Positive Life NSW Blog

PrEP: A tool in the arsenal to prevent HIV

Posted by on in Treatments

Image: a medicine bottle with Truvada on it. A doctor sits in the background.Pre Exposure Prophylaxis (PrEP), a once a day medication taken to prevent acquiring HIV, is long overdue compared to places like the US.

While PrEP prevents HIV acquisition, as it is intended to do, it has brought other polarising attitudes and challenges to HIV negative people who want to use PrEP. These range from trusting the pills to do the job and what happens if I miss a dose to prejudice towards those taking PrEP. There are enough challenges as it is such as universal access to PrEP for all those that want it and ensuring people accessing PrEP remain engaged in quality health care for monitoring purposes. Access to the right HIV prevention, education, support and medication is paramount.

Truvada is a pill that combines two drugs to supress HIV: tenofovir and emtricitabine. It does not protect against other sexually transmitted infections (STIs) and blood borne viruses (BBVs) including Hepatitis C that can also be sexually transmitted. Truvada’s safety has been established for use with people living with HIV with very few side effects. People have asked why they would take a drug used to treat people with HIV? The medications used to treat HIV doesn’t kill the virus, but blocks it from entering and using the cells within the body to reproduce. Truvada is very effective at preventing HIV entering cells that causes someone to become HIV positive, if taken as prescribed.

The challenge is taking these pills as prescribed, every day, without missing doses. Many people living with HIV on medications face this challenge every day. This raises questions about what to do when you miss a dose? If you forget to take it within 10 hours of when you were meant to take it, it is best to wait till the next dose is due. There is no need to double dose and as these pills remain in the blood and cells for a very long time so there is no need to worry. The time to be concerned is if a lot of doses are missed and taking medication becomes erratic. If this is happening then it’s time to talk openly to your doctor or another experienced healthcare worker to explore your options. They typically understand without judgment and work with people to achieve what is practical.

People are asking me about access to PrEP. There is the demonstration project PrELUDE which has a limit of 300 hundred places to date. Search Google at prelude.org.au for ‘The PrELUDEStudy’ to find participating clinics. If you are accepted into PrELUDE you will have to undergo a series of tests. To begin, participants will need to take the medication as prescribed for 28 days before they are considered protected from HIV, and then once a day after that to maintain their protection. Some people will not fit the criteria to be eligible or places may already be taken. Some people are already seeking medications in other ways or they are getting it from their mates or importing it via online. Irrespective of how you access PrEP, it is important to ensure regular follow-up appointments, at least every three months, with your prescribing doctor. An added bonus will be getting your overall health regularly monitored and a reminder for STI and BBV checks.

Clinical research is exploring other medication combinations and how to administer PrEP drugs. While showing some promise there has been a lot of debate and reservations about the efficacy including some people becoming HIV positive. So we need to have better evidence and confidence about the use of these other strategies. More information on the time taken for the drug to reach protective concentrations within skin linings of the arse, vagina and differences for transgender people are some of the questions yet to be answered.

PrEP is beginning to appear on dating apps alongside other messages of undetectable viral load (UDL) and results of last STI or BBV test. What is important with any of these messages is they remain within the context of and not a replacement of other HIV prevention methods and practices you use. A recent test result is only as relevant as the result of that date. It does not cover recent exposures within the time and ability of the test to detect infection nor the variations in viral load in the presence of other STIs. In short, the posting of tests are not a reliable prevention strategy but a point from which to start a conversation. Knowing your own HIV status and regular STI and BBV check-ups are imperative. If you want to assess your risks for HIV in a given set of circumstances and parameters go to knowtherisk.org.au/over-18. Don’t wait till you’re about to hit the sack. Check it out now and explore your fantasies. Further support available via the Treatments Officer at Positive Life NSW on (02) 9206 2177, ACON or your Sexual Health Clinic.

Also online at GNN

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Guest Saturday, 04 April 2020

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