The use of PrEP (pre-exposure prophylaxis) for preventing HIV, particularly among gay and bisexual men, has been growing and growing in recent years. But now, with the need to stop hooking up for sex to limit the spread of COVID-19, lots of questions are being asked about what this means if you're taking PrEP.
Current advice from the government on preventing the spread of coronavirus is clear: stay at home and only see those within your own household. This is to not just protect ourselves but to protect the most vulnerable in society and to play a part in reducing the building burden on the NHS, as explained by our medical director Dr Michael Brady.
This also clearly has implications for our sex lives and intimacy. Quite simply, it means hook ups with people we don't live with are off the menu for the time being. So, let's look at some of the most frequently asked questions that we've seen on social media and via our THT Direct helpline.
Do I need to keep taking PrEP even when I'm not having sex?
No, you do not. You can start and stop PrEP any time you like. PrEP is only intended to be used when you are at risk of exposure to HIV. If you're not having sex – you don't need to use PrEP.
How do I stop PrEP?
For cis men (people who were assigned male at birth and still identify as a man) and non-binary people assigned male at birth, you need to keep taking one PrEP pill per day until you have two sex-free days.
For trans women who are not taking gender affirming hormones, you need to keep taking one PrEP pill per day until you have two sex-free days.
For everyone else including cis women (people who were assigned female at birth and still identify as a woman), trans women taking gender affirming hormones, non binary people assigned female at birth and trans men, keep taking one PrEP pill per day until you have seven sex-free days.
How do I restart PrEP?
Cis men and trans women not taking gender affirming hormones can take a double dose (i.e. two PrEP pills) between two to 24 hours before sex then follow up with one pill daily for as long as needed. For some people this will be a return to daily PrEP dosing, for others it might be 'on-demand' use, so remember to keep taking one PrEP pill until you have two sex-free days (as above).
For everyone else, take one PrEP pill per day for seven days before you have sex. Follow up with one PrEP pill per day for as long as needed and remember – you need to take one PrEP pill per day after the last sex, until you have had seven sex-free days when stopping (as above).
If you think you've been exposed to HIV in a period when you haven't been taking PrEP, we recommend that you contact a sexual health clinic and ask about PEP (post-exposure prophylaxis) and that you have an HIV test before restarting PrEP.
What if I want to keep taking PrEP?
We totally understand that PrEP offers a lot of people additional benefits beyond the prevention of HIV. We know taking PrEP can help reduce stress and anxiety around sex and in our lives in general. That is particularly pertinent at this current time.
We appreciate many people will be experiencing unfamiliar worries and concerns. If continuing to take PrEP offers you some comfort and reassurance in this current climate then carry on taking PrEP. We want people to look after their mental health and wellbeing and much as we want them to take care of their physical and sexual health.
Will I still be able to get my PrEP pills?
Clinics are taking a different approach to how they manage things during the COVID-19 outbreak so it's best you contact your local clinic to find out what is happening. Please check their website first and only call or email if you need to.
If you access PrEP via the NHS or a trial you should still be able to get your PrEP pills, but some services may have to ‘pause' things during the lockdown or if they don't have enough staff. Some clinics will be issuing PrEP users with a six-month (six pack) supply so you don't need to come to the clinic as often.
There's no current issue with the supply chain of these drugs and we don't expect to see any shortage or interruption of drug supply for PrEP users or for people living with HIV who also rely on these drugs. You do not need to do anything additional at this time – your clinic will contact you to update you on any changes to their services. Check your local clinic's website for information or give them a call.
If you self-source PrEP (buy it online) you might experience some delays in delivery. It's always advisable to order a PrEP refill at least four weeks before you are due to run out to ensure you have plenty of medication and allow some time for delays. You can be assured that online sellers are doing their best to maintain a smooth and prompt delivery service for their customers.
Will I still be able to get my regular HIV and STI check ups?
There'll be changes to sexual health services and this includes changes to regular monitoring for PrEP users. It's likely that most clinics will move consultations online or by phone. In an effort to reduce unnecessary travel and social contact many sexual health services will move to home testing/home sampling. Check your local clinic's website for information or give them a call.
Will PrEP protect me from COVID-19?
There's no evidence that the drugs in PrEP provide any protection against COVID-19.
A clinical trial in Spain is looking into whether TDF/FTC will prevent COVID-19 or reduce the severity of the illness in healthcare workers. However, doing a trial does not mean that the drugs will work – it just means that it is being explored as a possibility. We don’t advise people to start TDF/FTC to prevent or treat COVID-19.
It's really important people don’t self-medicate with treatments or preventative medicines which have not been through rigorous scientific trials. Currently the best protection remains staying at home, isolating from others and regular hand washing. Our health agencies will issue official advice on new courses of action or treatments. Please follow that advice and trust in the science.
Greg Owen is PrEP Lead at Terrence Higgins Trust.