express takes your frequently asked questions about the drug that stopping HIV infections to three of NZ’s leading PrEP experts.
Based at Auckland’s Sapphire clinic, Dr Garsing Wong is a General Practitioner with a special interest in HIV medicine. Dr Wong is an approved Pharmac prescriber for PrEP, and regularly gives talks on his PrEP prescribing, including Pharmac Seminars to teach other doctors about PrEP.
How does someone go about getting on PrEP in NZ?
Although any GP would be able to apply for PrEP if you qualify, at this point in time, not all GP’s are familiar with PrEP, so it pays to ask directly if your family doctor is familiar with obtaining special authority for “Truvada” to prevent HIV. An alternative is to visit www.endinghiv.org.nz and click on their interactive map to find a doctor.
PrEP requires knowledge about a special medication and knowledge on the funding process. Although your local doctor may know of it, if they are not looking after patients on PrEP, they may be unfamiliar with the health checks that are needed. Most doctors will need to write to a specialist colleague to process the applications to obtain funding for PrEP.
How long before and after unprotected sex should PrEP be taken?
PrEP needs to be taken 7 days before unprotected anal intercourse and for 28 days after having had unprotected anal intercourse to prevent you from getting HIV.
Is it just one pill per day?
Yes, it is that simple.
What does PREP do to stop HIV being transmitted?
When we are talking about PrEP, we are referring to Truvada or Emtricitabine and Tenofovir Disoproxil Fumarate at present as this is the combination medication that is proven to prevent HIV infection. The combination of medicine blocks the activity of HIV-1 reverse transcriptase which is one of the key players in the mechanism of infection.
What are the side effects you can expect when taking PrEP?
The most common side effects we see are tummy upsets, cough, runny nose, sleep disturbance, rash, headache dizziness, or blood changes. That is why you need to be monitored by your doctor every three months. To date, I have not had any patients who have needed to stop taking Truvada as a result of any side effect, as most of the side effects are transient, however, some are more serious which may require you to stop taking the medicine.
Dr Jason Myers is the Executive Director of the New Zealand AIDS Foundation, a healthcare organisation focused on preventing the transmission of HIV and providing support for people living with HIV.
What are the important steps to remember when taking PrEP?
Firstly, talk to your GP or sexual health clinic about it to assess your level of risk, ensure you’re HIV negative and get a full STI screen. In some people PrEP can affect the kidneys, so you’ll need to have blood tests to check your kidney health before you start.
If you decide to go on PrEP, you’ll need to take it for 7 days before you have adequate protection from HIV for receptive anal sex (bottoming), and 20 days for insertive anal sex (topping) or vaginal sex.
The most important step is making sure you take it every day. Repeatedly missing doses can decrease the level of protection that PrEP provides.
You’ll then need 3-monthly check-ups where you’ll be tested for HIV and all other STIs, as well as checking your kidney function hasn’t been affected.
If you decide to stop taking PrEP, you’ll need to continue taking it for 28 days after your last potential HIV exposure.
What will it cost the average express reader to be on PrEP?
Since March this year, PrEP is a publicly funded medicine. So if you meet the PHARMAC criteria, PrEP will cost up to $5 for a three-month supply. This is on top of the cost of doctor’s visits.
People who don’t meet PHARMAC’s criteria can also import generic versions of PrEP with a prescription. At the moment this is around $25 a month, including shipping.
As PrEP is more widely used do you expect rates of other STIs to rise?
STIs have been on the rise in NZ for a long time – especially syphilis and gonorrhoea. Some overseas modelling has predicted that with an uptake in PrEP use, the mandatory three-monthly testing will actually lead to a decrease in overall STI rates. If you imagine that someone who was previously being tested for STIs once a year – or not at all – is now being tested 4 times a year, then we should see STIs being treated much more quickly, which means they’ll be passed on at a much lower rate.
We don’t want to see a drop in condom use – condoms have been a mainstay of HIV prevention in NZ for a long time and are very effective at preventing transmission. For most people, condoms are still the best option, which means STI transmission rates aren’t likely to be affected.
It’s also worth noting that with the exception of HIV, most STIs can be passed on through oral sex.
How long can someone remain on PrEP?
With regular three-monthly check-ups to make sure everything is going well, someone could remain on PrEP indefinitely. But life circumstances often change and there are many reasons someone might stop PrEP – like entering a monogamous relationship, or going through a period where their sex life is less… abundant. We don’t expect most people will be taking it for the rest of their lives.
Have studies revealed if there are health effects for taking prep long term?
PrEP hasn’t been around for long enough for there to be any studies on long-term use. But PrEP is made up of two of the main drugs used in treating HIV, so if someone does acquire HIV then it’s very likely they’ll end up taking these same drugs anyway – plus usually at least one more.
What we can also say is that if there are any long-term health effects from PrEP, it’s likely that they’ll be minor compared to the potential harm caused by HIV infection.
Mark Fisher is the Executive Director or Body Positive an HIV+ peer support organisation. His answers come from members of the Body Positive board that he represents.
What does PrEP mean for the positive community?
Tools and knowledge like PrEP and U=U are the great levellers in the discourse around HIV. PrEP, in particular, means that you are taking ownership of your sexual health and removing the fear and barriers to a connection that have plagued our communities since the early days of the HIV epidemic. We know that fear and ignorance drive the stigmatisation of PLHIV so these interventions act as an equaliser. It’s a bold, tangible step that HIV negative people can take to empower themselves.
Thus far, do you think PrEP has had an effect on the stigma of being HIV positive?
It most certainly has already had a major impact. Whenever we introduce new tools, and language into the public lexicon it always takes some time to get a grasp on. Already I am finding people to be more knowledgeable and proactive around sexual health and the nuance of what modern HIV prevention looks like. When you are empowered and informed it takes the fear out of the equation. The knowledge that PrEP is safe sex and protection from contracting HIV, and that an undetectable viral load means you are no longer able to transmit HIV sexually. Both of these are complete and utter game changers in terms of how we navigate our sex lives and the fear around disclosure. And it will only get better as these tools really take hold.
For more information on PrEP visit EndingHIV.org.nz/PrEP or talk to your GP.
