The Government’s 2020 budget announcements in early October included the long-awaited news from the Department of Health that a national PrEP programme for Ireland will begin on November 4. This is fantastic news, and, if things go as hoped, it will mean many more people are able to enjoy the powerful HIV prevention offered by PrEP.

With the details of the programme finally falling into place, we thought it would be a good time to share some practical information about how the programme will actually work.

What’s new?

Under the new programme, PrEP users who meet the eligibility criteria and have a prescription from an approved PrEP service will be able to get their medication for free from community pharmacies. Doctors and clinics who are not an approved service can still write prescriptions for PrEP, but users will have to pay for the medication themselves (the same as has been the case).

Although the demand for the programme is expected to be high, service capacity will be limited in the first few months. Fortunately, the Government has earmarked €5.4 million in the 2020 budget to fund full PrEP roll-out over the next year. This should lead to more clinics being added over the next few months, making it easier to access PrEP across the country. It is also of benefit to non-PrEP users as it provides new funding for badly-needed improvements in public sexual health services overall.

The programme is scheduled to begin on Monday, November 4 and prescriptions from an approved service written from this date forward should allow users to get free medication at their preferred community pharmacy.

However, because the electronic system to authorise access to free PrEP won’t be active before that date, only prescriptions issued from November 4 forward will be eligible for free PrEP.

That means that if you have a prescription issued before November 4, you will not be able to get free PrEP from a pharmacy because your information won’t be in the system yet.

With an expected increase in demand from new users, most clinics will be too busy to re-issue prescription issued before that date. PrEP users who are already attending a service and have a follow-up appointment scheduled for after November 4 are advised to wait until that appointment to get a new prescription if possible however, if you’re concerned about running short of PrEP contact your clinic.

How can I get PrEP for free?

To participate in the new PrEP programme, you’ll need to meet the HSE’s eligibility criteria.

These require that you must be HIV-negative and willing to visit a clinic for a check-up every three months AND you must meet at least one of the following criteria:

I. You are having sex with a partner who is living with HIV and not on treatment OR on treatment but with a detectable viral load. If you have only one partner and they are on effective treatment with an undetectable viral load for at least six months, you may not be prescribed PrEP because there is no risk of contracting HIV through sex with that partner.

OR

II. You are a man (cisgender or transgender) having sex with other men, or you are a transgender woman who has sex with men AND meet at least one of the following:

-had anal sex without a condom with more than one partner in the last six months
-had an STI diagnosis in the last year
-used PEP (post-exposure prophylaxis) in the last 12 months
-used drugs during sex (chemsex) in the last six months

OR

III. You don’t meet either of the above criteria, but you are assessed by a specialist STI doctor at an approved clinic as being at substantial risk for HIV.

What else do I need to know?

To access free PrEP from a community pharmacy, you’ll need to get a Drugs Payment Scheme (DPS) card. You can also use a medical card or long-term illness card if you have one already. To get a DPS card you’ll need a PPS number and proof of address. The DPS card is used to access the electronic pharmacy system, and it is available for free to anyone living in Ireland. You’ll find info at www.hse.ie/dps, and you can apply online at www.mydps.ie.

If you don’t have a DPS card yet, you can ask your pharmacist to give you a “temporary emergency registration” when you get your first 3-month prescription. You’ll need a PPS number to do this. You’ll also still need to submit a regular DPS application to renew your prescription.

Also note: the PPS number and DPS card requirements apply only to those seeking free PrEP through the HSE programme. Other public STI services will continue to operate as before with no requirement to provide a PPS number.

What if I can’t get free PrEP through the HSE?

We don’t know how strictly the eligibility criteria will be applied. We think people can be trusted to judge if they’d benefit from PrEP and that it should be available to anyone who asks for it. The criteria may be useful to help identify people who should be informed about the availability of PrEP, but they should not become a barrier to access.

If you want to use PrEP but cannot access an approved service or encounter other obstacles, it is still possible to get the necessary tests and prescription and pay for PrEP at a community pharmacy yourself. Generic PrEP can be found in Ireland for around €50 for 30 tablets at many pharmacies. It’s also possible to order PrEP online for as low as €20 for 30 tablets—although there’s a risk of it being seized by customs if you have it delivered to an Irish address.

Where can I get more info?

For more info, you can visit the HSE’s PrEP information page which provides information about how to get and use PrEP safely.

You’ll find the most up-to-date list of approved PrEP services at www.sexualwellbeing.ie/sexual-health/prep/where-to-get-prep.

You can also visit www.getPrEP.online, our community-created PrEP resource, for the latest news about PrEP in Ireland.

If there’s information you can’t find in either of those places, the PrEP in Ireland Facebook group is a place for PrEP users in Ireland to share information with each other.