Demystifying PrEP: What to do if you know you might become exposed to HIV

By Karl Mikkelsen

A new HIV prophylaxis is expected to be distributed to several HIV/AIDS organizations throughout Uganda in 2017, including Reach Out Mbuya Parish HIV/AIDS Initiative. Pre-exposure Prophylaxis, or PrEP, is an ARV that can be taken to prevent HIV infection, and should be used together with other preventative measures.

In 2012, WHO released guidelines for the use of PrEP, advising that the drug should be available to discordant couples (couples where one is positive and the other is negative) and MSMs (men who have sex with men) only. Last year, the guidelines were changed, and WHO now advises medical workers to prescribe PrEP to anyone who is in a substantial risk at acquiring HIV. The new guidelines state that people should be given access to PrEP if they are:

  • Engaging in sexual relationships with several partners at once,
  • Engaging in transactional sex (sex where something is given in return),
  • Using or abusing injectable drugs and alcohol,
  • HIV-negative but have a positive partner,
  • Using PEP (Post-exposure prophylaxis) frequently,
  • Engaging in anal sex,
  • A part of a key population (sex-workers, truck-drivers, fishermen, soldiers, etc.),

 

How does PrEP work?

PrEP prevents the HIV DNA from entering your blood cells, thereby preventing the virus from spreading in your body. It is important to understand that PrEP must be taken before a possible contraction of HIV, otherwise it will not work.

 

Where can I get PrEP?

Even though PrEP will not be distributed to public healthcare facilities in Uganda, it will be accessible from several HIV/AIDS organizations, including Reach Out Mbuya. If you feel that you are at risk of contracting HIV, or if you fall under one of the categories mentioned above, please talk to a doctor or clinician from one of these organizations.

 

What is the success rate of PrEP?

Studies show that the success rate of PrEP is purely based on the client’s adherence. If the client does not adhere well or fails to take their medication, PrEP will most likely not protect them from infection. If on the other hand, the client has good adherence and takes their medication every day at the same time as the day before, the success rate is over 99%. However, the average success rate of PrEP is 51%, meaning that a lot of people on PrEP are not currently adhering well.

 

Is it possible for the HIV virus to become resistant to PrEP?

Studies show that the HIV virus cannot become resistant to PrEP, if the client starts PrEP before they are infected. If a client is already HIV-positive and starts a PrEP treatment, the virus can develop resistance to the drugs. It is therefore very important that you are 100% sure you are HIV-negative before starting PrEP.

 

How long does it take for PrEP to work fully?

After 7 doses of PrEP (taken over 7 days), the drugs should provide maximum protection from HIV infection. Some studies show that the drugs provide full protection for only anal sex after 4 doses, but it is advisable to wait for 7 days before engaging in sex of any kind. If you are exposed to HIV before the 7 doses of PrEP, you are advised to switch to PEP (Post-exposure Prophylaxis) immediately.

 

I am no longer at risk of contracting HIV. When should I stop taking PrEP?

You should continue taking PrEP for 28 days after your last sexual encounter where you were at risk of HIV infection. If you stop taking PrEP before the 28 days have passed, the HIV-virus has a chance to infect your cells with HIV DNA, resulting in the virus spreading in your body.

 

My partner is HIV-positive and I am negative, but on PrEP. When can I have sex with him/her without risking infection?

If your HIV-positive partner adheres to his/her ARV-treatment, it should take approximately 6 months for his/her viral load to be suppressed, meaning he/she is no longer contagious. Your partner should ALWAYS test his/her viral load before you engage in sex or stop taking PrEP, in order to be 100% sure that his/her viral load is fully suppressed.

 

 [photo credit http://www.avert.org] 

 

 

 

 

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