In the latest COVID sex guidance released by the Australasian Society of HIV, Viral Hepatitis & Sexual Health Medicine (ASHM) was a brief mention of new cases of HIV in Australia in people who had stopped PrEP during the pandemic when social distancing recommendations commenced.
Across my own patients I have seen many men who had stopped taking PrEP as they were not having sex during the lockdown. With restrictions easing some people are starting to explore sex again, albeit tentatively as the threat of Coronavirus still very present.
With the reintroduction of sex, PrEP also needs to be reintroduced. The question for many patients is “if I am not having sex that often, do I need daily PrEP or just ‘PrEP on demand’ “? PrEP on demand is also called ‘event based PrEP’ ‘intermittent PrEP’ or ‘2, 1, 1 PrEP’.
Both daily PrEP and PrEP on demand are effective protection against HIV infection however PrEP on demand has some finer points that are important to be aware of.
PrEP on demand has been proven to be highly effective in preventing HIV infection in CIS men who have sex with men.
PrEP on demand is not recommended for heterosexual or trans men and women – daily PrEP is the recommended regimen for these people.
If you are living with Hepatitis B daily tablet is the safest way to take PrEP.
How to take PrEP On Demand
PrEP on demand requires your sex life to be predictable, at the very least to have a 2-24 hour window of notice before you have sex.
To initiate PrEP on demand you need to take 2 tablets of PrEP at the very least 2h before you have sex. This ensures you will have adequate concentrations of the medication to protect. After this initial dose you need to take 1 tablet of PrEP every 24h till 2 days has passed since your last sexual activity.
To help people with reminders Gilead have developed an app PreventR (click to see in apple app store or here for the google play store) to help create reminders for both daily PrEP as well as event based PrEP.
If your sex is less predictable or if you find remembering the follow up tablets tricky, I recommend daily PrEP. From my own experience I have found daily PrEP was easier – I just need to take a tablet each morning.
Restarting Daily PrEP
If you have stopped PrEP restarting daily is straight forward.
- For Cis men who have sex with men – take 2 tablets of PrEP 2 to 24h before your first sexual activity, after then resume your daily single tablet of PrEP.
- For all other people you need to take 7 days of daily PrEP before you will have protective levels of PrEP in the body.
If sex happens before you have protective levels of PrEP condoms are recommended.
Regular medical review and sexual health screening are an important part of your PrEP regime. Be sure to book in with your doctor.
Not all doctors are seeing people face to face however many, myself included, are able to organise PrEP and the full testing via tele-health appointments.
If you are importing your PrEP be sure you place orders earlier as postal services can be slower due to decreased airline activity.
Stay safe, look after yourself and your friends.
Dr George Forgan-Smith