HIV pre-exposure prophylaxis (PrEP) is available free of charge through the HSE to those who are at substantial risk of contracting HIV through sex.
What is PrEP?
PrEP stands for pre-exposure prophylaxis. PrEP is taken by HIV negative people before having sex (pre-exposure) and after sex to prevent HIV (this is called prophylaxis). PrEP is a combination tablet containing two drugs: tenofovir and emtricitabine. These medicines, which are widely used to treat HIV, have been licensed for use as PrEP in Europe since August 2016.
PrEP is the newest HIV prevention tool available and is best used in combination with other HIV prevention measures.
If you decide to use PrEP, it’s important that you do so with support from a healthcare provider and that you understand how to take PrEP correctly.
What is the difference between PEP and PrEP?
PEP (post-exposure prophylaxis) is the use of HIV treatment after exposure to HIV, to reduce the risk of HIV infection.
If you have a possible exposure to HIV, such as having sex without a condom, sharing needles or pricking yourself with an infected needle, you should consider PEP.
PEP must be started within 72 hours (3 days and nights) after a possible exposure to HIV, and the sooner you take it, the better. A full course of PEP is for 28 days (4 weeks). PEP is only available following an assessment by a healthcare professional. For more information on PEP or the list of locations where you can be assessed for PEP, please visit sexualwellbeing.ie/pep or man2man.ie/prevention/pep.
PrEP (pre-exposure prophylaxis) is the use of HIV treatment before exposure to HIV to prevent HIV infection.
If you’re HIV negative and don’t always use condoms for anal or vaginal sex, then you may be at risk of HIV and should consider PrEP.
For PrEP to be most effective, the medicine needs to be at protective levels at the time you may be exposed to HIV, which means PrEP needs to be taken both before sex and for several days afterwards.
Depending on your circumstances and how often you have sex, PrEP can be taken every day (daily PrEP) or taken around the time of sex (event-based). Your healthcare provider will help you decide what is best for you.
How well does PrEP work?
PrEP has been shown in many studies to be safe and highly effective at preventing HIV. When taken correctly, PrEP has been found to be about 99% effective.
In PrEP studies where HIV infections have happened, most of those who became HIV positive were not taking the medication properly at the time they contracted HIV.
Am I eligible for free PrEP?
PrEP is available through the HSE free of charge to those who are considered to be at substantial risk of contracting HIV through sex and meet the eligibility criteria.
To avail of free PrEP through the HSE you need to:
- test negative for HIV
- be able to attend for a check-up at least every three months.
You also need to meet at least one of the following eligibility criteria:
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 (don’t have an “undetectable” viral load)
2. You are a man who has sex with men (includes transgender men who have sex with men) or a transgender woman who has sex with men, who meets any one of the following:
- had anal sex without condoms with more than one partner in the last 6 months
- had a sexually transmitted infection (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 to be at substantial risk of contracting HIV through sex, by a specialist STI or infectious diseases doctor.
Where can I get PrEP?
PrEP is available through approved PrEP service providers that meet the National Standards for PrEP. The list of approved PrEP service providers (public and private), including contact information, is available on www.sexualwellbeing.ie/getprep. This list will be updated as further services are approved.
What do I need to do to get PrEP?
To access PrEP for free through the HSE, you need to attend an approved PrEP service for a clinical assessment and to see if you are eligible for free PrEP. If you are eligible for free PrEP, you will be provided a prescription and can collect the medication through a community pharmacy free of charge.
You will need a medical card or drug payment scheme (DPS) card to access free PrEP through the HSE. Anyone with a PPS number can apply for a DPS card. Please see www.myDPS.ie and download an application form or ask your pharmacist.
If you don’t have a PPS number, you need to apply for one. See www.citizensinformation.ie for further information.
What if I’m not eligible for free PrEP?
If you don’t meet the criteria for free PrEP you can decide to pay for PrEP yourself. You can buy PrEP through community pharmacies with a prescription.The doctor in the STI clinic or your GP can give you a prescription.
Regardless of how you’re getting PrEP, it’s recommended for your safety to follow the same assessment and monitoring guidelines for PrEP.
Before starting PrEP
There are a number of tests you need to have before starting to take PrEP. These include testing for HIV, hepatitis B and other STIs. You will also have a blood test to check your kidney function.
This is also a good time to be vaccinated or to boost a previous vaccine. The hepatitis A and B vaccinations are recommended for gay, bisexual and other men who have sex with men (MSM) and people who inject drugs (PWID). The HPV vaccination is recommended for MSM up to and including 45 years of age to protect against genital warts and HPV-associated cancers. These are available for free through public STI clinics.
Once you are taking PrEP
If it’s your first time taking PrEP, you may be offered an appointment after 1 month. This is to make sure you are okay with the medication or if you need any more tests or vaccinations.
Once you’ve started PrEP, you’ll need to go for a check-up every 3 months. This is to test for HIV and STIs, and to check your kidney function.
Although side-effects are rare with PrEP, the clinic monitoring will help to identify any potential problems at an early stage.
What are the side-effects of PrEP?
Most people taking PrEP don’t report any major side-effects. However, like all medicines, PrEP has the potential to cause side-effects. Less than 1 in 10 people taking PrEP report mild nausea, diarrhoea, bloating or headache. These side-effects usually stop within the first month.
Occasionally PrEP can cause more serious side-effects. PrEP can also affect your kidneys, which is why monitoring your kidney function is important. PrEP can also reduce bone density by between 1% and 2%, causing slight thinning of the bones. This loss reverses after PrEP is stopped.
What happens if I take PrEP incorrectly?
For PrEP to be most effective, the medicine needs to be at protective levels at the time that HIV exposure may happen. As the body takes a while to absorb medicines, this means PrEP needs to be taken both before sex and for several days afterwards.
If you take PrEP incorrectly, you may not have the protective level of drug in your system and may be at risk for HIV. It’s important that you understand how to take PrEP correctly and discuss this with your healthcare provider.
For more information on how to take PrEP, visit www.sexualwellbeing.ie/prep. Information is provided on daily PrEP (taking PrEP every day) and event-based dosing (when PrEP is taken around the time of sex).
What if I miss doses?
This depends on what type of sex you’re having and if you’re taking PrEP every day or taking event-based PrEP.
If you miss doses and have had condomless sex, you may need PEP (post-exposure prophylaxis) and should discuss with your healthcare provider immediately.
What about other STIs?
PrEP doesn’t protect against other STIs, such as syphilis, chlamydia, gonorrhoea and hepatitis C. If you are taking PrEP, you can combine condoms and PrEP to reduce the risk of contracting other STIs.
Regular STI testing at least every three months is recommended for people taking PrEP.
Where can I get further information?
For further information on how to take PrEP and how to access it, visit www.sexualwellbeing.ie/prep.
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