Importance Of Getting Hiv Tested Before Starting Prep And Going Forward
The updated 2017 PrEP guidelines published by Centers for Disease Control and Prevention offer a protocol of medical and ethical best practices for offering and prescribing PrEP. Of great importance is the guideline that you are confirmed HIV negative through an antigen and/or antibody HIV test before starting PrEP. In some cases, a provider may wish to do an additional test 30 days after starting PrEP. Both of these tests are there for your protection, as starting PrEP while already having HIV could result in developing a strain that is harder to treat.
It is recommended that you use PrEP daily while you are at risk of acquiring detectable HIV. Your provider will likely ask you to be tested for HIV every three months, as well as to receive screening for syphilis, gonorrhea, and chlamydia quarterly .
When getting tested for sexually transmitted infections , you will most likely be offered a swab in your throat, your rectum, your vagina. People with penises will be asked to submit a urine sample. This is called “multi-site testing,” which maximizes the identification of infection in any of the sites where STIs can be found. Multi-site testing is done because an STI in your rectum would not show up in urine or in other areas, thus with limited testing it would not get properly treated.
Prep Facts: Introduction & Faq Learn More About Pre
PrEP, or pre-exposure prophylaxis, is a prescription medicine that you take before you come in contact with HIV that will prevent HIV infection. There are two medications approved for PrEP: Truvada and Descovy, plus a generic version of Truvada. These medications are highly effective when taken as prescribed, and are very safe and generally well-tolerated by most people.
Anyone can use PrEP to prevent HIV infection. If condoms arent or cant be used during sex, or if using clean syringes is not possible, then taking PrEP is an effective way to help prevent HIV. PrEP does not prevent other sexually transmitted infections or pregnancy.
In this series of articles well introduce you to the basic facts about PrEP:
Frequently asked questions about PrEP
There are no known interactions between the two. Taking PrEP outside the times you drink can help you avoid missing doses.
Recreational drugs are not known to interact with either Truvada PrEP or Descovy PrEP. Both medicines belong to a class of HIV meds called NRTIs that generally do not interact with drugs such as marijuana, cocaine, or MDMA. Search the HIV Drug Interaction website for more information.
No cases of this kind of transmission have been reported. PrEP stops HIV from reproducing in the body, so it cant establish an infection and eventually dies. If your partner has sex with someone living with HIV with a detectable viral load, they will not pass on HIV to you.
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What Is Prep How Does It Work
PrEP stands for pre-exposure prophylaxis. It’s a pill you can take when you don’t have HIV but are likely to get the virus, perhaps because of sex or injection-drug use. It helps before you’re infected, so HIV can’t settle into your body and spread.
The PrEP medications sold as Descovy or Truvada, which are a combination of two drugs — tenofovir and emtricitabine — which taken correctly prevents HIV from taking hold in your body. There’s no generic version of PrEP yet.
You need to take PrEP medicine once a day, every day.
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A Note On Gonorrhoea Resistance
Gonorrhoea resistance causes significant concern and may be one of the most significant medical risks of increased STI prevalence. The Neisseria gonorrhoeae bacterium easily becomes resistant to antibiotics. Originally treated with sulphonamides and then penicillin in the 1940s, gonorrhoea became progressively resistant to those drugs and then to tetracycline and ciprofloxacin, which replaced them.
As the proportion of gonorrhoea resistant to ciprofloxacin in the UK climbed to 50% in gay men and 20% in heterosexuals, a switch was made to a whole new class of antibiotics the cephalosporins. A single drug from this class, cefixime, was used for first-line treatment of gonorrhoea starting in 2006.
However, the proportion of gonorrhoea with resistance to cefixime rapidly increased in gay men from about 5% in 2008 to 31% in 2010. As a result, in 2011 the recommended therapy changed, to dual combination therapy. This combined another cephalosporin, ceftriaxone, with the macrolide drug azithromycin.
Emphasising this as the only approved regimen for gonorrhoea, and guarding against over-treatment, appeared to have positive results both in the US, where rates of resistance to ceftriaxone fell tenfold between 2011 and 2014, and in Europe, where in the UK and Belgium resistance to both drugs halved between 2011 and 2014. No cases of ceftriaxone-resistant gonorrhoea were detected in Europe in 2016, compared with seven in 2013.
Where Is Prep Available
Currently, PrEP is not available everywhere in the world and even in countries where it has regulatory approval it may not be easy to get hold of for a number of political or resourcing reasons.
