All you need to know about the Pre-exposure Prophylaxis

What the Pre-exposure Prophylaxis is

Pre-exposure prophylaxis is also known as PrEP. It is the use of an antiretroviral medication to prevent the acquisition of HIV infection by HIV-negative (uninfected) individuals (1).

The daily intake of PrEP can ensure the presence of the medicine in your bloodstream and stop HIV from spreading through your blood in your body. In case you don’t follow the daily intake of PrEP you increase the chances of not providing enough medicine in your bloodstream, thus PrEP might not block the virus (2).

In 2018, the Federal Minister for Health announced that PrEP will be subsidised by the Australian Government through the Pharmaceutical Benefits Scheme (3).

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People advised taking PrEP

In case you belong to one of the below-mentioned categories, you are advised to talk to your doctor about PrEP. Initially, you must make sure that you are HIV negative, this is why your doctor will check your HIV status and then evaluate the risk of infection and also discuss with you the possible side effects of The PrEP. You should consider taking PrEP if you are:

Furthermore, PrEP is a matter of consideration for people who have been prescribed non-occupational post-exposure prophylaxis and report continued risk behavior (2).

In Australia, according to the national statistics, sexually active gay and bisexual men, transgender people and heterosexual people with an HIV positive partner who does not have an undetectable viral load are among the groups of people on higher risk for HIV (5).

People advised taking PrEP​
What are the available PrEP options?​

What are the available PrEP options?

One PrEP option – and the most usual- is the orally taken treatment. It is based on using an antiretroviral drug available for the treatment of HIV infection and is a combination of emtricitabine and tenofovir. Another PrEP option is the one applied topically as a vaginal gel containing tenofovir. However, the efficacy of the orally taken PrEP is greater while the efficacy of gel is moderate. Moreover, there are more studies about the oral PrEP and they show that its use has high efficacy on the prevention of HIV (1).

How effective PrEP is

According to the literature, PrEP is highly effective for preventing HIV but it should be used following the doctor’s instructions. Therefore, it is important to take PrEP consistently because otherwise, it is much less effective (2).

The efficacy of PrEP is widely accepted by the scientific community. Specifically, oral daily PrEP has been recommended by WHO since 2015 as an effective prevention option for people at HIV risk (6).

The Centers for Disease for Disease Control and Preventions highlights that PrEP reduces the risk of getting HIV from sex by about 99% and in the group of people who inject drugs, it  reduces the risk of getting HIV by at least 74% when taken consistently (2).

Side effects

PrEP can cause some side effects including nausea, headache, rash, vomiting, loss of appetite,  but these generally subside over time. In general, no serious side effects have been observed (7). However, some people, may experience an increase in creatinine and transaminases- enzymes related to the kidneys and liver. High levels of these markers indicate damage to the above-mentioned organs. Therefore, long-term use of PrEP can potentially damage the kidneys. Another possible long-term side effect is the loss of bone mineral density (8).

Should I visit in person a healthcare provider for starting PrEP?

Not necessarily. However, only a health care provider can prescribe PrEP. Thus, the alternative way instead of visiting in person a healthcare provider is a telemedicine. It can happen through a video or phone consultation and mail-in self-testing. There is a specimen collection kit that contains the supplies for the required testing to start or continue taking PrEP, without the need for an in-person appointment (7).

Video or phone consultation and mail-in self-testing

When PrEP is not the right medication for you

PrEP is not for everyone. You should stop taking PrEP if:

Take home message

Folllowing the WHO guidelines, people at substantial risk of HIV infection should be offered PrEP as a supplemental prevention choice, in the context of a comprehensive prevention (1). No matter if you are getting PrEP, you should not stop using condoms when you have sex. Even though PrEP prevents the infection from HIV, it doesn’t protect you against other sexually transmitted diseases like chlamydia, Hepatitis, and gonorrhea. In adults at increased risk of HIV infection, orally taken PrEP decreases significantly the risk of acquiring HIV infection, however the effectiveness decreases with suboptimal adherence (9).

References

1) World Health Organization. n.d. Pre-Exposure Prophylaxis. [online] Available at: <https://www.who.int/hiv/topics/prep/en/> [Accessed 22 October 2020].

2) Cdc.gov. 2020. Prep | HIV Basics | HIV/AIDS | CDC. [online] Available at: <https://www.cdc.gov/hiv/basics/prep.html> [Accessed 22 October 2020].

3) 2020. [online] Available at: <https://www.afao.org.au/our-work/policy-and-submissions/prep/> [Accessed 22 October 2020].

4) Healthdirect.gov.au. 2020. Pre-Exposure Prophylaxis (Prep). [online] Available at: <https://www.healthdirect.gov.au/Pre-exposure-prophylaxis-PrEP> [Accessed 22 October 2020].

5) 2020. [online] Available at: <https://www.afao.org.au/wp-content/uploads/2018/03/2335_afao_prep_fact_sheet_11-1.pdf> [Accessed 22 October 2020].

6) Who.int. 2020. Exciting New Results From Long-Acting Prep Study Show It To Be Effective In Preventing HIV Acquisition In Men Who Have Sex With Men And Transgender Women. [online] Available at: <https://www.who.int/news/item/20-05-2020-exciting-new-results-from-long-acting-prep-study-show-it-to-be-effective-in-preventing-hiv-acquisition-in-msm-and-transgender-women> [Accessed 22 October 2020].

7) Cdc.gov. 2020. Prep | HIV Basics | HIV/AIDS | CDC. [online] Available at: <https://www.cdc.gov/hiv/basics/prep.html#is-PrEP-safe> [Accessed 22 October 2020].

8) Stanfordhealthcare.org. 2020. Pre-Exposure Prophylaxis. [online] Available at: <https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/treatments/prep.html> [Accessed 22 October 2020].

9) Chou R, Evans C, Hoverman A, et al. Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019;321(22):2214–2230. doi:10.1001/jama.2019.2591

Is Stigma Health legal?

Absolutely. The process may seem new and different to how you usually go about medical tests, but we are in full compliance with Australian law and Medical Board of Australia Guidelines for Technology-based Patient Consultations.

Why Should I get tested with Stigma Health instead of going to my GP?

Convenience, pure and simple. If you want to skip the trip to the GP, then the Pathology Centre then the one back to your GP for the results then we’re your solution!
If you get tested with us we deliver your Pathology Referral online and you only have to make the one trip to the Pathology Centre and that’s it, your results are delivered to you safely, securely and privately directly to your mobile phone.
Not to mention we’re saving you the awkward conversation!

Can I get an STI Test through Stigma Health?

You can currently undergo a convenient and private STI test through us if you are in Australia and are over 16 years of age. Fit the criteria? Let’s get started.
If you are under 16 then we, unfortunately, cannot provide you with a Pathology Referral to get an STI test. We urge you to visit a doctor to arrange a test ASAP. Alternately you can visit an STI clinic or hospital clinic to get an STI test. If you want to talk to someone prior to doing so you will find the details for several Sexual Health info lines operating across Australia in our Resources section.

Who is Stigma Health?

We are an online healthcare service that aims to make your life more convenient by eliminating the barriers like embarrassment and inconvenience, which often prevent people from undergoing simple medical tests. We started with STIs because they are a serious problem in Australia and are for the most part easily tested for and treated, but we will be expanding our service offering soon so stay tuned!