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WHAT IS PrEP?

What is PrEP ?

PrEP stands for Pre Exposure Prophylaxis. PrEP is a tablet you take reguarly, which protects you from HIV. If you take PrEP once a day, you can maximize your protection against HIV by around 99%.

  • PrEP helps you stay HIV negative.
  • It does not protect against any other STI, only HIV. You need to take other precautions in addition to PrEP to protect yourself from all other STIs.
  • HIV is the only STI for which there is no cure or vaccine. PrEP is a great additional tool which means you can be sure you are protected against HIV.
  • If you are on PrEP and taking it correctly, you need not worry about a sexual partner's HIV status because you are protecting your own negative status by taking PrEP.
  • We recommend regular STI testing. You should have an HIV test every 3 month.

 

Branded PrEP vs Generic PrEP

  • PrEP is sometimes refered to by its brand name: Truvada. 
  • Generic PrEP (unbranded) has various names the active drugs are the same: tenofovir TDF and emtricitabine FTC.
  • This means that Truvada and the generic equivilant can beused as PrEP and all do exactly the same thing.
  • Generic PrEP which has been approved by government health organisations is just as effective as branded PrEP and contains nothing more, and nothing less. 
  • The only difference (apart from the names) is which company makes the drugs and the cost. Currently 30 Truvada pills costs around £400 and 30 Tenvir-EM pills costs £48.

 

PrEP on the NHS

  • PrEP is not currently available on the NHS.
  • The NHS was due to announce it's decision on access to PrEP in April 2016, that has was pushed back to June 2016 and pushed back again further.NAT launched a successful legal battle against NHS England - AND WON!
  • You will not be able to get a prescription for PrEP from your GP (unless you pay them for private appointment) or from your local sexual health clinic - apart from 56 Dean Street who offer the UK's only private PrEP clinic.
  • You can use the NHS, especially sexual health clinics, to help you get follow up and support services (including free HIV and STI tests) when starting to use generic PrEP that you have bought online. To see our verified online retailers, visit ourBuy PrEP Now
  • We recommend telling the doctor or nurse that you want to start PrEP and they can advise you to make sure you are getting the correct follow up tests and advice.
  • It's easy to find your local sexual health service - go here and type in your postcode or town.

 

Getting PrEP through private healthcare

You can get PrEP through private healthcare or you can pay an NHS doctor to write you a prescription. But you then have to get the prescription exchanged for PrEP from a pharmacy. A local Boots or Superdrug will not stock it, which means going to a specialist pharmacy who can charge you whatever premium they choose. To put this into context - getting your branded PrEP (Truvada) from 56 Dean Street who sell it privately at cost price to them is £400 for 30 pills. Generic PrEP (that you can buy here) costs a tenth of the price for the same protection - £48 for 30 pills.

Clinic Hopping

One way to get Truvada (branded PrEP) right now and for free on the NHS from a sexual health clinic or A&E department is by doing what is known as 'clinic hopping'. This is considered very unethical but it's still an option for those who cannot afford the £45 per month

 

Who Needs PrEP?

  • PrEP is a great idea for someone who is HIV negative that has sex in a variety of situations where condoms are not easily or always used for penetretive sex (top or bottom).
  • PrEP can have huge emotional benefits for a HIV negative person that might be struggling to maintain their HIV negative status. People on PrEP say they suddenly started to relax and felt much less anxiety and guilt than they used to, their fear of catching HIV had been removed.
  • If you are protecting yourself with PrEP then you not only keep yourself negative, you keep all of your sexual partners negative too. People who think they are negative but haven't had a HIV test for a long time, have recently picked up the virus and don't know it yet are the most likely people to pass the virus on.
  • Being on PrEP means that you do not have to worry about the status of your partner, since you are protecting yourself. Remember that someone who knows they are positive and take their medication (ART) responsibly whilst not missing doses and undetectable cannot pass on HIV. Undetectable people + people on PrEP = double the protection.

 The 56 Dean Street private PrEP clinic outline the following ctriteria as their 'Target Population' 

  • HIV negative men who have sex with men (MSM) who have had condomless anal sex in the previous 3 months.
  • HIV negative MSM diagnosed with rectal STIs or syphilis in the preceding year.
  • HIV negative MSM who are likely to continue having unprotected anal intercourse.
  • HIV negative MSM who have engaged in chemsex in the last three months.
  • Serodiscordant (one partner HIV negative, one partner HIV positive) MSM or heterosexual coupleswho wish to continue having unprotected sex where the positive partner is not on treatment and wishes to remain off treatment.
  • Anyone who has been on PEP twice in the last 12 months.

 

Before Starting PrEP

Essential things to know before you go on PrEP

  • PrEP is best used as a daily pill.
  • You have to be committed to taking that pill each day.
  • It’s not forever, PrEP is an ‘opt in’ treatment. 
  • Your circumstances and situation might change and you might find that for whatever reason you no longer need or want PrEP. Again, it's always your choice. As our lives and lifestyles change so do our methods and options of sexual protection. 

Get Tested

  • Before starting PrEP you need to get a HIV test and must return a negative result 4 weeks after your last 'risky situation'. You should test again every 3 months or so after this.
  • It’s very important to be 100% sure you are HIV negative before taking PrEP, otherwise you might create a few drug resistance issues (explained below).

