Being informed and being able to communicate with partners freely about things like HIV, STIs, condom use, PEP, PrEP, HIV treatments, viral load in the strongest weapon we have to keep ourselves and our partners HIV & STI free.  In this seemingly complex maze of HIV & STI prevention strategies it would be naïve to not look at the bigger picture when making informed decisions on how to best prevent HIV and STI transmission.  So get reading and put yourself in the know!

 

PEP (Post-Exposure Prophylaxis)

PEP is a drug you can take immediately after a possible exposure to HIV to lessen the chances of infection?

PEP is a course of HIV medication which you can take if you have been at risk of HIV infection. The course of HIV medication lasts 28 days and, if taken within 72 hours of putting yourself at risk, may be able to prevent you from becoming infected with HIV. PEP stands for Post Exposure Prophylaxis – it is a form of protection (against HIV) that you can take after you have taken a risk or had a condom break on you.

Where to get PEP

You can get PEP at a GUM sexual health clinic or in Accident and Emergency. A&Es are especially important at weekends because most sexual health clinics will not be open. You must start PEP within 72 hours of putting yourself at risk of HIV, though the sooner you start PEP the more likely it is to be effective.  Please note we cannot provide PEP at Pitstop Walk-in Clinics. For more information visit this site: https://www.gmfa.org.uk/pep

 

PrEP (Pre-Exposure Prophylaxis)

PrEP or pre-exposure prophylaxis involves HIV negative people taking a combination medication previously licensed as "Truvada" as a method of helping to prevent HIV infection. Recent research has shown that if taken 7 days a week PrEP is very, very highly effective at reducing HIV risk. 

PrEP is another layer of defence in preventing HIV transmission, it is particularly effective when used by guys, who regularly engage in unprotected anal sex or have frequent chemsex. PrEP will not prevent other STIs and should be included alongside condom usage as a part of the suite of HIV prevention strategies.

NHS England recently announced that the PrEP IMPACT Trial (where 13,000 people in the UK were given PrEP for free) has been increased to 26,000 places. Information about the trial, and where to go to express an interest in joining it, can be found in the links below:-
https://www.prepimpacttrial.org.uk/
https://www.england.nhs.uk/2019/01/update-on-the-prep-impact-trial/

For further information on getting PrEP via private prescription, buying PrEP online, PrEP Access Fund and information about the medication itself visit these sites:
http://www.iwantprepnow.co.uk/
https://www.iwantprepnow.co.uk/buy-prep-now/
http://prepster.info/
https://prepster.info/buying-prep-online/
https://doitlondon.org/prep/
https://www.tht.org.uk/our-services/online-services/mags-portman-prep-access-fund
https://prepster.info/wp-content/uploads/2018/06/PrEP-QA-booklet-e-use.pdf

If you're already taking PrEP and are buying it from somewhere else (other than a UK clinic) - for example if you are buying PrEP online, or if you are considering starting PrEP, make sure you speak to a sexual health clinician or your GP so you get the best advice about dosing and that you have access to kidney function blood tests to ensure that PrEP is not harming you. 

 

TasP (Treatment as Prevention)

TasP or treatment as prevention, is a HIV prevention strategy which refers to someone who has been diagnosed HIV positive.  If taken effectively HIV treatment can reduce the amount of the virus in a persons body.  When there is so little HIV in a persons body, it is referred to as an 'undetectable viral load' or 'undetectable'  If someone has an undetectable viral load they can't pass on HIV to partners during sex.
http://www.aidsmap.com/Zero-transmissions-mean-zero-risk-PARTNER-2-study-results-announced/page/3311249/

It is possible to rely on an undetectable viral load if:

  • The HIV positive partner has had a sustained undetectable viral load for more than 6 months, does not miss doses of their treatment, and that their viral load is checked by a clinician every 3 - 4 months

Because of these variable factors, it is important that we view TasP as one part of the puzzle in the HIV prevention arsenal.

TasP will not prevent other STIs meaning that condom usage is still recommended to offer protection for yourself and your partners, particularly for those having casual sex, those in new relationships and those in non monogamous relationships.

As a HIV prevention strategy in isolation of all other strategies (such as PrEP and condoms) TasP requires incredibly high levels of trust between partners, high levels of communication and a certain vigilance on the HIV positive partners part to ensure adherence to HIV medications and regular viral load checks. Most studies have therefore taken place with gay couples in a relationship, where one partner is HIV positive and the other is not. 

TasP is most certainly one of the game changers in HIV prevention.  Like most HIV prevention strategies TasP will be a great option for some people but is an unlikely technique to suit all.

To learn more about TasP visit the below links:

http://www.aidsmap.com/Transmission-and-viral-load/page/2258342/

http://www.aidsmap.com/Undetectable-viral-load/page/1320141/

 

 

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