Pre-exposure Prophylaxis (PrEP)

Pre-exposure Prophylaxis (PrEP) is a pill you can take to protect yourself from HIV. It can be taken by an HIV negative person to reduce the risk of getting HIV from sexual exposure.

PrEP, available through the NHS in England, is a single tablet containing Tenofovir Disoproxil and Emtricitabine. These drugs have been used for many years as part of treatment for people living with HIV.

PrEP has been shown to be very effective at reducing risk of transmission of HIV infection from sexual exposure. If it is taken as directed, it is likely to be over 98% effective.

For men who have sex with men (MSM), a study done in England has shown that use of emtricitabine/tenofovir (brand name Truvada) as daily PrEP reduced HIV infections by 86%. In a study with gay men in France, PrEP taken before and after sex also reduced infections by 86%.

For heterosexual men and women, in a study done with couples in Africa, it reduced infections by 75%.

However, most cases where PrEP did not work were likely because the people did not take the pills as directed or they forgot to take them.

Read more detailed information from AidsMap.com

PrEP does not protect against other sexually transmitted infections such as Syphilis, Gonorrhoea and Chlamydia.

Most people taking PrEP do not report any side effects. Some people may notice feeling sick, loss of appetite, bloating, diarrhoea or headache. If you do get these they usually settle quickly.

In some people, PrEP can affect how the kidneys work. The risk of this is higher if you are older, if you are already known to have kidney problems, have other medical conditions that can damage the kidney (e.g. diabetes, high blood pressure) or if you are taking certain other medications. Your kidney function will be checked regularly whilst on PrEP. If changes do occur, they are often reversed when the PrEP is stopped.

In some people, PrEP can reduce the mineral density of bones which can make them more fragile to potential fractures (breaking your bones). This has been reported in 1-5% of people taking PrEP and again the change reverses when PrEP is stopped.

If you live in England and are over 16 years old, and you haven’t previously been told that you have HIV infection, you can access PrEP if any of the following apply:

• You are a man who has anal sex with other men without condoms.
• You are transmale or transfemale and you have anal sex or front sex without condoms.
• Your regular partner is living with HIV which is not fully controlled on treatment.
• You have sexual partners who are at higher risk of HIV (for example, from a country where the number of people living with HIV is high).
• People who inject drugs, who do not have access to clean needles.

PrEP has been available on the NHS in Leeds since October 2020 and is supplied by Leeds Sexual Health free of charge. Previously, PrEP was available through the PrEP IMPACT trial. Anyone who was in this trial can continue to receive PrEP from sexual health clinics. PrEP is available to purchase online privately, but we recommend monitoring through a sexual health clinic if you choose to do this. You must have a negative HIV test prior to starting (ideally within the previous month).

For males having anal sex with other men:

1. Daily PrEP :

Take one tablet once a day at the same time every day.

If you are starting daily PrEP and think you might have a risk within the next few days, start with a double dose (2 tablets taken together at least 2 – 24hrs before sex). Otherwise use a condom for the first 7 days to be protected. To stop PreP safely take it for at least 48 hours after your last sex.

2. On demand or Event Based Dosing (EBD) (not suitable if you have Hepatitis B):

• Take 2 tablets (Double-dose) of PrEP 2-24 hours before sex.
• Then take a single dose of PrEP every day until last episode of sex.
• Continue a single dose every day for a further 48 hours.

3. T’s and S’s regimen: (only recommended for those who want to minimise their PrEP exposure but do not want to take EBD & not suitable if you have Hepatitis B)

Start by taking one tablet every day for 7 days. You are protected against HIV after the first 7 days. Then drop down to taking one tablet on Tuesday, Thursday, Saturday and Sunday every week (4 tablets per week. Take tablets on days beginning with T and S). To stop PreP safely take it for at least 48 hours after your last sex.

This method means there is less of the drug in you and so a missed dose may mean you are not protected. This method has the least evidence to say it is effective.

For Heterosexual men and women, Trans men and women & those who inject drugs:

DAILY PrEP is recommended based on the evidence we have.

1. Daily PrEP :

Take one tablet once a day at the same time every day.

You need to take the tablets for 7 days to be covered against HIV. So for the first 7 days, you should use condoms. If you want to stop PreP, continue PreP for 7 days after the last sex before stopping.

PEP is Post Exposure Prophylaxis, which is medication taken to prevent HIV transmission after sex. It is started as soon as possible after sex, and no more than 72 hours later. You may need this if you know you have missed doses of your PrEP. It is available from Leeds Sexual Health or A&E if we are closed.

For males having anal sex with other men - when do you need PEP:

• If you usually take PrEP daily, ask about PEP if you have anal sex and you know you have taken less than 3 tablets in the last 7 days. If you have taken 3 in the last 6 days, and today is day 7, take a dose now and continue daily as normal.
• If you usually take PrEP event based (EBD), ask about PEP if you have not taken the tablets as recommended for event based PrEP

For Heterosexual men and women, Trans men and women & those who inject drugs – when do you need PEP:

• Ask about PEP if you have taken less than 6 tablets in the last 7 days or it has been more than 48 hours since your last dose.

PrEP can interact with other medications which can lead to serious side effects. Please check with us before you start any other medication, including over the counter medication, herbal medication and internet sourced drugs.

You will need an HIV test and sexual health screen every 3 months. The clinician may recommend other things including Hepatitis virus testing, kidney function testing, and vaccines

Read another useful resource from I Want PrEP Now.

Contact phone numbers:

If you would like to start PrEP please call us on 0113 8434495.

If you already take PrEP from Leeds Sexual Health, we have now started e-consultations for you to get your PrEP. This means you fill in a questionnaire on your phone or computer and send it back to us. We will organise a time for you to have a check up and pick up PrEP. This is not appropriate for everyone and you may want to come in for a clinic appointment anyway.

If you would like to use our PrEP e-consultation please access our SystmConnect page.

If you would like to come to clinic for a PrEP follow up appointment or have questions (eg. side effects, missed doses, how to take), please ring us on 0113 843 4495.

Please use condoms if you run out of PrEP before your appointment.