MODERN GAY HEALTH: WHAT IS PREP?

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To PrEP or not to PrEP: Is Truvada really a sexual health game changer?

There’s a lot of discussion at the moment about the use of PrEP as a safe sex tactic for gay men. Writer David Mang explains what PrEP is and looks at whether or not it’s the right tactic for you.

While the horrors of the AIDS crisis of the 1980s are mercifully consigned to history, HIV remains a major health risk for all sexually active people, particularly gay and bisexual men. In 2014, around 2,800 LGBT men were diagnosed HIV positive in the UK – many of whom could potentially have avoided infection had they been using a PrEP drug such as Truvada.

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, and is a method of preventing HIV infection which has recently been made available for sale in some territories, including the USA. It involves taking an antiretroviral drug on a daily basis. At present, the leading drug on the market is Truvada, which has been shown to reduce the risk of HIV infection for people who are identified as ‘high risk’ by as much as 92%.

The easiest way to think about is is to remember that PrEP is the method, whereas Truvada is simply a brand name. When the patent on Truvada expires in a couple of years time, the market may well be flooded by equally effective alternatives, lowering the cost of the drug.

How does it work?

First of all, it’s vital to remember that PrEP is not a vaccine. When you take PrEP on a daily basis, it enters your bloodstream and can stop HIV from taking hold and spreading. However, of you fail to take PrEP consistently, it’s effectiveness weakens, and there may not be enough medication in your bloodstream to protect you.

Should I be using PrEP?

The reduction rate in HIV transmission from using PrEP is hugely significant. With the medication broadly considered to be safe and relatively low on harmful side effects, the evidence in favour of taking them is compelling – particularly if you frequently engage in high-risk sexual activities such as barebacking, anonymous sex or group sex, or if you’re an intravenous drug user. It could also be a major breakthrough for mixed HIV status couples. According to a study by HIV I-Base, around half of gay men in London would take oral PrEP drugs to reduce their risks of contracting HIV.

On the other hand, PrEP is not a silver bullet for sexual health. First, it is only effective if taken consistently, so don’t think of it as a gay version of the ‘morning after pill’. If you decide PrEP is for you, it’s critically important that you take the drug every day. It also provides no protection against other STIs such as chlamydia, gonorrhoea, anal warts and syphilis.

What are the potential side effects?

Some people who have taken Truvada have complained of mild side effects including loss of appetite, insomnia and an upset stomach. However, in most cases these issues have resolved after regularly taking the drug for a month or so. Beyond that, it appears to be a fairly comfortable and easy drug to take.

How do I get hold of PrEP?

A relative newcomer to the sexual health market, PrEP is not currently available on the NHS in the UK, and can only be accessed by participants in selected medical trials. However, in other countries such as the USA it has been brought to market, albeit at a high price point. Sexual health campaigners are calling for Truvada to be made available on the NHS, and it is hoped that before too long PrEP will become another powerful weapon in our sexual health arsenal.

For more information on PrEP click here 

Image by Bruce Weber for VMAN.

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