Pre-Exposure Prophylaxis, or PrEP, is a new HIV prevention strategy in which HIV-negative people use HIV antiretrovirals (ARVs), drugs usually used to treat HIV infection, to reduce their risk of becoming infected with HIV.
Since the summer of 2018 the NHS services in Wales have been able to prescribe the generic preparations of the drug used for PrEP (Emtricitabine 200mg and Tenofovir Disproxil 245mg). There are several manufacturers who meet the standards satisfactory to WHO and the FDA. ‘Teva’ is the generic brand supplied through NHS Wales.
On average, over the past six years, there have been approximately 153 new cases of HIV infection diagnosed annually. The vast majority of infections diagnosed in Wales are sexually transmitted with 47.5% of new diagnoses since 2011 being attributed to men who have sex with men (MSM) whilst 31.6% of infections are recorded as acquired through heterosexual contact.
There is a steady increase in the number of people living with HIV in Wales, reflecting both an increase in survival and new diagnoses.
If you protect yourself with PrEP and you are exposed to HIV, PrEP prevents HIV from entering your cells and replicating. Therefore you should remain HIV negative. However, PrEP is only effective when there is a sufficient amount of the active substances in your blood before you are exposed to HIV.
PrEP is for people without HIV who are at very high risk of getting it from their sexual behaviour or their potential exposure to HIV infection, so if you are HIV negative, and don’t always use condoms, then PrEP could help reduce your risk of getting HIV.
Signs that you may be at higher risk of HIV, other than behaviour, are that you have recently had a sexually transmitted infection or that you have used post-exposure prophylaxis (PEP).
Trials among men who have sex with men, transgender women, heterosexuals, and injecting drug users have shown that PrEP can reduce HIV infection risk quite significantly – when PrEP is taken consistently, and if other safer sex methods are used as well.
However, prior to starting PrEP, you must be certain that you are HIV negative. A confirmed HIV-negative test is absolutely necessary to start on PrEP. Also people on PrEP need to get re-tested for HIV every three months. You can get an HIV test at your local Integrated Sexual Health Clinic.
When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP reaches a protective level for anal sex by taking a double dose 2-24 hours before sex and then taking one tablet at 24 hours and again 48 hours after first dose. However, if not taken daily the protective effect reduces. For vaginal sex, PrEP reaches maximum protection at about 7 days of daily use and it is recommended that it needs to be taken daily to maintain the protective effect.
PrEP is only for people who are at ongoing very high risk of HIV infection but have had time to take the drug so that it reaches its protective levels before being exposed to HIV. POST-exposure prophylaxis (PEP) may stop you developing an HIV infection if you think they’ve recently been exposed to the virus. However, it doesn’t always work. You must start the treatment as soon as possible after you’ve been exposed to HIV, ideally within a few hours and within a maximum of 72 hours after a recent possible exposure to HIV to have any possibility of working. PEP is taken daily for up to 28 days after it’s prescribed to someone who thinks they’ve been exposed to HIV.
PrEP does not prevent against the transmission of other STIs – you need to use condoms to protect against STIs. PrEP trial participants and clients of PrEP programmes generally do have high rates of STIs, but as these participants and clients are inclined to risky sexual behaviour, this is true at the outset before they start on PrEP. Most studies indicate that men at highest risk for HIV - which includes those who already do not use condoms - are most likely to seek PrEP. In many cities where demonstration projects have taken place STI rates were on the rise well before PrEP became widely available.
In order to be given PrEP by the NHS in Wales you need to meet certain criteria. In the same way as getting PrEP online, you will NOT be able to be given PrEP the same day that you attend the clinic to be assessed for it. You will have blood tests to check that your kidney and liver function are normal, as it can be affected by the drug. You will also be tested to make sure that you are HIV negative as taking the drug for PrEP alone is not sufficient to treat HIV, therefore if you have HIV already it may result in the virus developing drug resistance which would make it difficult to treat you.
If you are given PrEP you will be prescribed one month the first time. Assuming that your blood results remain normal at the clinic review at the end of the first month, and that you wish to continue to use PrEP, you will be prescribed enough for three months at subsequent visits. Each time you attend you will have blood tests to make sure that your kidney and liver function are still ok, you will also be tested for HIV and other STIs.
To get PrEP you need to attend one of the Sexual Health Clinics in Wales – those who will be providing PrEP are:
Proof of Welsh residency will need to be provided in order to access the treatment from clinics in Wales. Monitoring of people using PrEP outside of the NHS (e.g. those who have purchased PrEP online for themselves) will be offered regardless of residence.
PrEP can easily be bought online and imported into the UK, without breaking any laws. There are a number of websites where you can buy generic versions of Truvada® which are considerably cheaper. These sites can be accessed via: https://www.iwantprepnow.co.uk/buy-prep-now