HIV transmission is dependent on the route of acquisition, the infecting viral load and the presence of inflammation and activated immune system cells below mucosal surfaces.8 Addressing these factors lowers HIV transmissibility. Unprotected, especially receptive, anal sex remains a high-risk behaviour for HIV transmission with a transmission risk about 18 times higher than for penile-vaginal sex, and is a major driver of high HIV rates among MSM.9 IDUs who inject themselves with HIV-contaminated needles provide a direct access point for HIV, and established infection can therefore occur with relatively lower viral loads. CSWs are likely to transmit HIV if they become infected themselves because of the greater number of sex partners that they encounter. All these population groups benefit from targeted HIV programmes.
What is PrEP?
Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy where HIV negative people take medications daily to prevent them from becoming positive if they are exposed to the virus.
PrEP has been shown to significantly reduce the risk of HIV infection in sexually active adults and in people who use drugs. PrEP is effective in preventing HIV even if you don’t use condoms, however, PrEP will not protect against other STIs. Using condoms together with PrEP will provide additional protection against STIs
What I should know?
PrEP could be used by men who have sex with men (MSM), who bottom, top, or who are versatile.
A small proportion of men may get minor side effects but these generally go away after a few weeks. In extremely rare cases, PrEP can affect your kidneys. Your doctor will screen you to make sure this is not a problem.
If you take PrEP daily, you have very little risk of being infected with HIV. Regular testing will ensure that if you should become infected, it will be detected early.
You can stop taking PrEP altogether if you no longer think that you need it. Good HIV protection has been demonstrated if PrEP is taken for four or more days per week, however the best level of protection occurs when taking it daily.
If you take PrEP and do not use condoms when you have sex you will still have up to 92% protection against HIV; however, PrEP does NOT protect against other STIs, such as syphilis, chlamydia and gonorrhoea or HPV.
If you are taking PrEP and not using condoms, you should increase the frequency of your STI testing.
PrEP can be used for many different reasons:
- Some HIV-negative men may use PrEP because they are with an HIV-positive partner and they want to add more protection.
- PrEP is effective in preventing HIV infection when taken correctly
- Many men are not consistent with using condoms; sometimes a condom can break or slip off during sex. PrEP can function as a backup plan and protect from being infected with HIV.
- Some men are in relationships where regular condom use is not desirable or possible or where bareback sex is preferred.
A few basic screening tests are needed to make sure PrEP is suitable and safe for you before you start.
Where do i get it?
PrEP is available at any retail pharmacy in the country. It requires a script from a GP and you will need an HIV test and kidney function test first. HIV negative people who believe they are at res for acquiring HIV and access healthcare in the private sector can access PrEP from an educated GP. The retail cost for PrEP is R600pm for the original drug (Truvada) or R250pm for a generic version. Some medical aids will contribute to this.
PrEP is currently available for MSM and sex workers at no user cost in the public sector at selected state facilities. PrEP is available for MSM at the Ivan Toms Centre for Men’s Health in Cape Town (021 447 2844) and Health4Men at Yeoville clinic in Gauteng (011 648 7979 or 072 654 0816). If you reside in Pretoria you can access free PrEP at TEN81 (012 430 3272) to make an appointment. Sex workers can access PrEP from the Wits Reproductive Health & HIV Institute (WRHI) clinic in Hillbrow. The Department of Health is working towards providing expanded PrEP access for other population groups in the future, e.g. adolescent girls and young women.
Click here to learn more about the myths & facts about PrEP.