PrEP (Pre-exposure Prophylaxis)

To order PrEP medication, you must:

• be over 18 years old
• be HIV negative
• have a high chance of HIV exposure

You need to take an HIV test before starting PrEP and then test every 3 months while on PrEP to check that you’re still HIV negative. This is just one of the tests you need to take (see below, ‘What tests do I need before I can start PrEP?’).

You have a higher risk of HIV exposure if you do not use condoms during sex and you are:

• a man who has sex with men
• a transgender person who has sex with men
• a woman who has sex with bisexual people
• a sex worker
• having sex with someone from a country with a high rate of infection
• having sex with someone who is HIV positive and has a detectable viral load (they have a high amount of the virus in their blood)
• having sex with someone whose HIV status is not clear
• injecting drugs using needles, syringes and other equipment, and sharing those with others
• someone who has recently migrated to the UK
• having condomless anal or vaginal sex with people who have a higher chance of getting HIV

What tests do I need before I can start PrEP?

Before you can begin taking PrEP, you will need to make sure that you:

• are HIV negative
• have normal kidney function

Additionally:

• if you have not been vaccinated against hepatitis B, you will need to check that you are negative for hepatitis B
• if you are a man who has sex with other men or are a trans woman, you will need to check that you are negative for hepatitis C

It’s not safe to take PrEP without taking these tests.

Once you begin PrEP, you will need to repeat these tests at different periods (see below, ‘How should I care for myself when taking PrEP?’).

You can still order PrEP medication through Superdrug Online Doctor if you haven’t taken all the PrEP tests you need when starting PrEP. However, you must take these tests and get your results before you start taking your PrEP medication (even if your order arrives before you get your results). A doctor will send you a message to explain which tests you need and how to get these done when you complete your medication order.

Order your PrEP tests online from Superdrug Online Doctor

You can order the following PrEP test kits through us, depending on what you need to check.

• Advanced PrEP test to check your HIV, kidney function, and hepatitis B and C status
• Basic PrEP test to check your HIV and kidney function status only. For example, if you know your hepatitis status already or this doesn't apply to you.

Kidney Function test to check your kidney function only. For example, if you've checked your HIV status separately and you don't need to check your hepatitis status.

You can also order a standalone HIV test. For example, when you need to regularly check your HIV status once you start taking PrEP. We go into more details about these tests, further below.

It's also recommended that you do a full screen test for sexually transmitted infections (STIs), both before and every 3 months while on PrEP.

When your test kit arrives, simply collect your sample at home and send it to our partner laboratory. Our doctors will send you a confidential message through your account containing your results and advice.

Don't start PrEP if you test positive for hepatitis. We’ll let you know that you need to make an appointment with your GP to refer you to a liver specialist.

If you're already taking PrEP, don't stop taking this if you get a positive hepatitis result. Contact your GP to see a liver specialist as soon as possible.

If your test shows abnormal kidney function you’ll be asked to do a repeat test to see if it normalises. At this stage, we’ll recommend that you see your GP for this test as they want to examine you and do further testing, but you can test again with us.

If you require any further testing due to your results, you should not take PrEP until you have clear confirmation that it’s suitable for you.

Why is it important to be HIV negative before and during PrEP therapy?

You need to know your HIV status before taking PrEP to make sure it's safe for you to take the drug. This is because PrEP contains 2 antiviral drugs used to treat patients who are HIV positive (in combination with other medications).

Using these drugs on their own when you're HIV positive can mean you become resistant to them, which would make treating the infection in the future more difficult.

PrEP is highly effective in preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV through sex by about 99% when taken daily.

PrEP is less effective when it is not taken daily unless it’s taken as part of a different regime that has been validated, such as the ‘on demand’ method. One study found that the ‘on demand’ method could increase the effectiveness of PrEP and reduce pill burden with similar effectiveness in men who have sex with men. This means that taking PrEP on demand for this group could be an effective alternative to daily methods for people who find it difficult to take PrEP daily.

“It is important that you take PrEP exactly as it has been prescribed to you to maximise its effectiveness. If you don’t, there is an increased risk that you will get HIV if you are exposed to the infection. There are several ways PrEP can be taken, and your doctor will discuss these with you to find the most effective method for you. It is important that you practice safe sex and use condoms to minimise the risk of HIV and other STIs further.” - Dr Clair Grainger

Recent updates to the national PrEP guidelines mean that anyone who qualifies for PrEP can start it with a double dose and become protected from HIV within 2 hours.

You can take PrEP daily or on demand (around the time of having sex), depending on which method suits your lifestyle and needs.

Daily PrEP

Daily PrEP is best taken at the same time every day and is suitable for both anal and vaginal or frontal sex. To take PrEP daily, you should:

• start by taking a double dose (2 tablets) at least 2 hours before you have sex
• then, 24 hours after your initial double dose, start taking 1 tablet at the same time every day – this will keep you protected from HIV

You will be protected within 2 hours of starting PrEP. You should take it with food, and it can be taken at any time, as long as you take it at the same time each day.

Daily PrEP is a good option if you do not like to plan sex or do not want to worry about remembering to take it when you do have sex, because it will naturally become part of your daily routine. Taking PrEP daily is around 99% effective at protecting you from HIV.

