All about HIV PrEP (Pre Exposure Prophylaxis)

What is PrEP?

PrEP (pre-exposure prophylaxis) is a medication that protects you from HIV. It is a course of tablets that you take before and after sex. There are different ways to take PrEP depending on the type of sex you are having, but if taken correctly it is 100% effective. Taking PrEP means you can feel in control of reducing your risk of HIV.

There are 2 types of PrEP:

Tenofovir Disoproxil and Emtricitabine (sometimes known by the brand name Truvada)
Tenofovir Alafenamide and Emtricitabine (sometimes known by the brand name Descovy)

Both are types of medication used to treat HIV. They work by stopping HIV from getting into your body and replicating (making copies of itself). PrEP is only effective if there is enough medication in your body at the time you come into contact with HIV, so it is important to take it correctly.

As PrEP only protects against HIV, we recommend that you have regular sexual health screening, especially if you are using PrEP instead of condoms.

Is PrEP right for me?

PrEP is a discreet and empowering way to protect yourself from HIV.

PrEP may be suitable for you if you:

are HIV negative
have anal, vaginal or frontal sex in a variety of situations where condoms are not easily or always used
want to protect yourself from HIV

Where can I get PrEP near me?

PrEP is provided for free as part of NHS specialist services in all ‘level three’ sexual health clinics in England, Scotland and Wales.

In Brighton & Hove PrEP is accessible through all of our clinics including Clinic M, Clinic T and our Young Persons Clinic.

If you want to start PrEP, come and see us – you can book online or call us on 01273 523 388.

If it’s your first time booking an appointment online here’s some information about how to create an online account.

If you’re already on PrEP, it’s important to have regular STI/HIV screens (and kidney monitoring if necessary) every 3 months. Your follow-up appointments can be booked when you attend for your PrEP appointment. If you’ve missed an appointment, please book another appointment online or call us on 01273 523 388.

If our phone lines are closed, please wait until they re-open.

If you have run out of PrEP and have sex – use a condom.

If you are not in Brighton & Hove, you can still access PrEP from your local sexual health clinic.

What should I expect before starting PrEP?

You will be seen by a clinician who will discuss the type of sex you are having, take a medical history, and advise whether PrEP would be suitable for you.

You will need to have an HIV test as well as a kidney function (blood and urine) test on the day you start PrEP or just before. You may need to repeat tests 4 weeks after starting PrEP.

If you have used a home HIV self-test you will still need to have an HIV test which is conducted in a lab.

You will also be offered:

Testing for sexually transmitted infections (STIs)
Vaccinations to protect yourself from hepatitis A, hepatitis B and HPV if you are eligible and have not had this in the past.

How do I take PrEP?

There are two ways that PrEP is usually taken:

Daily PrEP: you take one pill every day (suitable for everyone taking PrEP)
On Demand or Event-Based Dosing (EBD): two tablets taken 2-24 hours before sex, then daily until 48 hours after the last sex (suitable for people who are only having anal sex)

PrEP takes longer to get into the tissues of the vagina than the anus, which is why we don’t recommend event-based PrEP for people having vaginal or frontal sex. We usually recommend daily PrEP for everyone unless you are able to plan in advance when you will be having sex.

Starting daily PrEP

When you start taking daily PrEP, it can take time to reach a safe level of protection in the body.

If you are using PrEP for anal sex we usually recommend you take 2 tablets to start with. You will be protected after 2 hours.

If you are using PrEP for vaginal or frontal sex it takes longer to reach a safe level of protection. You will need to take PrEP daily for 7 days before you are protected against HIV.

Frequently asked questions (FAQs) about PrEP

We know from research studies that PrEP is a very safe medication. Often when people start taking PrEP they experience some gastrointestinal side effects (usually feeling sick or having diarrhoea). These are usually mild and resolve within a few weeks of starting PrEP.

Less frequently, taking PrEP can affect kidney function and bone mineral density. This is why we need to take blood tests to check how your kidneys are working while you are using PrEP.

If your kidney function changes while using PrEP, there are things we can do to avoid any damage to your kidneys. It is really important that you let the clinician know if you have any other medical problems (even if they are not related to sexual health) or if you take any medications (including over the counter medications or recreational drugs), so that we can choose the safest option for your PrEP treatment.

Any effect on bone mineral density is usually mild and reverses once PrEP is stopped, however if you have a condition which affects your bones like osteoporosis, please ensure you tell the clinician this so we can choose a treatment which won’t have this effect.

Taking PrEP offers excellent protection against HIV, but it needs to be taken as prescribed. If you have missed doses and have had sex without a condom you you may need PEP. The advice about when PEP might be needed also depends on whether you are taking daily PrEP or event based PrEP.

Daily PrEP:

If you are using daily PrEP for anal sex only, you will need to take PEP if you have taken less than 4 doses of PrEP in the last 7 days.
If you are using daily PrEP for vaginal or frontal sex, you will need to take PEP if more than 48 hours have passed since your last PrEP dose, or you have taken fewer than 6 doses in the last 7 days.

Event-based PrEP:

You may need PEP if you haven’t taken event-based PrEP exactly as prescribed (2-1-1 dosing).

If you currently have a supply of PrEP we recommend that you take a double dose as soon as possible and continue with PrEP daily while you seek advice about PEP.

When you first start PrEP we will see you every 3 months for sexual health screening and review, and to complete vaccinations or other treatment as needed. We will also conduct kidney function tests annually (or every 6 months if needed).

When you have been taking PrEP for a while we offer the opportunity to book your appointments through our PrEP Emerge app.

We will see you in clinic every 6 months for a review, a sexual health screen, and kidney function tests (if needed). At 3 and 9 months we will send you a home STI testing kit to complete and send back to us. Your results will be uploaded to the PrEP Emerge app for easy access. If you would like this option but prefer to attend for sexual health screening you can book into one of our ‘quick check’ clinic sessions.

We will aim to give you enough PrEP to ensure you don’t run out before your next appointment. If you are about to run out of PrEP please contact us on 01273 523 388 and we will try to see you as soon as possible. If you do not have enough PrEP you will need to use a condom every time you have sex until you have restarted to protect yourself from HIV.

If your partner has HIV, is taking daily medication and is undetectable, you do not need to take PrEP. Once someone is undetectable they cannot pass HIV on to anybody else. However, if you have unprotected sex with other people than your partner, we would recommend PrEP.

If you are HIV positive, PrEP is not suitable for you. PrEP is only suitable for people who are not diagnosed with HIV. If you have been diagnosed with HIV we can can offer access to HIV care and treatment.

UK sexual health services are confidential and so your GP will be unaware that you have attended. If you take any other medications we advise letting your GP know that you take PrEP so they can make sure it won’t interact with your treatment.

Even if your partner takes PrEP we recommend you also consider it. This means that you know you are in control of your own HIV risk even if your partner forgets to take their PrEP.

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