 

Before Starting PrEP

As well as taking PrEP everyday, you need to keep getting tested regularly for HIV every 3 months, and keep an eye on your kidney function. You shouldn’t have any problems with these but you can easily get tested at your local sexual health clinic to make sure you're not having any unexpected reactions. It’s also a great idea to do all your other STI tests whilst you’re at the clinic.

 Drug Resistance

Drug resistance is in reference to the HIV virus in your body developing a drug resistance, not your body developing a resistance to the PrEP medication. You can only develop a drug resistance if you actually have HIV in your system (i.e. you're HIV positive). That’s why it’s so important to make sure you’re negative. If you are negative and taking PrEP, as long as you stay negative, you will not have any drug resistance issues to worry about. Your body does not ‘get used to the PrEP’ and stop protecting you from HIV, which is a common confusion that people have. Take PrEP – stay negative.

 

How To Get PrEP

PrEP availability online in the UK

PrEP can easily be bought online and imported into the UK, without breaking any laws. The UK allows anyone to import a 'personal amount' of pharmaceutical drugs, with a personal amount being specified as up to 3 months worth. We have been advised that UK Customs officers are not interested in stopping shipments of pharmaceutical drugs (that are within the law) for investigation, and they do not add customs charges.

Various websites on the internet sell generic versions of Truvada (PrEP) for a greatly reduced price (around 85% less) compared to official branded Truvada pills (produced and sold by Gilead Sciences Inc.), and they may or may not ask you to upload a prescription depending on which country they are based in.

 

Prescription or no prescription?

Some online pharmacies will ask you to upload a prescription for the meds you buy after you've placed the order, whereas some websites simply don't. This is all down to the country that they operate in. The law in some countries require the seller of certain pharmaceutical drugs to ask for a prescription that has been issued from a Doctor, it doesn't matter which country the prescription is from.

It's the companies that operate in places where their laws do not to require you to upload a prescription, that provide the most affordable and convenient way for people in the UK to get PrEP. The selling process itself is not covered by UK law, that only covers what you're importing into the country. It does not matter if an online pharmacy asks you to upload a prescription or not, this is not a reflection on how reputable or trustworthy that company is.

 

How To Take PrEP

The 3 ways to take PrEP

How you take PrEP depends on you and the way you have sex. Not necessarily how much sex you have.

·        How regularly do you have sex?

·        How far in advance do you plan having sex?

Taking PrEP once a day is the only strategy that has been proven to be fully reliable in large trials. Research studies that led to the approval of PrEP in the US all used daily dosing (1 PrEP pill per day), and the UK's PROUD study also tested taking PrEP once a day. 

This doesn’t mean that PrEP can’t be used in other ways, especially as many people in the studies did not actually manage the once a day course. Other ways of using PrEP are likely to still be effective, however, there is very little reliable evidence to support this.

You can take PrEP with or without food, and at any time of the day. It is best to take PrEP at the same time each day so that it becomes part of a daily routine. You can keep your PrEP next to your tooth brush and tooth paste and take your pill each morning after you brush your teeth. It's little things like this that will help you remember to take your PrEP. Remember PrEP is an 'opt in' treatment - it's not forever. So the least you can do while you are on PrEP is be kind to yourself, responsible and remember to take your pill every day. Your peace of mind and relieving the stress and anxiety involved in staying HIV negative is also hugely important. It’s not just about sex, it's about your head and your heart too.

Once - A - Day, Everyday

This is the method which we strongly reccomend. Its also the most straight forward and reliable method which gives maximum protection (over 99%). You take 1 PrEP pill per day, everyday. It’s not a disaster if you miss a pill once in a while (although it does slightly decrease your level of protection for a short time each time it happens), but commiting to taking a pill once a day and everyday is the best way to get maximum HIV protection and peace of mind too.

Alternate Days - 4 pills per week

Take 1 pill every other day. This has shown to be around 95% effective at protecting you against HIV. If the cost of PrEP is a major issue, the advantage of this method is that it cuts down on the cost of your PrEP by almost half, because over 4 weeks you only take around 14 pills instead of 28. However if you miss a day then the risk is increased far more than if you were taking PrEP everyday.

4 doses a week is only sufficient protection for anal sex if you are bottoming for gay sex or for women who only have anal sex. This is because PrEP has 100 x higher concentrations in rectal tissue vs vaginal tissue. Women need to take 6-7 doses a week to get similarly effective PrEP levels in vaginal tissue.

Event Based PrEP

This is potentially more confusing to explain and offer information on as there is lots of conflicting information and not enough substantial studies on this method. Although there might not be enough research or evidence to prove the protection levels this method offers, it is still an option and it does suit some people. 

If you know that you might have unprotected sex at least about 24 hours in advance, 

·        Take 2 tablets the day before having sex (but can be anywhere from 2 - 24 hours before, ranging in reliability).

·        Take 1 tablet just after sex (or the same day).

·        Take 1 more tablet the following day.

This means taking four tablets if you had sex once in a week. This also means taking four tablets if you had sex lots of times all on one day. Information is conflicted over how far in advance you should take the first dose, as the drugs take different times to reach and protect different parts of the body (e.g. the mouth and the anus). There have been studies that have shown there was no protection against HIV in the anus until 8 hours after taking the dose.

We strongly recommend taking PrEP once a day, every day. It is the most effective and most reliable way to use PrEP for maximum protection.