Dear Dr Laura,
I’ve seen a lot of chat about PrEP and I think it might be good for me to take, but I’m confused about where to get it. Is it available on the NHS? Does it suit everyone? Are there any side effects?
PrEP (pre-exposure prophylaxis) is a highly effective way to reduce the risk of acquiring HIV by taking HIV medication. Most of the data and experience is using two drugs, tenofovir and emtricitabine, combined in a single pill, and any mention of PrEP from here means PrEP with these two drugs. The branded version of these drugs is Truvada but there several unbranded or generic versions around too. Studies show that taking PrEP every day, or before and after sex (intermittent or event based PrEP), reduces the risk of getting HIV by around 90%. PrEP works, that’s clear. PrEP is not recommended for people at low risk of HIV, for example, if you are a gay man in a monogamous relationship with an HIV-positive man who is on effective HIV therapy with an undetectable virus there is no risk of transmission and you don’t need PrEP; if you have condomless sex with other sexual partners whose HIV status you don’t know then PrEP would be recommended.
The answer to whether it’s available on the NHS depends where on the UK you live:
• Northern Ireland no PrEP on the NHS at the moment
• Scotland PrEP is available on the NHS if you are at high
risk of HIV. In Scotland they are using generic PrEP, which
is cheaper than branded PrEP
• England NHS England, after many, many months of
discussions, decided to not provide PrEP routinely but
instead fund a trial called the PrEP IMPACT trial – more
• Wales is also running a trial but, unlike the one in
England, there is no cap on numbers, which means
anyone eligible for PrEP can get it.
So why is NHS Scotland using generic PrEP when others aren’t? NHS England won’t use generic PrEP routinely but can on a trial. The rules around drug patents and the legality of generics are a complex area so NHS England have decided to await the decision of a European court case on this very issue.
Assuming you live in England you can find out about the IMPACT trial here: https://www.prepimpacttrial.org.uk/ Essentially the trial is expected to provide PrEP to 10,000 people, mainly gay men, though some of the places are reserved for other people at high risk of HIV including heterosexuals and trans individuals. Some clinics have already filled all their places for gay men, some haven’t, some have yet to open – the most up to date information is on the website. If it turns out you can’t get a place at a clinic convenient for you there are other options. Firstly, some clinics are keeping details of people eligible for the trial in case more places become available, however, if you’re at risk now you have two options to access PrEP. The first is to buy branded PrEP privately – 56 Dean Street offers this in London and Same Day Doctor in London and Manchester – you’re looking at a few hundred pounds for 30 days of treatment. Less expensive and, in my view, just as reliable, is to buy generic PrEP. Your options here are:
1) Same Day Doctor: £330 for a month of generic PrEP +
consultation fee http://samedaydoctor.org/service/prep-or-pep-hiv-treatment/
2) 56 Dean Street: £55 for a month of generic PrEP http://dean.st/prepshop
3) IWantPrepNow links to several generics suppliers –
their current preferred supplier is Dynamix and it costs £35 for a month of PrEP https://www.iwantprepnow.co.uk/buy-prep-now
The team at Chelsea & Westminster measured drug levels in people buying generic PrEP online and concluded the medications were real and produced drug levels as good as branded product. My advice would be to go generic and I’ll leave the choice of 1, 2 or 3 up to you. There are likely other private suppliers you can find online and other ways to buy generic – Google away, but if you are going to buy generic drug directly then I can’t think of any reason to not use IWantPrepNow. Importantly, it is entirely legal in England to purchase up to 3 months of any generic drug online for your own use.
You asked if PrEP suits everyone. As I’ve already mentioned, PrEP is only recommended for people at high risk of HIV. Not everyone wants to take a tablet, and condoms, regular testing and knowing your partner’s status are all recommended regardless. If you are worried about taking tablets every day you can go for the event-based option (two tablets before sex and 1 tablet every 24 hours after sex for at least 2 doses, better explained here: http://i-base.info/uk-guide-to-prep/).
PrEP is associated with some side effects. It’s quite common to experience symptoms like nausea and/or tiredness – this is usually mild and tends to get better with time. Uncommon side effects include changes to your kidney function – this will be monitored with urine tests and/or occasional blood tests to check the health of your kidneys. You should have urine and blood tests to check your kidneys before you start PrEP as if you have kidney problems then PrEP may not be recommended. PrEP also causes a very small amount of bone thinning and this returns to normal when you stop PrEP. Finally if you have hepatitis B the drugs in PrEP are also effective against that virus too – stopping and starting PrEP could cause a ‘flare’ (rise in hepatitis B blood levels) so you should check with a doctor before starting and you should take PrEP every day rather than event-based dosing.
So, check online about getting a place on the IMPACT trial; if there are none in your area, visit a sexual health clinic for advice – even if the clinic doesn’t offer PrEP they can give you advice and many will check your kidney tests for you so you can buy it yourself safely online.