PrEP – Pre-exposure Prophylaxis

PrEP means Pre-Exposure Prophylaxis. Prophylaxis means prevention. PrEP is used by HIV-negative people to prevent them being infected with HIV. This is a pill containing two anti-HIV drugs, tenofovir and emtricitabine, either taken regularly or before and after sex

Who's suitable for PrEP?

HIV-negative men who have sex with men (MSM) / trans⃰ who have had condomless anal sex in the last three months and are likely to continue to do so.

HIV negative people who are having sex with a partner who is HIV positive and whose virus is not undetectable (suppressed by treatment).

Where and how to get PrEP?

The HIV drugs used for PrEP cannot be currently prescribed on the NHS to prevent HIV through PrEP. This is frustrating for healthcare professionals as well as for you.

It is legal to buy generic PrEP for personal use (3 months’ worth of the drugs) from outside the EU. You need to make sure that the pill you order contains both tenofovir and emtricitabine. If you want to buy PrEP you can access a supply from here.

A month’s supply costs about £40. The manufacturers listed on this website have been checked and the pills supplied appear to be genuine.

This website has a lot of information on it. Not all may be relevant to you but it is very useful to read.

If you don’t understand it, it is best that you come into one of the sexual health clinics to talk to a doctor or health adviser, as PrEP is complex.

The Departments of Sexual Health will look after you ( by monitoring your blood and urine tests) whilst you are taking the tablet.

Before you start

Ideally, speak to one of the senior doctors at the clinic before starting PrEP, but don’t be worried if you have already started before you attend.

It is important for you to be tested for HIV before starting PrEP. This is because the medicines used for PrEP are also used for treatment for HIV, and if you are already infected but don’t know that you are, your future treatment options may be limited.

You should also be tested for hepatitis B before starting PrEP. This is because the medicines are also used for a treatment of this infection, and it may affect how we advise you to take PrEP. If you are infected with hepatitis B, you might also need to see a liver specialist. If you don’t have hepatitis B and haven’t been vaccinated, we would strongly advise that you start the vaccine.

You need to have an STI screen, a urine test and a blood test to check your kidney function; the drugs can sometimes affect your kidneys so we need to know how well they are working before you start.

The doctor /health adviser you see will also talk to you about the best way to take the PrEP tablet.

Whilst being on PrEP

Whilst you are taking PrEP you should have regular HIV, STI and urine tests – at least every three months. Once a year at least, you should have a blood test to check your kidney function.

If you get ill with fevers and/or if you have missed some pills and had sex, you will need to come in sooner and have an HIV test in case you have “seroconverted” (ie become infected with HIV). It is important to identify this early so we can get you on the right medication.

Stopping PrEP

It is important to speak to a doctor before you stop PrEP.  Stopping PrEP should be timed correctly after the last risk, and you (and your partner if relevant) should have an HIV test at least 4 weeks after your last risk. That said, if you are no longer having the same risks, it’s not sensible to stay on PrEP just because it is “easy” to do so.  There are some long-term risks associated with these drugs, as there can be with any medications.

Sources of information

This is an amazingly handy guide to taking PrEP and has all the information that you need. It is also available online. 

This is a private clinic at Dean Street in Soho, London where you can access medication but it costs £400/month; monitoring is provided free on the NHS.