In some countries PrEP is available for free, or subsidised as part of the national health system, in other countries you will have to pay for it privately.
The good news is that international guidelines now recommend that PrEP should be made widely available, so even if it’s not available to you right now, it may be an option in the future.
If you are interested in getting PrEP contact a healthcare professional who should be able to advise you on how you can do this. They will also be able to offer the advice, monitoring and support to help you take PrEP correctly and ensure you are fully protected.
There are also dedicated websites that can help you buy PrEP. However, taking PrEP without medical advice and monitoring has health risks, so you should always get a professional health check if you do buy PrEP online.
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Do I Still Need To Use Condoms If Im Undetectable
HIV medicines only prevents HIV transmissionthey dont prevent other sexually transmitted infections , either from you to others, or others to you. Condoms are still very useful, especially if youre having sex with multiple partners or in situations when you dont know if your partner could have a detectable HIV viral load or might have an STI. I do recommend that people strongly consider using condomsbut its often for the other STIs or due to an unknown HIV status of their partners.
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 or visit the PrEP Access Now website for other cost-effective options. Keep in mind you may have to pay for your doctors visit if its not a bulk billing service.
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How To Get Started On Prep
You can get PrEP through Nurx by answering some simple questions about your health and lifestyle, as well as undergoing several lab tests. One of these is an HIV test, which will ensure that you are HIV-negative and can start PrEP. We can send the lab kit to your home, giving you a discreet option for obtaining PrEP. You can also have the testing done at a lab near you. If its a healthy option for you and can help reduce your risk of contracting HIV, we will ship your medication to you in discreet packaging.
PrEP is an effective way to prevent HIV in those who are at a higher risk of contracting the virus.
How Can Providers Tell Someone Is Taking Prep As Prescribed
There are ways a provider can explore whether you’re taking PrEP as prescribed. In most cases, they will simply ask you about taking your medication and any obstacles you may have to using it consistently. Some research trials and clinical demonstration projects use methods such as measuring pill counts in bottles, tracking pharmacy refills, and testing blood plasma.
The newer technology of dried blood stain testing, which first became available in 2011, allows researchers to see a timeline of adherence going back four to eight weeks. Even newer advances in hair analysis can show a time of adherence going back approximately 90 days. Although DBS tests and hair analyses are not commercially available, they can be accessed through an ongoing study at University of California-San Francisco.
The SERO PrEP Initiative is a resource provided by Grant’s laboratory for people who may have become HIV infected after receiving PrEP, and it offers confirmatory lab tests and other services free of charge.
When providers and patients follow established protocols, meet with each other regularly, and communicate openly and honestly, then PrEP can play a significant role in lowering HIV rates among individuals, groups, and larger communities. But exactly how well does it work, and why does it occasionally fail?
TheBody will remain a fact-based resource for empirically driven research updates as they become available in these cases, and for additional reports in the future.
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- Pre-exposure prophylaxis is an oral medication that prevents HIV in people at risk of infection with the virus.
- PrEP reduces the risk of getting HIV by up to 99% when taken consistently as prescribed.
- All GPs in Australia can prescribe PrEP.
- PrEP doesnt protect against sexually transmissible infections . Condoms are still the best protection against infections .
- HIV transmission can also be prevented by using condoms during anal or vaginal sex, using sterile injecting equipment, not sharing injecting equipment or achieving and maintaining undetectable HIV viral loads if you are HIV-positive.
Does Pep Cause Side Effects
Some people taking PEP may have side effects, like nausea. The side effects are usually not serious and often get better over time. If you are taking PEP, tell your health care provider if you have a side effect that bothers you or that does not go away.
PEP medicines may also interact with other medicines that a person is taking . So it’s important to tell your health care provider about any other medicines that you take.
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How Well Does Prep Work
PrEP is very effective when you take it every day. It reduces the risk of getting HIV from sex by more than 90%. In people who inject drugs, it reduces the risk of HIV by more than 70%. PrEP is much less effective if you do not take it consistently.
PrEP does not protect against other STDs, so you should still use latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
You must have an HIV test every 3 months while taking PrEP, so you’ll have regular follow-up visits with your health care provider. If you are having trouble taking PrEP every day or if you want to stop taking PrEP, talk to your health care provider.
