PREP & PEP

New Way to
Reduce Infection

Think you might have put yourself risk? Are you thinking about the possibility that you might have been exposed to HIV? PrEP/PEP may be your answer.

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Fast Facts

  • PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.
  • PEP means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.

What is PrEP?

PrEP stands for pre-exposure prophylaxis. The word “prophylaxis” means to prevent infection or disease. PrEP is a new way for people who do not have HIV to prevent themselves from becoming infected by taking a protective pill every day.

This pill, called Truvada, contains two medicines that are also used to treat HIV. If someone takes PrEP and if they are exposed to HIV via unsafe sex (or unsafe needle use), these medicines can work to keep the virus from establishing itself inside their body. PrEP is an effective HIV-prevention strategy in populations in which HIV testing is common. This is important to remember when making recommendations for or against using PrEP: testing regularly is essential for its success.

How effective is PrEP?

Recent studies have indicated that PrEP, if taken consistently, can prevent 92% of HIV infections.

Other studies have shown that under ideal circumstances (if users absolutely never forget to take it), protection can be as high as 99%.

Note that this is an even higher protective effect than using condoms (80%). Combining PrEP with condom use leads to a 99.2% level of protection, according to the US Centers for Disease Control and Prevention.

If taken correctly, PrEP works.

However, PrEP only works for HIV and not other sexually transmitted infections. Therefore, preventions for other STIs must always be taken into account

Is PrEP a vaccine against HIV?

No.
PrEP medicine is not injected into the body and does not work the same way as a vaccine

A vaccine teaches the body to fight off infection for several years. PrEP is taken in pill form every day by mouth, and it must be maintained on a daily basis for the protective effect to continue.

Can I also take PrEP now and then rather than every day?

Some studies have found that PrEP is, under certain specific circumstances, also effective if taken intermittently, such as only during periods of exposure. This is sometimes called “intermittent PrEP” or iPrEP.

A 2014 study in France instructed gay men to take a double dose of Truvada (two pills) 2 to 24 hours before they anticipated having sex and then one pill the day after and another pill two days after having unprotected sex.

For men who followed this regimen strictly, this reduced the incidence of HIV by 86% (with a 95% confidence interval of 40%–99%). Although this is a smaller protective effect than taking PrEP every day, the result of the study is still impressive.

The US Centers for Disease Control and Prevention, however, continues to recommend that people who take PrEP should do so continually (every day).

Who should take PrEP?

The US Centers for Disease Control and Prevention recommends PrEP for

  • People who are HIV-negative and at substantial risk for HIV infection. This includes HIV-negative people who are in an ongoing sexual relationship with someone who is living with HIV.
  • Gay and bisexual men who have had sex without a condom or have been diagnosed with an STI within the past six months.

    Based on existing epidemiological data from several Asian cities, a significant number of men who have sex with men and transgender people would qualify for PrEP based on these criteria.
  • People on PrEP remain under medical supervision and test for HIV every three months. PrEP can affect the kidney function, so kidney function tests should be conducted for those on PrEP.

If I start taking PrEP, must I take it for the rest of my life?

No.
People go in and out of periods in which they are at high risk for HIV infection—not everybody is equally at risk or equally sexually active all the time. You can advise friends or clients that if their risk declines or even disappears, they can stop taking PrEP; for example, if they get a boyfriend and enter into a monogamous relationship.

However, if after a few years the relationship ends and they enter into a party mode once again, they can easily go back on PrEP.

How soon after starting PrEP does the protective effect begin?

According to the manufacturer of PrEP, it takes at least seven days for the medicine to reach a sufficiently high protective level in the body.

However, recent French and British studies on intermittent use of PrEP showed that taking a double dose of PrEP 2 to 24 hours before sex, followed by one pill the day after and another two days after having sex had a protective effect of up to 86%. This would suggest that the protective effect of PrEP starts quicker if a double dose is taken.

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Do PrEP medicines have side effects?

For the first few weeks of starting PrEP medication, a minority of users complain about nausea, vomiting, fatigue and dizziness. For most people, these symptoms eventually disappear once the body gets used to it.

One potential danger when using the drug is developing kidney problems.

Another study found that some people taking Truvada had a minor decrease in bone mineral density within the first month of taking it.

Once Truvada was stopped, the bone density appeared to return to normal measures.

These are two reasons why it is recommended to be under medical supervision, with quarterly check-ups to ensure the kidneys and bones remain healthy.

Does PrEP medication change the way the body or face looks?

No.
There is no scientific evidence for this.

If someone starts using PrEP, can they stop using condoms?

Like condoms, PrEP is highly effective at preventing HIV when used consistently and correctly. PrEP only protects against HIV and not other STIs, thus regular testing is crucial.

Some people will keep using condoms while on PrEP and others will decide to stop using them. If you are already using condoms consistently and doing so makes you feel comfortable and protected, then keep doing what feels right to you. Many people struggle with using condoms consistently, which is one reason why PrEP was developed.

But you must decide for yourself what level of protection feels right and gives you the peace of mind to lead a sexually fulfilling life.

Where does someone get PrEP?

To commence on PrEP medication, eligible patients must be issued a prescription by a doctor. PrEP can be obtained from certain pharmacies, clinics, and some government hospitals in Malaysia. Regular consultation and STI testing are part of the regimen for getting a prescription for PrEP.

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What is PEP?

Post-exposure prophylaxis, or PEP, is an anti-HIV medicine that is taken as soon as possible after someone has (or may have) been exposed to HIV to reduce the chance of becoming infected. Anyone who goes on PEP should continue to take themedicine for 28 days.

Who should take PEP?

PEP should be taken only if there is a real and substantial risk that HIV infection might have occurred. For example, if you have recently been exposed to HIV during sexual intercourse.

What is important to consider is also the HIV prevalence in the general men who have sex with men and the transgender population. For example, in a country with few HIV cases, the chance of encountering someone with HIV is much smaller than in a city like Bangkok, where in some saunas, up to 50% of patrons might have HIV.

There is no golden yardstick according to which someone can decide whether to take PEP or not. It depends partly on how worried they are!

How soon after possibly having been exposed to HIV should someone take PEP?

The sooner, the better—but it should be within 72 hours after possible exposure to HIV. The virus may have started to replicate beyond that, and PEP would not be able to work.

Does the availability of PEP encourage risky behaviours?

Some people fear that having PEP as a back-up safety net may lead to people deliberately “forgetting” to use condoms. You should be well aware that, taking PEP is not fun, it is not a game!

First, it can be a hassle to get them via particular channels that frown on using them for this purpose.

Apart from that, side effects while taking it can make you quite sick: note that PrEP and PEP are not the same drugs and that a person who thinks they may have had an HIV exposure should not use PrEP as PEP.

Where does someone get PEP?

PEP is available in selected MOH hospitals with infectious disease physicians, university hospitals and private clinics. In cases of officially reported sexual assault of women, PEP may be made available for free to them.

More resources about PrEP & PEP

New and Effective Way to protect yourself from HIV
Research shows that 99% of people who took PrEP everyday are protected from HIV infection
5 Facts you should know about PEP