If you answered yes to any of these criteria, you should consider taking PrEP, or if you are unsure, speak with your doctor.
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 which you can collect from a pharmacy. It’s important to remember that PrEP is more than just a pill; it is a program which 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, you will not be eligible to receive subsidised PrEP via the PBS. However, you may be able to access PrEP through the MI-EPIC PrEP Study if you meet certain eligibility criteria. You can learn more about MI-EPIC here.
If you are ineligible for the MI-EPIC Study, but would still like to access PrEP, you might 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 there may be a cost associated with your appointment or required testing. To access PrEP via personal importation, we recommend visiting the PrEPAccessNow website pan.org.au.
Know the Facts about PrEP
You may have lots of questions about PrEP, these factsheets in the following languages below answer some of the most common ones asked:
- Arabic (2mb)
- Chinese (Simplified) (6mb)
- Chinese (Traditional) (2mb)
- English (2mb)
- Indonesian (2mb)
- Portuguese (2mb)
- Spanish (2mb)
- Thai (2mb)
- Vietnamese (2mb)
If you would like to speak to someone in your own language, call the Translating and Interpreting Service (TIS) on 131 450 to ask for an interpreter and then ask them to call the NSW Sexual Health Infolink on 1800 451 624.