Tests To Have Regularly While Taking Prep
Regular monitoring is important. Every three to four months you should have:
- HIV: fourth-generation blood test, able to detect antibodies and p24 antigen
- Kidney function: test for protein in urine
- Sexually transmitted infections.
Once a year you should have:
- Kidney function: test for creatinine and eGFR in blood.
Your sexual health clinic should be able to provide these tests. Sexual health clinics in some of the larger cities may have more experience of supporting people with PrEP.
If your clinic seems unwilling to help, you could try asking to see a consultant . It might be helpful to show staff the British HIV Association and British Association for Sexual Health and HIV s Position Statement on PrEP in the UK. This gives clinicians information on how they can support people using PrEP.
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Important Things To Know About Prep
Before starting PrEP, your doctor will check your health and organise some tests at your first appointment including:
- an HIV test
- kidney and liver function tests.
You will also receive information about how to reduce your risk of acquiring HIV.
PrEP must be taken as prescribed for maximum effective protection.
How Often Do I Take The Prep Medication
You and your healthcare provider can work together to decide the best way for you to use PrEP. There are two different ways that people take PrEP:
Daily PrEP: Daily PrEP involves people of any gender identity taking 1 pill once a day, every day. With daily PrEP, a person can feel protected from HIV whenever they have sex or inject substances. It is for people who have possible exposure to HIV on a frequent basis, or an unpredictable basis. An important benefit of daily PrEP is that the person is always protected and can establish a daily habit of taking the medication. Daily PrEP with Truvada is the only method proven to be effective for cis-gender women and transgender men who have vaginal intercourse.
It is important to talk with your healthcare provider about whether daily PrEP or on-demand PrEP is right for you.
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Prep And Multiple Sex Partners
The efficacy of PrEP does not appear to be diminished by many of the traditional risk factors associated with infection.
While inconsistent condom use and multiple sex partners, for instance, are known to increase the risk of HIV infection, they might not reduce the effectiveness of PrEP in high-risk individuals.
However, this is not proven and more research is needed.
The case of the person who contracted a wild-type HIV while on PrEP was part of a European PrEP study. The man took the medication as prescribed, which was confirmed through blood tests.
He reported over 90 sex partners and over 100 acts of condomless anal sex during the 12-week trial. While on PrEP, the man was diagnosed twice with rectal gonorrhea and once with rectal chlamydia.
Given his record of taking the medication, some researchers suspect that the medication may have been overwhelmed by very high levels of exposure to HIV or other factors, such as having other STDs when exposed to HIV.
If so, these still-unidentified factors may place others at risk. Until researchers know more, safer sex practices, such as using condoms, should be adhered to if only to provide an additional layer of protection.
This added protection is particularly important if you don’t know whether or not your partners were tested for HIV, or if they have HIV but you’re unsure if they’re being treated with medication.
In addition, PrEP does not protect you against other types of sexually transmitted infections.
Can I Take Pep Every Time I Have Unprotected Sex
PEP is only for emergency situations. It is not the right choice for people who may be exposed to HIV frequently – for example, if you often have sex without a condom with a partner who is HIV-positive. In that case, you should talk to your health care provider about whether PrEP would be right for you.
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Will Prep Work If I Might Already Have Hiv
For PrEP to protect you, it needs to be taken before you come in contact with the virus. PrEP isn’t a cure for HIV.
If you think you’ve been exposed, call your doctor right away or head to the emergency room. If you start taking a different kind of medication called PEP within 72 hours, it can lower your odds of HIV infection.
What Medication Is Available
There are currently two medications approved by the FDA for PrEP: Truvada and Descovy.
Both of these medications can be up to 99% effective at HIV prevention when taken correctly. However, the notable difference between these medications is that Descovy is currently only approved for use in cisgender males and transgender females, while Truvada is approved for all genders.
PrEP does not have any significant health effects even with long-term use, but you may experience some side effects, such as:
- Abdominal pain
- Changes in weight
Some more severe side effects that may occur can be kidney issues, liver problems, or bone density loss. But these often occur in people who had health issues prior to taking PrEP. Ultimately, it is between you and your doctor to determine whether or not PrEP is the best choice for you.
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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 youre 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 .
Can anyone get PrEP?
PrEP is available for people who are at risk of acquiring HIV.
For gay and bisexual men the risk criteria can include having condomless sex with a partner who doesnt 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.
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.
I dont have Medicare, what does that mean for me?
What if I want to import PrEP myself?