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Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is medicine which HIV-negative people can take to protect them against HIV infection. 

Taking PrEP correctly will reduce your risk of getting HIV to almost zero, however it won’t protect you against other sexually transmitted infections (STIs). Condoms are still the best protection from these.  

PrEP is not taken for life – it is only taken for short periods of time when you may be at risk of HIV infection.

PrEP is different from PEP (post-exposure prophylaxis), which is an emergency treatment for HIV taken after possible exposure to the virus. For PrEP to work you must start taking it before you have unprotected sex.

What does PrEP look like?

PrEP normally comes as a pill that you swallow.

PrEP is also available as an injection (long-acting injectable PrEP). Although the injection is recommended by the World Health Organization, it will be some time before it is available everywhere.

PrEP is also available as a vaginal ring. You insert the ring yourself and it can protect you for a whole month.

See the ‘In detail’ tab for more information on how to take PrEP.

How does PrEP prevent HIV?

HIV infects the body by replicating (making copies of itself). The anti-HIV drugs in PrEP stop the virus replicating in your body. If you are exposed to HIV, for example during sex without a condom, but have been taking PrEP correctly, there will be high enough levels of the drugs in your body to prevent HIV. 

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How effective is PrEP?

Used correctly, PrEP is very effective and will reduce the risk of HIV infection to almost zero. 

If I take PrEP, can I stop using condoms?

This will depend on your circumstances. PrEP will protect you from HIV, but it doesn’t give you any protection against other STIs. Using a condom is the best way to prevent other STIs such as gonorrhoea, chlamydia and hepatitis C. PrEP also doesn’t prevent pregnancy

Who can take PrEP?

PrEP is for anyone who is HIV-negative and is recommended if you are at a higher risk of HIV. 

PrEP may be a good option for you if: 

  • your partner has HIV and does not have an undetectable viral load 

  • you have sex with multiple partners and you don't always use condoms  

  • you’re having sex with a new partner and are not sure what their HIV status is  

  • you have sex for money, or receive gifts for sex 

  • you’ve shared injecting equipment or have been in a treatment programme for injecting drug use. 

PrEP can be used by anyone who is sexually active - men and women, both trans and cisgender, whether you are gay, bi or straight

What is the right PrEP option for me?

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Does PrEP prevent HIV via any kind of sex?

Yes. PrEP can prevent HIV infection during both vaginal and anal sex, but there are different recommendations for how to take it depending on your gender and the kind of sex you have. 

See the ‘In detail’ tab for more information.

Do I take PrEP for life?

No. PrEP is normally taken for periods when you are most at risk of HIV. This might be during specific relationships, after the break-up of a relationship while dating new people, when planning a holiday when you know you will be sexually active with new people, while dealing with drug use problems, or when trying to conceive and one of you is HIV positive

While you’re taking PrEP, you should visit your healthcare provider for regular check-ups (at least every three months). 

Real-life story

Personal story: Lerato

Personal story: Lerato

PrEP gave me extra protection

Does PrEP have any side effects?

Many people feel no side effects from PrEP, others might experience mild issues like nausea, vomiting, fatigue and dizziness, but these usually disappear within a week or two. 

In rare cases PrEP can also affect kidney functions. This is why it's recommended that people on PrEP have regular health check-ups so that healthcare providers can monitor their health. 

Talk to your healthcare provider if you experience side effects while taking PrEP. 

Where can I get PrEP?

PrEP isn’t available everywhere but it is being rolled-out in more and more countries. Ask your healthcare provider if it’s available where you are. 

How much does PrEP cost?

The cost of PrEP will be different depending on where you live – in some countries it may be free, in others there may be a cost.

If you’re interested in PrEP, you should ask your healthcare provider if it’s available where you are. 

What should I do if I want to take PrEP?

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How do I take PrEP?

Before starting PrEP, you must take an HIV test. This is because if you already have HIV, taking PrEP can be damaging to your health as it can make HIV treatment less effective. 

There are different ways to take PrEP. Whichever method you choose, you must start PrEP before unprotected sex because it takes some time to start working. Ask your healthcare worker for more information.

PrEP as a pill

There are two ways to take PrEP in the pill form. Talk to your healthcare provider about the best option for you. 

1. One tablet per day 

  • This is the most common way to take PrEP. It works best when you take PrEP at the same time each day. For PrEP to work you must not miss doses.
  • You will need to take PrEP for 7 days before you are protected. During this time you should continue to use condoms. 
  • You should take PrEP every day for as long as you want protection. 

2. Event-based (on-demand) where you take PrEP before and after planned sex 

  • This option would work for you if you are able to plan for sex at least two hours in advance or you can delay having sex for at least two hours. 
  • There are different types of event-based PrEP depending on your pattern of sexual activity, so make sure you talk this option through with a health provider. 

PrEP as an injection

  • Injectable PrEP is a form of PrEP that can be injected by a trained healthcare provider.
  • To get full protection from HIV you will need to have two injections one month apart followed by an injection every other month.
  • Many people may find this easier than taking a daily pill.  

Currently injectable PrEP is only available in a few countries. The World Health Organization now recommends injectable PrEP is offered to people at substantial risk of HIV. But it will take some time until injectable PrEP is more widely available. You can ask your healthcare provider if it’s available where you are.

PrEP as a vaginal ring 

  • The PrEP vaginal ring is a flexible ring you put in your vagina which slowly releases antiretroviral drugs.  
  • You need to insert the ring at least 24 hours before sex to get maximum protection. You can keep the ring in for the next 28 days, then you need to replace it with a new one.
  • Anyone with a vagina can use the ring to protect themselves from HIV. 
  • The ring is easy to insert yourself and will need to be replaced every 28 days. 
  • It’s a good option if you don’t want to take a daily pill, don’t like injections or want something long lasting that you are in control of. 

The PrEP vaginal ring is harder to get hold of than any other methods of PrEP. It is also less effective than the PrEP injection or the PrEP pill. Many people find this the most convenient way to use PrEP as you can insert it yourself so you’re not reliant on a health worker. You can also keep a supply of rings at home, meaning you have fewer trips to the clinic. 

Why do I need to test for HIV when I’m taking PrEP?

Taking PrEP while not knowing that you are HIV positive is bad for your health. PrEP provides a low dose of antiretroviral treatment (ART). With good adherence, this amount of ART is enough to stop you from getting HIV, but if you already have HIV, it could make you more likely to develop HIV drug resistance. This is where your ART stops working. Small amounts of ART are not enough to stop the virus from replicating. Instead, the HIV virus is able to change itself so that it can by-pass the effects of ART and create new copies of itself anyway. 
Testing regularly while you take PrEP means that you will find out if you are HIV positive as soon as possible, so you can avoid developing HIV drug resistance. Taking PrEP as prescribed will prevent you from getting HIV. 

What’s involved in HIV testing?

Can I take PrEP if I want a baby?

Yes! PrEP does not stop you from getting pregnant and is safe for women to take during conception, pregnancy and breastfeeding. PrEP is one of the ways that couples with different HIV statuses can try for a baby safely. 
If you want to have a baby, but think you're at high risk of getting HIV, then PrEP could be a good option for you. If mothers get HIV during pregnancy and breastfeeding, it puts their babies more at risk. This is because your viral load is especially high in the first few weeks after getting HIV. Taking PrEP protects both you and your baby, so you can stay HIV-negative throughout conception, pregnancy and breastfeeding.  

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