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PrEP – Pre Exposure Prophylaxis

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What is it?

Pre Exposure Prophylaxis (PrEP) is a course of medication that, when taken correctly, can reduce the risk of HIV developing in your body.

PrEP is a daily pill of anti HIV drugs that can be used if you think you will be at risk from HIV. It can protect you from HIV transmission in cases of anal or vaginal sex without a condom, or sharing needles during drug use.

PrEP can be used to help you remain HIV free but taking PrEP does not guarantee that HIV will not develop. It is important that it is taken correctly and that depends on what you are using it for. Research has shown that times when people have been taking PrEP and have contracted HIV it has been because they were not taking the drug correctly or because the HIV they contracted was resistant to the drug.

If you are having vaginal or anal sex without a condom it is possible to contract other STIs in addition to HIV. If you are sharing needles or any other type of drug paraphernalia it is possible to contract other infections like Hepatitis C, as well as HIV. PrEP will not protect you from these infections.

There are many things to be taken into consideration with taking PrEP. Taking PrEP may help you to feel safer when having sex or doing drugs. Below are some things that are important to know before you decide.

 

There are side effects associated with PrEP.
What you will be taking are anti HIV medication that is strongly anti-viral with quite a lot of associated side effects. The drugs involved can also have a negative impact on your kidneys and liver. When taken incorrectly it is possible to develop a drug resistance to HIV which would mean that should you ever contract HIV in the future, your treatment options might be affected or limited.

It is not guaranteed to work.
There are many different types of HIV. Some types of HIV are resistant to the drugs which make up PrEP. This is something to consider when deciding if you will use PrEP or not.

You need to see a doctor to receive PrEP.
PrEP is available on a prescription from your GP, at your GP’s discretion, therefore you may have to pay for your appointment and prescription. If you cannot afford to maintain this, it might be better to look at other ways to remain HIV free.

It is only available in some places.
Not all pharmacies stock PrEP. You can ask your local pharmacy to order it in if they don’t stock it.

Here is a list of Pharmacies in the Mid West Region currently known (as of Feb 2018) to be stocking PrEP:

  • Lloyds Pharmacy, Skycourt, Shannon, Co.Clare
  • Lloyds Pharmacy, Unit 16, Jetland, Ennis Road, Limerick
  • Lloyds Pharmacy, Parkway, Limerick
  • Lloyds Pharmacy, 53 William Street, Limerick
  • O’Sullivans Pharmacy, Sarsfield Street, Limerick
  • Lloyds Pharmacy, Oakville, Clonmel, Co.Tipperary

Not everyone needs it.

You only need to consider taking PrEP if you are at risk from HIV transmission.
People who do not need PrEP include:

  • A HIV negative sexual partner of a person living with HIV who is on medication and has an undetectable viral load
  • People who regularly use condoms (sex workers etc) and intend to continue doing so
  • People who are already living with HIV

For example:

– You might wish to start taking PrEP if you are HIV negative and have a sexual partner who is recently diagnosed with HIV and is waiting for medication, or who has issues taking medication regularly and on time.

– You might wish to start taking PrEP if you find yourself using substances that would impair your ability to use condoms

– You might wish to start taking PrEP if you are in a relationship where you find negotiating condom use difficult

– You might wish to start taking PrEP if you are having sex without a condom with someone who has not tested for HIV, or has recently been at risk from HIV.

 

You need to be very organised.

Taking PrEP properly requires a considerable amount of time for medical tests. People who are already living with HIV should not take PrEP. Therefore if you are planning to take PrEP you need to do a 4th generation HIV test before beginning your course of medication. It takes at least 4 weeks following exposure to HIV for a 4th generation test to detect HIV antibodies/antigens. If you have had sex without a condom within the 4 weeks prior to testing, you will need to be retested 4 weeks later, before beginning PrEP.

PrEP is a medication that works by building up to effective levels in the blood to block the HIV virus from taking hold within your body. You need to take PrEP at the same time every day, to ensure this happens.

It is important that PrEP is taken for a while after the potential exposure to HIV. The recommended time span is at least one week.

If you are planning anal sex, vaginal sex, or intravenous drug use this changes how the PrEP should be taken. Some activities require double doses before and after the sex, within a specific time frame.

It is therefore important that you get good medical advice and regular monitoring of drug levels and HIV status from a medical professional. You might chose to see your GP or your local STI clinic.

If you are someone who finds it difficult to take medications on time, then you might like to consider other ways to remain HIV free.

For more information about PrEP contact the STI Clinic in University Hospital, Limerick on 061 482382 or by emailing theclinic@hse.ie, ask your GP, or download this HSE booklet HIV PrEP In Ireland by clicking here (Portuguese version of HIV Prep in Ireland is available by clicking here)

Health Professionals might also like to read these guidelines on PrEP – Practical-PrEP-guidance & PIL December 2017