How to get PrEP

Prep, Prep is a pill that prevents HIV

If you are HIV negative and don’t always use condoms then you may be at risk of getting HIV. Taking PrEP can prevent HIV.

You may be eligible to get PrEP for free. You need to attend an approved PrEP service provider to access free PrEP.

Find out where to get PrEP from an approved PrEP service provider.

If you are eligible for free PrEP, you also need to have a medical card or Drug Payment Scheme (DPS) card. There is no means test for a DPS card but you do need a PPS number.

Who is eligible for free PrEP?

To get PrEP for free through the HSE you need to:

  • test negative for HIV
  • be able to attend for a check-up at least once every 3 months
  • meet at least 1 of the following criteria for free PrEP

1: You are having sex without condoms with HIV-positive partners who:

  • are not on HIV treatment, or
  • are on treatment but not virally suppressed (do not have an ‘undetectable’ viral load)

2: You are a man who has sex with men. This includes transgender men who have sex with men or a transgender woman who has sex with men, who meets any 1 of the following:

  • had anal sex without condoms with more than 1 partner in the last 6 months
  • had an STI in the last year
  • used HIV post-exposure prophylaxis (PEP) in the last year
  • used recreational drugs for sex (also known as chemsex) in the last 6 months

3: You are a heterosexual man or woman who is considered by a specialist STI doctor, to be at a large risk of contracting HIV through sex.

If you are not eligible for PrEP

If you do not meet the criteria for free PrEP you can decide to pay for PrEP. You can buy PrEP through community pharmacies with a prescription.

Who should not take PrEP?

PrEP should not be used if you are HIV positive.

You may not need PrEP if you are:

  • using condoms consistently and happy to continue using them
  • only having sex with HIV-positive partners who are on treatment and have an undetectable viral load

An undetectable viral load is when the virus exists in such small amounts that it can’t be detected by standard blood tests. It means the level of HIV in your body is so low, it can’t be passed on. This needs to be monitored regularly by a healthcare professional.

Buying PrEP online

It is possible to buy generic PrEP products over the internet.

In Ireland, it is illegal for a person to source prescription medication without a prescription.

The Health Products Regulation Authority (HPRA) have information on the risks of buying medicines online.

What is PrEP?

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.

How does PrEP work?

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.

How often do you take it?

PrEP is licensed for daily use but studies have shown that it can be effective when taken ‘on demand’. However, if you are a trans man you must take PrEP as a daily pill and not the ‘on demand’ option.

The two ways to take PrEP are:

Daily

  • Take one pill every day.
  • You need to take one pill every day for 7 days before it becomes fully effective.
  • Daily PrEP is suitable for anal and vaginal sex.
  • It is best to take your pill at the same time every day so that it becomes routine, but a few hours early or late is fine.
  •        Daily PrEP is recommended if you are a trans man.

Watch video on daily PrEP here https://youtu.be/KwMWUk9P23M

On Demand

  • If you know that you might have condomless anal sex in the next 24 hours
  • Take two pills between 2-24 hours before sex,Take one tablet 24 hours after thatTake one more pill 24 hours after that.
  • If you are having sex for an extended period of time perhaps over a few days or a weekend, continue to take a pill every 24 hours until you have 2 sex free days.
  • On demand PrEP is only suitable for anal sex
  • On demand PrEP is not suitable if you have an active Hepatitis B infection.
  •  On demand PrEP is not suitable if you are a trans man.

Who is PrEP for?

PrEP is now available through the HSE free of charge to those who are considered to be at high risk of contracting HIV through sex.

Click on the following link to find out where you can get PrEP. www.sexualwellbeing.ie/getprep

For all updates on this programme please visit https://www.sexualwellbeing.ie/sexual-health/prep/

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.

What you need to do before taking PrEP?

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.

What you need to do while taking PrEP?

Once you have started PrEP, monitoring is important.

Every 3-4 months:

  • Have a ‘4th generation’ HIV blood test. This is also called and ‘antigen/antibody’ HIV blood test.
  • Have a full screen for other sexually transmitted infections (STIs).
  • Have a urine dipstick test for protein when you have your STI check up; if there is more than a trace, an additional blood or urine test can be sent off for kidney function.

Every 12 months:

  • Have a blood test to check your kidney function.
Drugs Payment Scheme

To get PrEP free of charge in Ireland, you need to have a Drugs Payment Scheme (DPS) Card.  Here’s an update on the application process.

The Primary Care Reimbursement Service (PCRS) has advised that the process of applying for a Drugs Payment Scheme (DPS) has been made easier with a 14-day turnaround time and no visa requirement. Some people might have applied for emergency DPS which expires after three months. It is recommended that PrEP users/potential PrEP users complete the application process if you have not yet done so.

It is also advised that you bring your DPS card/number with you when attending PrEP services. It is important to have your valid unique community identifier with you when you attend your PrEP service.

To apply for the DPS visit www.mydps.ie

What about other sexually transmitted infections?

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.

Tests: what you need to know