What is HIV PrEP?
Use of oral anti-retroviral drugs by HIV-uninfected people to block the acquisition of HIV before exposure to HIV.
Why HIV PrEP?
Many trials have been conducted to determine the effectiveness of oral HIV PrEP across couples of all orientations. When patients follow the treatment and prevention strategies closely, significant prevention of HIV levels was achieved
In 2014, WHO (World Health Organisation) developed consolidated HIV guidelines for key populations, including men who have sex with men, sex workers, transgender people. In those guidelines, HIV PrEP was strongly recommended for men who have sex with men (MSM).6
During travel, the risk of acquiring HIV is the result of a change of HIV prevalence at the destination, and more importantly the change of sexual behaviour abroad and the increase of risk-taking behaviour. Studies have shown that amongst the MSM community, awareness of a special form of PrEP use, often described as “holiday PrEP” is becoming increasingly popular. This holds true even for MSM who do not consider themselves to be at high risk for HIV.7
Prior to starting PrEP, your doctor will do blood tests to monitor your kidney and liver function, a full STI screen if you have not had one recently and also an HIV test.
Subsequently when on PrEP, your renal function will be monitored every quarter. Long-term PrEP use will also require monitoring of your bone density.
How you take your PrEP depends on10:
- how far in advance you plan on having sex
- how regularly you have sex.
It does not necessarily depend on how much sex you have.
There are 4 Different Ways to Use HIV PrEP
There are 4 different ways to take PrEP, we discuss this further below:
1.) Daily PrEP
Daily PrEP Regimen:
- Lead in time 7 days.
- Taken daily at the same time +/- a few hours ok
- Anal, Vaginal/Frontal sex
- Can be taken any time of the day with or without food
- In the event a pill is missed, adequate protection is still conferred.
2.) On-Demand PrEP (Event-Based Dosing)
On-Demand PrEP Regimen:
- Planned condomless sex 24 hours in advance:
- take 2 pills 2 – 24 hours before sex
- take 1 pill 24 hours later
- take 1 more pill 24 hours after that
- If having sex for an extended period of time, perhaps over a few days or a weekend, continue to take a pill every 24 hours until you have 2 sex-free days.
- Only for Anal sex and NOT for Vaginal/Frontal sex
- This option is not recommended if you have an active hepatitis B infection. The drugs in PrEP also suppress the hepatitis B virus and so starting and stopping PrEP can cause viral flare-ups and liver inflammation.
3.) Ts and Ss (Tues, Thurs, Sat, Sun dosing)
Ts and Ss Regimen:
- Daily dosing for 7 days,
- then dropping down to 4 pills per week on Tues/Thurs/Sat/Sun
- Only for Anal sex NOT for Vaginal/Frontal sex
- If you only have sex once or twice a month, you might not want to take a pill every day.
- 4 pills per week will maintain a good baseline of the drug in your system and you can choose to increase up to daily 7 pills per week when you know you’re in a more sexually active period.
- Some people using PrEP On Demand find that they might be taking 4 pills per week most weeks of the month and so opt for structuring this into the Ts and Ss instead.
4.) Holiday PrEP
Holiday PrEP Regimen:
- PrEP before a pre-planned block of time when your risk of exposure to HIV will be higher due to:
- an increased number of partners of unknown HIV status
- situations where condoms are not easily or always used
- where alcohol or substances might be used
- having sex while travelling to a country with a high HIV prevalence
- Based on a 7-day period we recommend 7-7-7:
- 7 days daily dosing before the period
- 7 days daily dosing during the period (or for as long as the specific period lasts)
- 7 days daily dosing after the period.
- Anal, Vaginal/Frontal sex
- 7 days of PrEP before and after your last sexual encounter for several reasons:
- 7 days lead-in provides adequate levels for both anal and vaginal or frontal sex.
- 7 days lead in before the holiday or travel will allow the body to adjust to any possible side effects, most people do not experience any and these should have subsided within a week.
Worry Less, Worry Free!
PrEP is an ‘opt-in’ treatment – it is not meant to be taken forever.
Trying to stay HIV negative during the holiday or trip result in an anxious and stressful experience.
Your peace of mind and release from this stress and anxiety is important so that you can enjoy the moments that matter with your partner!
Safe Trip and Have Fun!
This article was written by Dr Tan & Partners, in collaboration with Oogachaga.
- Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. International Journal of Infectious Diseases. 2010;14(10):e842–51.
- Svensson P.,et al. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Medicine and Infectious Disease. 2018; Jul – Aug;24:65-88
- Riddell Jt, Amico KR, Mayer KH. HIV Preexposure Prophylaxis: A Review. Jama. 2018;319(12):1261-8.
- WHO Guidelines Approved by the Guidelines Review Committee. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. Geneva: World Health Organization Copyright (c) World Health Organization 2015.; 2015.
- Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS and behavior. 2016;20(7):1400-7.
- Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, et al. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. Tropical diseases, travel medicine and vaccines. 2016;2:25
- Hampel B, Reinacher M, Fehr JS, HIV pre-exposure prophylaxis (PrEP): Is it time to rethink HIV prevention in travelers?, Travel Medicine and Infectious Disease (2018), doi: 10.1016/j.tmaid.2018.06.008