Frequently Asked Questions
- What is PrEP?[+]Pleasure and sexual intimacy are important, whether it’s with your long-term partner or with someone you’ve just met. They are important for everyone, whatever your gender identity or sexual orientation.
PrEP (Pre-Exposure Prophylaxis) is an internationally recommended daily prevention pill for HIV-negative people who are especially vulnerable to getting HIV. Taken daily, PrEP is up to 99% effective at preventing HIV.
Many people who take PrEP report they experience peace of mind while having sex. That peace of mind brings relief from the intense fear — and stigma — of HIV that has characterised our sexual lives for far too long. PrEP users also report feeling safer in their relationships and more in control regarding their sexual health and wellness.
You can read about other ways to reduce your risk here.
- Is PrEP for me?[+]PrEP is about self-determination. It’s another tool you can choose to make your sex life safer and take control of your sexual health and wellness. PrEP is designed for people who are HIV-negative and vulnerable to getting HIV. PrEP is for people that are sexually active and may come in contact with HIV. PrEP can also help people who inject drugs stay HIV-negative.
You might consider PrEP if:
- You don’t always use condoms when you have intercourse with partners of unknown status. “Always” means every time, not sometimes. Unknown status is someone who hasn’t had a recent HIV test.
- You have been diagnosed with a sexually transmitted infection in the last six months.
- You’re unsure of the HIV status of your sexual partners.
- You're in a relationship with an HIV-positive partner who may or may not be on HIV treatment.
- You are in an open relationship where condoms aren’t always required.
- You are a person who injects drugs, or you’re in a sexual relationship with an injection drug user and don’t always use new needles and works.
- You’re HIV-negative and interested in PrEP.
You can read about other ways to reduce your risk here.
- Am I eligible to take part?[+]You are eligible to take part if you are HIV negative male that has sex with men, are at least 18 years of age, and are currently at risk of acquiring HIV through sexual practices.
You are considered to be at risk of HIV if in the last three months:
- you have had anal sex without a condom with a male partner who is known to be HIV positive; or
- you have had receptive anal sex without a condom with partners whose HIV status you don’t know; or
- you are an uncircumcised man and have had insertive anal sex without a condom with male partners whose HIV status you don’t know;
- you have been diagnosed with rectal gonorrhoea, chlamydia or infectious syphilis;
- or you have had a history of methamphetamine use.
Note: If you are diagnosed with HIV at enrolment you will be supported with clinical care.
- Does PrEP work?[+]Several large clinical trials have shown that have shown that daily use of Truvada (tenofovir plus emtricitabine) or tenofovir alone reduced HIV transmission. Among gay men in a large PrEP study for example, daily dosing was equivalent to a 99% reduction in HIV risk, whereas taking less than 4 doses per week was associated with a 76% reduction in HIV risk. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently.
- How long after I start taking the pills do they become effective?[+]When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP reaches maximum protection from HIV for receptive anal sex at about 7 days of daily use.
For all other activities, including insertive anal sex, vaginal sex, and injection drug use, PrEP reaches maximum protection at about 20 days of daily use.
This advice is adapted from HIV Basics by the Centers for Disease Control and Prevention.
- Do I need PrEP if my partner is on treatments?[+]If you are in a steady relationship with an HIV-positive partner you should discuss with your doctor whether PrEP is a good idea for you. Recent studies among both gay and heterosexual couples where one partner was HIV positive found that the chance of HIV transmission to the other partner was reduced dramatically when the HIV-positive partner was on treatments and had an undetectable viral load.
- What are the side effects?[+]Many people who take PrEP say they haven’t had any side effects, but like with any drug, there are some reported side effects to consider.
Short term: Approximately 10% of people taking PrEP initially experience mild side effects, such as nausea, diarrhoea and headaches. These tend to go away quickly.
Long Term: A small number of people taking PrEP may experience changes in their kidney function and in their bone density. These side effects are not common.
It is important to see your health care provider regularly so they can monitor you for all potential side effects and help you stay healthy.
