Pre-exposure Prophylaxis (PrEP)

What is PrEP?

Pre-exposure prophylaxis (PrEP) means that it protects against an infection before coming into contact with it. This medication is used to prevent HIV in people who are considered high risk but are currently HIV-negative. So it is different from PEP (post-exposure prophylaxis) which is taken after exposure to the virus. A helpful comparison would be the difference between the contraceptive pill and the morning after pill; both are preventative measures but one is taken before the act and the other is taken afterwards.

PrEP has proven to be a successful medication, with prevention rates up to 92% when taken correctly. The reason that this is so important is because HIV (human immunodeficiency virus) can be a cruel disease, that attacks the cells of your immune system. Over time, this damage can become more severe and leaves your body weak to serious infections and cancers. If the HIV infection becomes so severe that your immune system is extremely damaged, then this would signal that the infection has moved into its most grievous phase; AIDS (acquired immunodeficiency syndrome).

Once you contract the HIV infection (and become HIV-positive), you will live with it forever, as the human body can never get rid of the virus completely (even with treatment). However, you may not show symptoms for an extended period of time, the disease is manageable and some people live their whole life without HIV ever becoming AIDS.

Unlike some viruses (like cold and flu), HIV is not airborne and cannot be passed from one person to another through close proximity, casual contact (hugging, shaking hands, kissing), or sharing toilets, dishes or glasses. It also cannot be passed through bodily fluids like saliva, sweat, urine, or tears, or by mosquitos (or other blood-sucking insects).

The HIV virus exists exclusively in a person’s blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. So it can only be transmitted by unprotected sex (especially anal, but also vaginal), by sharing needles, syringes and other drug equipment, and occasionally from mother to child during pregnancy. Even if the infected person’s HIV has progressed to the AIDS stage, it still can only ever be passed on as HIV. AIDS cannot be passed on; it develops in the body over time.

How does PrEP work?

Once the HIV virus is in your body, it attaches itself to your cells, multiplies and then destroys them. PrEP medications contain the same active ingredients as HIV-positive medications, which work as a barrier between the HIV infection and your body’s cells. So should you come into contact with the virus, the drug kills it before it can latch on.

The drug typically takes 7-20 days to become effective, but after that, it should successfully protect you from the HIV infection.

How do I use PrEP?

PrEP medication should be taken every day for long-term protection against HIV, but can also just be used before and after sex. The drug is only advised for those who are currently HIV-negative, but who are considered at high risk of contracting it.

Because of the way the virus infects the body, those who engage in anal sex are one of the highest risk, especially those who receive it. So men who have sex with men (especially those who have multiple partners without using protection) are at high risk, particularly the man who is receptive (known as “bottoming”) rather than insertive (known as “topping”).

You are also considered high risk if you have sex in an area of the world where HIV is rife (such as sub-Saharan Africa), or if you have sex with someone who does or did live there. As an extension of this, black Africans are more prone to the disease, regardless of sexual orientation.

Sex workers are also at higher risk (because of the number of sexual partners), as are women who have sex with men, who’ve had sex with men. “Chemsex” is another activity that increases risk of HIV (having sex using certain drugs), as is drug use in general (especially sharing needles).

Before starting PrEP, you will need tests to ensure you are HIV-negative, and then you can begin treatment straight away.