PrEP (Pre-Exposure Prophylaxis) is a HIV prevention strategy that involves HIV negative people taking ARVs (antiretroviral drugs) before and after sex to dramatically reduce the chances of sexually acquired HIV infection.
Results in clinical studies have been overwhelmingly successful and so the effectiveness of PrEP is now widely accepted in significantly lowering the risk of becoming HIV positive.
The medication used for PrEP is a tablet which contains two drugs; tenofovir and emtricitabine. This drug is marketed as Truvada but increasingly, generic versions of PrEP have been made available throughout Europe.
PrEP works by stopping the HIV virus from replicating in your body. When the virus cannot replicate it cannot establish an infection.
If you are taking PrEP properly and are exposed to HIV, the drug will stop the virus from replicating and you will remain HIV negative.
PrEP is licensed for daily use but studies have shown that it can be effective when taken ‘on demand’.
The two ways to take PrEP are:
PrEP is a great prevention option for people who are HIV negative and have sex without condoms or have sex in situations where condoms are not available or not easily used at the time.
PrEP is suitable for anyone at risk of HIV infection. This includes men, women, trans people, non-binary people and those in a relationship with an HIV positive partner who does not have a undetectable viral load.
Other factors are related to a higher risk of HIV. These include:
Any of these mean you are likely to benefit even more from taking PrEP.
PrEP is now available on prescription in pharmacies across the Republic of Ireland.
You must have a doctor’s prescription to get PrEP.
There are two PrEP Monitoring Clinics (based in Dublin) where you can get a prescription.
Gay Men’s Health Service (GMHS)
The clinic takes place on Thursdays from 10am to 12 noon offering PrEP monitoring tests and support for men who have sex with men and the trans community.
Prevention Support Clinic at Clinic 6, Mater Misericordiae University Hospital.
Appointment only clinic on Tuesday afternoons. Tel: (01) 803 2063 to make an appointment or email email@example.com.
Prescription can be written by GPs and private sexual health clinicians however it is very important that you receive all the necessary monitoring tests before starting PrEP (see more in the next section).
We recently updated our information about getting PrEP online. You can read that here.
In Ireland, it is illegal to supply medication by mail order, including over the internet. The Health Products Regulation Authority provides information for the public in relation to sourcing medication over the internet which is available here.
Please talk to a health advisor, nurse or doctor at the clinic. They can help you if you are planning to take, or are already taking PrEP.
It is really important to have an HIV test before or as you start.
PrEP can only be used if you are HIV negative. If you are already HIV positive and don’t realise it, you could develop resistance to drugs that you will need for treatment.
Ask for a ‘4th generation’ HIV blood test. This is also called a ‘combined antigen/antibody’ test. This tells you your HIV status approximately 4 weeks ago. Most finger prick tests are currently ‘3rd generation’. They tell you your HIV status approximately 3 months ago. So don’t rely on a fingerprick test alone before you start PrEP.
If you are just starting PrEP and had a risk in the last 4 weeks, have another 4th generation HIV blood test 4 weeks after starting, just to be sure an early infection was not missed. Don’t start PrEP if you have flu-like symptoms and a recent HIV risk. This is to check that these symptoms are not related to a recent HIV infection (ie seroconversion).
If you are starting PrEP after PEP, it is best to start immediately if you have ongoing risks. Ideally you should have an HIV blood test around the time you finish PEP/start PrEP plus another HIV blood test 4 weeks into PrEP.
Remember that unprotected sex while taking PrEP will reduce your risk of HIV but not other STIs, use condoms to reduce your risk of other STIs.
You will also need to have your kidney function checked. Kidney monitoring just involves a blood test for creatinine, and a urine test for protein. These should ideally be done just before or on the day you start.
You will need to be tested for Hepatitis B as PrEP is also active against the Hepatitis B virus.
Once you have started PrEP, monitoring is important.
Every 3-4 months:
Every 12 months:
Research has shown that PrEP is highly effective at preventing HIV as long as it’s taken as directed.
However, PrEP will not protect you from other sexually transmitted infections (STIs) whereas condoms will. If you’re using PrEP it’s important that you go for regular STI screens every three months so you can get any other infections treated.