Dr Fiona Bisshop

PrEP, or Pre-Exposure Prophylaxis, is a pill you take once a day to prevent infection with HIV.  It’s been in the news a bit of late, and you may be wondering if it’s right for you.

In some parts of the world, a large percentage of men in the gay population are taking it, and it only takes a quick look on hook-up sites when you’re travelling to realise how widespread its use has become.  In fact in many cities it has become the norm for gay guys to be on PrEP, and if you’re not on it you might even be rejected as a potential sexual partner.

Some guys think of it as an extra layer of protection against HIV, but many guys are taking it instead of using condoms, relying on PrEP to protect them.  So are they right to be this confident?

Well, let’s look at the statistics available.

PrEP is currently used by thousands of men all over the world, mostly through demonstration projects where there is collection of data around prevalence of STIs and HIV.

So we know that so far in the years since it was first rolled out there have been 3 people who have acquired HIV whilst on full PrEP (taking their pill properly every day).  The first 2 cases turned out to be infection with resistant virus, which means the virus they came in contact with was already resistant to the drugs in PrEP.  This can happen if someone with HIV has had a number of treatment failures in the past, which have caused resistant virus to replicate in their body.  Both of these cases occurred in the USA.  The third recent case was actually infection with a non-resistant virus, the first such case reported, and no one knows how it occurred.  Some have speculated that in this particular case the guy involved was extremely sexually active, so potentially had a very high exposure rate.

Despite these 3 failures of PrEP, we are now starting to see decreased notifications of HIV in regions where PrEP is used.

I guess what we can say is that although PrEP is not a failsafe, it does appear to offer a high level of protection against HIV.

My advice is still that using condoms when you can, in combination with PrEP, is probably the best protection you can get apart from celibacy!

If you’re unsure, have a conversation with your sexual health doctor about it.  PrEP is available throughout Queensland via a demonstration project, and you can look for your nearest provider on the HIV Foundation website.