It’s Time to PrEP

Published in Esperanto Magazine: Sex Edition 2016

We’ve come a long way from the days when AIDS was a relatively unknown epidemic. When looking back at its history, we are immediately reminded of the difficult 80’s period where practically nothing was known about the HIV virus, and those who had it were immediately ostracised from society. The icing on the cake was the fear mongering tactics perpetrated by our government in the form of a grim reaper campaign.

Thankfully, AIDS stigmatisation is less accepted nowadays (though we still have a long way to go) and with the power of combination antiretroviral therapy (ART), AIDS has transformed from being fatal to being a manageable condition for many people.

There are two medications emerging at the forefront of HIV prevention research. These are aptly known as PEP and PrEP, or Post Exposure Prophylaxis and Pre-Exposure Prophylaxis respectively. Both have rather straightforward differences – PEP is taken after unprotected sex if you feel you have been exposed to the virus, while PrEP is taken as a safety measure beforehand should you ever go bareback in the future. Truvada is the only FDA approved medication for PrEP.

Yet between the two, PrEP has had its fair share of controversy, doing the rounds both in the medicine and media fields due to its innovation in decreasing escalating HIV statistics and its irony of possibly increasing riskier sexual behaviour. Numerous research has shown that Truvada is effective for PrEP, but despite this, the drug remains the central topic in heated debates.

Unfortunately, the government’s constant deliberation of whether or not PrEP should be more easily accessible to the Australian public has led to major delays of the drug being approved. At the moment, Australia’s Therapeutic Goods Administration has pushed the deadline for deliberation until May this year, but considering the deferrals its unknown when it will be largely available.

Being a writer who ashamedly had little knowledge about PrEP (Disclaimer: I had no idea PEP and PrEP were different from each other before writing this article. Go science!), I decided to do some sleuthing.

To feed my curiosity, I asked sexual health doctor, Vincent Cornelisse, to give me a lowdown on the medication.

“Pre-exposure prophylaxis (PrEP) is the practice of using HIV medications on a daily basis by people who don’t have HIV to reduce their risk of getting HIV. It works by stopping the HIV virus from replicating itself inside your body. If you take PrEP every day, it works very well to reduce the risk of getting HIV,” he said.

“For men who have sex with men, studies have found this risk reduction to be between 92-95%. Studies on women and transgender people have shown lower effectiveness in these populations, but the reasons for this are complex.”

However, Cornelisse specifies that PrEP does not protect against other sexually transmitted infections (except perhaps Hepatitis B) – so don’t think it’s the be all and end all solution to your fears of STI.

“The main risk from PrEP is that if you don’t take it regularly, and if you do get HIV whilst on PrEP, then the HIV virus may become resistant to the PrEP medication. This is a problem, because this may then make the treatment of your HIV virus more difficult,” Cornelisse adds.

“To avoid this, people on PrEP should make sure that they take it every day, and they should make sure that they have HIV tests before starting PrEP and on a regular basis whilst taking PrEP.”

But does PrEP actually encourage unsafe sex and consequently increase the rate of obtaining STI’s?

The answer is yes and no. Generally, PrEP is purposed to improve safety during sex. The question of what will happen to the probability of obtaining STI’s while on it is complicated, with each case being unique from the next. Cornelisse was nice enough to provide some case studies to get a better idea. For example:

Some people start PrEP because they don’t use condoms and/or because they have many sexual partners. Starting PrEP does not necessarily increase their risk of other STIs, because they are already at high risk.

Some people may increase their number of sexual partners, or may stop using condoms after starting PrEP. This would increase their risk of other STIs.

Personally, what my research has shown me is that PrEP is a great alternative method of protection, and a welcome essential in the fight to eradicate increasing AIDS statistics. The United States of America, France, even Canada have approved it, so strictly speaking the Federal Government are overdue in giving it the green light. We’re already lagging behind on marriage equality — let’s not lag behind this one too.

As for the side effects of taking the daily medication, they are far from pretty – but typically settle down after a few weeks. Initial reactions from your body include nausea, diarrhea and tiredness.
Taken long term, PrEP does have the ability to affect your kidneys and bone density hence it is imperative your doctor monitors your kidney function on a regular basis.

People on PrEP need to see their doctor every 3 months for HIV testing and for kidney function testing. They will also be offered STI screening during these doctors visits, so they are more likely to have more frequent STI screening than someone who is not on PrEP.

Nonetheless, despite the unfortunate delays in making PrEP fully available in Australia, Cornelisse strongly recommends talking to your doctor about it should you ever be worried of contracting the virus.

“Even though PrEP is not yet approved by the Therapeutic Goods Administration, if people feel that they are at risk of HIV, then they should talk to a sexual health doctor about possibly starting PrEP. And don’t forget, if you think you have been exposed to HIV, then come talk to a doctor about post-exposure prophylaxis (PEP). PEP is available from emergency departments and sexual health centres and needs to be started within 72 hours of a HIV exposure,” he advises.


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