Unless you’ve been hiding under a very large rock for the last twelve months, you’ve experienced just how much fun living through a pandemic can be (spoiler: it’s rubbish). However, a lot of people forget that we’ve technically been living through a different pandemic since the 1980s—HIV still infects more than 1.7 million people a year. Originally, the AIDS crisis was a threat looming over the heads of every member of the LGBTQ+ community, but nowadays, medicine has come a long way to develop treatments that make sex safer for everyone and allow HIV-positive people to live full, happy lives. One such treatment is pre-exposure prophylaxis, otherwise known as PrEP.
What is PrEP?
The PrEP pill is a revolutionary treatment that, if taken correctly by an HIV-negative person before they have sex, reduces the risk of catching HIV from unprotected sex by up to 99%. It can also prevent contraction of HIV from intravenous drug use with a success rate of up to 70%. It’s different from PEP (post-exposure prophylaxis), which is taken after sex when someone is concerned they may have been exposed to HIV to prevent them contracting the disease.
As of December 2020, over 900,000 people globally use PrEP, with around 200,000 people using it daily in the US, and just under 20,000 in the UK. In South Africa, there’s been a huge spike recently, and they now have over 100,000 regular users. However, PrEP is incredibly expensive in many countries, which makes it hard for people who can’t afford to shell out thousands a month to access it when they need it.
How does it work?
Since HIV acts on the human body by disabling the immune system, we cannot fight it off on our own—that’s why it’s so damn hard to get rid of. The PrEP pill contains antiretroviral drugs, which are the same drugs taken by HIV-positive people to treat their HIV. PrEP essentially acts like a bouncer for your white blood cells, preventing the virus from entering the cells that it usually destroys (CD4 cells). With the virus being blocked from getting into the cell, it can’t replicate itself inside of them—and therefore can’t spread and infect the rest of the body.
While PrEP can protect you from HIV, it cannot protect against any other STIs, nor can it prevent pregnancy in people with uteruses—so it isn’t a substitute for other forms of protection. It’s always best practice to wear a condom to ensure that you’re as safe as possible from passing on or contracting STIs. But if that isn’t an option for any reason, PrEP is a good safety net to have against the risk of HIV.
How do I get it?
Before last year, it wasn't very easy to get your hands on PrEP. It’s still very expensive in many countries, with a 30-day supply costing up to $2,000 in the U.S. Throughout Europe it costs a much less eye-watering but still pretty expensive fee of between $20 and $150 a month, and it wasn't available for free on the NHS across the whole UK until October 2020. However, there will likely be a waiting list to access the pill, as many clinics will take a while to stock up.
How do I take it?
First, always discuss with your doctor if PrEP is the right choice for you. You’ll need to take an HIV test before taking the pill to make sure you’re HIV-negative. You’ll also have to get a kidney function test, as a very small number of people develop issues with their kidneys when they use PrEP, and a test for Hepatitis B.
There are four ways to take PrEP, depending on how far in advance you plan on having sex, how regularly you have sex, and your budget. There’s a different stroke for every type of folk, so take your pick!
PrEP has a lead-up period, meaning it needs to be taken daily for four to seven days before you have sex so that it reaches an effective level in the blood and the rectum. People with a vagina may need to take PrEP daily for up to three weeks before it becomes fully effective, as the drugs are absorbed more slowly in vaginal tissue compared to rectal tissue.
If you take PrEP daily, it’s best to take it at the same time each day. A few hours later or earlier than usual is also fine, though. With daily doses of PrEP, it’s possible to miss a pill occasionally and still have enough protection—but still try to make it a habit, like cleaning your teeth or actually drinking water.
If you’re planning on having sex in the next 24 hours (lucky you), take two pills between two and 24 hours before sex. Then, take one pill 24 hours later, and take one more pill 24 hours after that.
If you’re going to be having regular sex over a couple of days (even luckier you!), keep taking one pill every 24 hours until after your second sex-free day.
If you’re using this method it’s really important not to miss any doses—otherwise, you might not be fully protected from HIV.
If you only have sex once or twice a month, it might not be practical for you to take a pill every day. This alternative dosing method involves daily dosing for seven days, then dropping down to four pills per week, often recommended to be taken on Tuesdays, Thursdays, Saturdays, and Sundays. It might be easier to remember that these are the T and S days of the week, which are of course the initials of our lord and saviour Taylor Swift.
Four pills per week will maintain a good baseline of drug in your system for sporadic sex, which can be increased to daily dosing if you become more sexually active. This is also a cheaper dosing method, as it practically halves the number of pills taken a month, subsequently halving the cost. If you live in a country like the US where PrEP is very expensive, this dosage method could be a more affordable way to protect yourself and also have enough money to pay rent.
This method isn’t really applicable at the moment thanks to Miss Rona (cry), but if you’re going on a holiday once the pandemic is over where you might have more sexual partners with an unknown HIV status, or going to a country with a high prevalence of HIV, you can use a shorter-term intensive dosing method to ensure safety. Take PrEP daily for 7 days before the holiday, for every day of the trip, and then for 7 days daily afterwards too. Then send me pictures so I can live vicariously through you.
What’s it like to take PrEP?
PrEP, like most medications, can trigger minor side effects, including nausea, tiredness, gastrointestinal symptoms, and headaches. These are usually only experienced during the first few weeks of taking PrEP, however, and should clear up soon after that.
I spoke to Patrick*, a 20-year-old who has been taking PrEP for over a year, about the side effects he experienced. He noted, “I didn’t really get any side effects except for a bit of nausea at first, although the main negative side effect for me was the culture around it. Men expect you to be on PrEP and I think that contributed to my decision to go on it.”
Despite all the benefits of taking PrEP, many people are hesitant to take it, and worry that their friends or family will disapprove, or that they’ll be slut-shamed.
Patrick told me he’s glad that he takes it, as it makes him feel safer.
“A huge benefit of PrEP is that with the nature of casual sex and drunk sex, it’s very easy to just forget about protection or give in to pressure from someone who doesn’t want to use it. It takes a weight off your shoulders to know that of all the things that could show up on your test results, a deadly virus that stole a generation from us is not one of them, which probably says a lot more about the cultural legacy of AIDS than how deadly HIV is today with the medicine available to us.”
All in all, PrEP is a wonderful resource for the queer community that allows people to live and love without fear of contracting a potentially deadly disease. Whether you decide it’s the right choice for you and your lifestyle or not, it’s encouraging to be living in a world where help is available if you need it. However, progress still needs to be made to make PrEP cheaper and more widely available worldwide, and to spread the word about the drug.By getting information about the pros and cons of PrEP out into the general conversation surrounding sexual health and protection, it allows more people to have the option to take it, and potentially save their own life. The more people who know about it, the closer we get towards wiping HIV out for good.