PrEP is the use of antiretroviral drugs by HIV negative people to greatly reduce the risk of contracting HIV upon exposure. Unlike PEP, PrEP is taken before any potential exposure to HIV and is usually taken on a daily, ongoing basis. If taken correctly, PrEP is highly effective at preventing the transmission of HIV. Currently there are two ways to access PrEP: you can get a prescription from your doctor and either purchase the drug over the counter or import the drug into Australia by ordering online.
PrEP is now available through the Pharmaceutical Benefits Scheme (PBS). This means people with a Medicare card who have a script from a doctor can buy PrEP from any Australian pharmacy at a subsidised cost. You will still need to pay a co-payment. If you do not have a Medicare card, you can purchase PrEP online and import it from overseas for a cheaper price. However, you will still need to get a prescription from a doctor.
Unlike condoms, PrEP does not protect against other STIs or pregnancy so the use of PrEP may be less applicable within a sex work context. If you are on PrEP, you should talk to your doctor about a regular HIV and STI testing schedule that is suitable to your specific needs. However, if you think or know you have been exposed to an STI, it is recommended you get a STI test in 7 days.
If you would like to know more about PrEP, including how best to access PrEP, contact your local sex worker organisation.
Additionally, refer to the HIV & AIDS page for more information.
PrEP on Demand
You can adjust the way you use PrEP to only use as it is needed. Usually, the way you take PrEP depends on the type of sex you have (anal or vaginal/front hole sex), how regularly you have sex, and how far in advance you know you will be having sex. This section will focus on ‘PrEP on demand’.
PrEP on demand refers to taking PrEP medication before you plan to have sex rather than taking it on a daily basis. It is suitable for people who have intermittent sexual activity and can plan when they have sex and the type of sex they will be having.
This method is only recommended for cis men who have sex with men. PrEP on demand is currently not recommended for any other group.
PrEP on demand is not recommended for trans and cis gender women (including when engaging in anal sex) and men having vaginal or anal sex with women as there is insufficient evidence testing the effectiveness of this way of taking PrEP. For cis gender women, PrEP adherence needs to be higher and more consistent to ensure the drugs reach adequate levels in the vaginal tissue to provide effective protection from HIV. Additionally, it is recommended that people with hepatitis B take daily PrEP to prevent flare ups of hepatitis B infection and to reduce the risk of developing drug resistant hepatitis B. For these reasons, trans and cis gender women, men having vaginal or anal sex with women, and people with hepatitis B are recommended daily PrEP. For people who engage in spontaneous sexual activity without using other forms of HIV prevention strategies, daily use of PrEP is also recommended.
It is argued that the same evidence used to understand the effectiveness of PrEP on demand for MSM can be used to understand the effectiveness of this method for transmen who only have anal sex with cis men. This would indicate that PrEP on demand could also provide adequate protection for transmen who only have anal sex with cis men. However, due to a lack of research specifically testing the effectiveness of PrEP on demand within this population, the Australian PrEP guidelines only explicitly recommends PrEP on demand for cis men who have sex with men. Transmen at risk of HIV can access daily PrEP.
Generally, PrEP on demand users are recommended to:
- take two PrEP pills together between 2-24 hours before sex.
- then 24 hours after the first two pills, take one pill daily until 48 hours have passed after the last time you have sex.
- if you plan to have sex again before 7 days have passed since the last time you had PrEP, you only need one initial PrEP pill 24 hours before sexual activity.
- if you resume sexual activity 7 days after the last time you used PrEP, then you need to take 2 PrEP tablets 24 hours before sexual activity, followed by one PrEP pill a day until 48 hours have passed since the last time you have sex.
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.