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Pre-Exposure Prophylaxis (PrEP) is the regular use of certain kinds of HIV medications by HIV-negative people to prevent HIV. PrEP is usually taken daily as an oral tablet, but some people use PrEP for shorter periods of time or specific events, such as parties or vacations.
Unlike Post Exposure Prophylaxis (PEP), PrEP is taken before potential exposure to HIV. If taken correctly, PrEP is highly effective at preventing the transmission of HIV.
PrEP does not protect against other STI/BBV or prevent pregnancy and should not replace safer sex practices.
Who should take PrEP?
PrEP is recommended for people who are at risk of acquiring HIV.
PrEP is recommended for
- men (cis and trans) and transgender women who have anal sex with men and do not always use condoms
- people who have a history of sexually transmitted infections such as gonorrhoea and/or chlamydia in the anus or rectum
- people who inject drugs
- sex workers who offer services that have a higher risk of HIV transmission
- people who have unprotected sex with people who use drugs
- have a partner who is living with HIV but has not achieved an undetectable viral load, and you do not always use a condom
- partners of people living with HIV who are trying to have a baby
The guidelines for prescribing PrEP are set by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). They are intended for medical professionals to use. If you would like to learn more about the ASHM PrEP guidelines, you can find them here. You will still need to talk to your doctor about whether PrEP is right for you.
How effective is PrEP?
If you take it correctly, PrEP lowers the risk of HIV infection by 99%. It is important to start taking the pills before having sex with someone who has or may have HIV.
If you already have HIV, taking PrEP does not reduce the risk of transferring the virus to other people through sexual contact or blood. Seeking treatment and using condoms can both reduce the risk.
You may have heard the phrase ‘Undetectable equals Untransmittable’ or ‘U=U’. It refers to the fact that people living with HIV who take antiretroviral therapy (ART) daily as prescribed and who achieve and maintain an undetectable viral load (meaning that the virus does not show up on blood tests) cannot sexually transmit the virus to an HIV-negative partner.
Are there side effects of PrEP?
Side effects are rare, but some people may develop nausea, diarrhoea, or headaches. People with high blood pressure or diabetes may be at increased risk of kidney and liver problems, so your doctor will check these regularly.
Types of PrEP
This is a general overview of the different ways people use PrEP. It is not medical advice, and we recommend you speak to your doctor about what form of PrEP works best for you.
Daily PrEP
Taking PrEP daily involves taking 1 pill daily for lasting protection. If you want to be protected from HIV without having to know when your next sexual encounter may be, you have a generally busy sex life, or you just prefer the structure of routine dosing, daily PrEP can work for you.
On-demand PrEP
PrEP on-demand (sometimes called ‘2-1-1 PrEP’) means taking PrEP medication before you plan to have sex rather than taking it daily. On-demand PrEP offers short-term protection and is usually used for an evening or weekend rather than daily.
On-demand PrEP can work for people who do not regularly have sex or can plan or delay sex (by at least 2 hours). On-demand PrEP can be a good option if the amount of higher-risk sex you have does not justify taking daily medication or if you are concerned about side effects.
Currently, on-demand PrEP is only recommended for cis men who have sex with other men as there is not enough research on its effectiveness for other groups.
If you are planning on using PrEP on-demand, it is recommended that you consult your HIV clinician to determine whether this method is suitable for you.
Periodic PrEP
If you do not want or need to take PrEP long-term, then periodic PrEP could be a good alternative. With Periodic PrEP, you take one pill once daily over a specific period when you want to protect yourself from HIV. It can be for as long as you need and can be appropriate for a shorter period when you think you might be having lots of sex.
Long-term injectable PrEP
Long-acting injectable PrEP is an HIV prevention medication that is injected (instead of a pill) and is effective for a longer time period than the pill. People using this form of PrEP visit their doctor for an injection every two months instead of taking a daily pill.
In August 2022, the Australian Therapeutic Goods Administration approved a drug called Cabotegravir as a long-term injectable PrEP. However, it will still take some time before it becomes available to the public. We will provide updates as they become available.
Accessing PrEP
To access PrEP, you need a prescription from a healthcare professional. All General Practitioners (GPs) and authorised nurse practitioners can prescribe PrEP. Your healthcare professional may ask you about your medical, sexual, and drug-use history to decide whether PrEP is right for you.
They will also require you to do a sexual health check before starting PrEP and 3-monthly HIV and STI testing after you start taking PrEP.
Speak to your doctor about what form of PrEP works best for you.
There are three ways to access HIV pre-exposure prophylaxis (PrEP) in Australia:
1. Through the Australian healthcare system
For an Australian resident with a current Medicare card, PrEP can be accessed through the Pharmaceutical Benefits Scheme (PBS) at a subsidised cost. Any doctor can write a prescription for PrEP, which can be taken to any pharmacy for dispensing. For most people, a 3 month supply of PrEP will cost $127.50 ($42.50 per month). You may be able to pay less If you have a concession card ($6.40 per month) or are an Aboriginal or Torres Strait Islander person.
2. Private prescription for supply from Australian pharmaceutical manufacturer
Any doctor can write a private prescription for PrEP, and patients can get the medication at a pharmacy. The cost of a private prescription is higher than for PBS-subsidised medicines. This option is generally used by people who are not eligible for Medicare and do not feel comfortable using the Personal Importation Scheme described below.
3. Through personal importation or purchase
If a person is not eligible to access PrEP through Medicare or finds the cost of purchasing PrEP locally too high, another option is to buy a generic version of the drug online from a reliable overseas supplier using the Therapeutic Goods Administration’s Personal Importation Scheme. A prescription from a doctor is still required before ordering online.
The PrEP Access Now website has more information on personal importation.
If you are considering PrEP, you should discuss this with a doctor experienced in HIV or sexual health to help decide if PrEP is right for you. If you are considering PrEP, you should discuss this with a doctor experienced in HIV or sexual health to help decide if PrEP is right for you. You can also contact your local sex worker peer organisation for more information.