On-demand

If you do not have sex frequently or like to plan when you have sex, an on-demand method of taking PrEP may be suitable for you.

If you have anal sex or are the person giving frontal sex, you:

• take 2 tablets at least 2 hours before you have sex
• then, take 1 tablet every day for 2 days, starting 24 hours after the first double dose
• continue taking 1 tablet every 24 hours until you have not had sex for at least 2 days – known as 2:1:1 dosing

2:1:1 dosing is not suitable for anyone who receives frontal sex or if you inject drugs, as it will not provide enough protection. Instead, if you are a cis woman, trans, or non-binary person receiving frontal sex or you inject drugs, you should take PrEP as follows:

• start by taking 2 tablets at least 2 hours before you have sex
• then, take 1 tablet every 24 hours for 7 days called 2:7 dosing
• continue taking 1 tablet every 24 hours until you have not had sex for at least 7 days

PrEP on demand is just as effective as taking it daily as long as you remember to take it on time. Even missing 1 pill can reduce its effectiveness.

Tuesday, Thursday, Saturday, and Sunday dosing (TTSS)

If you are already taking PrEP daily and have been for at least 7 days, you may choose to take your dose on Tuesdays, Thursdays, Saturdays, and Sundays (TTSS). This can be a more suitable way to take PrEP if on-demand methods are not right for you or if you are getting side effects when taking PrEP daily.

You may experience side effects when taking PrEP, but they should improve after a few weeks. If the side effects last longer or become difficult to deal with, you should talk to your doctor before deciding to stop PrEP.

Some common side effects are:

• feeling sick and vomiting
• diarrhoea
• headaches
• dizziness
• feeling tired
• stomach pain
• feeling bloated
• weight loss
• back pain
• depression
• itchy skin

Before we can prescribe you PrEP, we'll ask you about any medicines you're currently taking or have recently stopped taking. This is because taking PrEP at the same time as certain medicines may reduce the protection PrEP provides from HIV, or increase the risk of kidney damage.

Some medicines that may reduce PrEP protection or increase the risk of kidney problems are:

• some drugs for treating fungal or viral infections
• some antibiotics
• some painkillers
• medications for treating hepatitis C
• cancer drugs

Find out more about drugs that could interact with PrEP.

Taking PrEP with alcohol is not known to cause any interactions, but you should try to follow the recommended units of alcohol every week to keep your liver healthy.

PrEP is available for free on the NHS through any sexual health or genitourinary medicine (GUM) clinic.

PrEP works by blocking an enzyme which prevents the HIV virus from making more copies of itself in the body.

What is prophylaxis?

Prophylaxis is a type of medicine you can take, such as PrEP (pre-exposure prophylaxis), to prevent you from getting a disease.

Are there different types of PrEP?

The 2 forms of PrEP available in the UK are:

• 'generic PrEP', which most common
• the branded form Truvada

Both contain the same active ingredients, tenofovir disoproxil and emtricitabine.

PrEP is not a cure for HIV, but it can help lower your risk of getting HIV if you take it as prescribed by your doctor. We also advise that you still use condoms, as PrEP is only up to 99% effective.

There is currently no cure for HIV but it can be managed with a group of specialised antiviral drugs, which can help most people with the virus live a long and healthy life.

You cannot use PrEP as PEP. PEP stands for ‘post exposure prophylaxis’, and this is not the same as PrEP.

PEP is a medicine you take after having sex if you think you have been exposed to HIV. It is usually prescribed for a month, and should be taken immediately after you think you have been exposed to protect you from the virus.

If you think you’ve been exposed, visit your local sexual health clinic, GP, or A&E department immediately, as you may be able to take PEP providing it’s within 72 hours of possible infection.

PrEP will not protect you from other sexually transmitted infections (STIs) like chlamydia, gonorrhoea, syphilis or gential herpes, so you should use other methods of protection such as condoms.

We can also prescribe DoxyPEP to reduce the chance of bacterial STIs, such as chlamydia, syphilis, and gonorrhoea.

If you’re already taking PrEP, you need to repeat your PrEP tests at different stages. This is to make sure you’re healthy, and that PrEP is still suitable for you.

Every 3 months, you need to check that you are HIV negative. This is often referred to as your 'negative on PrEP' status, which means you're on PrEP and HIV negative. You can order our standalone HIV test for this.

Then, once a year, or every 3 to 6 months if you are in a higher risk group, you need to check your HIV status and kidney function, plus your hepatitis B or C status, if this applies to you (see above, 'What tests do I need before I can start PrEP?'). If you have a higher risk of kidney disease your doctor will let you know how often your kidney function needs to be checked whilst taking PrEP. You can order one of our PrEP test kits to do this.

• Advanced PrEP test to check your HIV, kidney function, and hepatitis B and C status
• Basic PrEP test to check your HIV and kidney function status only
• Kidney Function test to check your kidney function only. For example, if you've already checked your HIV status separately, you don't need to check your hepatitis status.

Regular STI screenings

We advise you to do regular STI tests or screenings.

Getting support

Here are some resources that you may find useful depending on your circumstances:

• If you’re transgender, you can get more information and support from Mermaids
• The Gay men’s health project offers information about HIV prevention and the stigma of HIV
• You can learn more and get support regarding drugs and chemsex from your local sexual health clinic or on Dean Street Clinic’s website