- How much does it cost?[+]If you are eligible and you decide to take PrEP, you will be required to pay $5 per prescription. You will need to pay this amount every 3 months, at the time you fill your prescriptions from Auckland Sexual Health pharmacy.
- How often do I have to go to the clinic?[+]After the study entry visit you will have a one month check-up and going forward you will need to see your doctor every 3 months (90 days). At this visit you will have sexual health tests and be given a new prescription for Truvada – which you will need to take to the Auckland Sexual Health pharmacy to be filled.
- How do I enrol?[+]You need to make an appointment to see a doctor at Auckland Sexual Health (Greenlane). Please advise the clinic at the time of making an appointment that you are interested in participating in the NZ PrEP Project.
- What happens at the end of the project?[+]This project provides PrEP to eligible participants for one year. After that time active follow up will end. Supply of the drugs will also stop after one year.
- Do I need to take a pill every day?[+]Yes. The results of the effectiveness of PrEP have come from clinical trials based on daily dosing. People who took the pills daily (or almost every day) were much less likely to get HIV than those who took their pills less often. Among gay men in a large PrEP study for example, daily dosing was equivalent to a 99% reduction in HIV risk, whereas taking less than 4 doses per week was associated with a 76% reduction in HIV risk.
- Can I stop and start the pills?[+]No. It’s important that you maintain high enough levels of the drugs to provide protection in case of exposure to HIV. This means taking the pills regularly. Taking the pills occasionally (for example, only around the time of having sex without condoms) with partners whose HIV status you don’t know will not provide sufficient protection.
If you stop taking the pills completely for a period of time, it is possible to start taking them again during the period you are part of the project. However, during the time you are not taking the pills you will not have the additional protection of the drugs against HIV infection. Please call the clinic you attend for further advice if this occurs.
If you just miss a dose or two, you should continue take to PrEP as normal. Everyone has trouble remembering to take pills, and it is very unusual that you will take all the pills exactly as directed. If you forget to take a pill, take it as soon as you remember that day. Do not take more than one dose of Truvada in a day.
- What does it involve?[+]
For everyone who is offered PrEP (whether you accept or decline):Everyone who is offered PrEP will be asked to complete an online survey that includes questions about their sexual practices, current relationship status, HIV/STI testing history, attitudes to PrEP, and use of conventional methods for preventing HIV. Your responses to the online survey are confidential and are not provided to your doctor. Everyone who completes the survey will have their HIV and STI test results accessed by the research team for up to 24 months
For people who decide to take PrEP only:Before you start PrEP you will have a full clinical assessment. This assessment involves a discussion of your medical history, previous sexually transmissible infections, and current sexual practices. You will also have a sexual health check (for gonorrhoea, Chlamydia and syphilis), and blood tests for HIV, hepatitis B, electrolytes, and liver function. You will meet with a peer educator who will be able to answer any questions you have about PrEP and HIV.After starting PrEP you will see your doctor every 3 months (90 days) for a period of one year to discuss and evaluate side effects, drug toxicity, adherence to the dosing requirements and your sexual behaviour. At each of these visits you will have a sexual health check, and blood tests for HIV and to measure the levels of Truvada in your blood. On the day of this visit (or soon after) you will fill out a short online survey on your experiences of taking the pills and your sexual practices since your previous visit, and of your overall satisfaction with the project.
- Can I withdraw if I change my mind?[+]You can stop your involvement in NZPrEP at any time. If you decide to withdraw from the project we ask that you advise your doctor immediately. We would also be interested in recording your reasons for withdrawing from the project—for example, whether your circumstances have changed, or you had a negative experience.
You can choose either to withdraw completely from the study or simply to stop taking PrEP but remain in the follow-up arm.
Your decision to stop will not affect your relationship with your doctor in any way.
If you decide to withdraw after you have already started taking the pills we recommend you continue taking the pills for 28 days after your last possible exposure to HIV. After you stop PrEP, the duration of protective levels of the study drug (Truvada) is not known but some studies have shown protective levels can last for up to 6 days.
You will have an HIV test one month after you stop taking the pills and another HIV test two months later.