Should I go on PrEP?

For many of you reading this blog one of your greatest fears has been receiving a HIV positive diagnosis. We’ve all been there, anxiously waiting after getting an STI check… convincing ourselves that we definitely are HIV positive. By now, many of you will have heard and probably know someone who is using the drug known as PrEP and are curious about it. I imagine you have a lot of questions- luckily for you, you’ve come to the right place.

PrEP is a big deal, and something that we in the medical world are very excited about! For the first time ever people can take control of whether or not they get HIV. By taking PrEP every day there is a 99% – probably closer to 100% prevention of contracting HIV! Exciting right?

So we know that the PrEP is pretty darn good at doing its job – reducing the risk of you getting HIV. Unfortunately, taking PrEP is solid commitment. You see, PrEP is most effective when taken every day and loses it effectiveness the more pills you miss (and trust me, you will miss the occasional pill). This is an important factor to consider before you decide to go on PrEP.

Going on PrEP is a personal decision and not everyone should be or will want to take it – and that’s OK. PrEP is a bit like the pill for women it gives you control over your body and you get to decide when and if you need it rather than leaving that decision up to somebody else.

When considering if PrEP is right for you, you should consider what your risk of getting HIV is. Some people will be low risk – these people might just be at a point in there lives when they are simply not having a lot of sex. They might be having regular sex with a partner that they can be sure does not have HIV or they know has HIV but has an undetectable viral load. These days we know that it’s virtually impossible to get HIV from unprotected sex with a HIV positive person who has an undetectable viral load.

If you do not fall into the low risk category you may be at a moderate risk of acquiring HIV but a risk level that isn’t high enough that they definitely need to be on PrEP. These are people who might honestly say they had sex with someone with unknown HIV status and

  • The condom broke or slipped off somehow more than once in the last 3 months (top or bottom)
  • They were a top and at least once in the last 3 months they didn’t use a condom

Remember, tops have a lower chance of getting HIV compared to a bottom – especially if you’re uncut).

Finally there is the high risk category. These people should really be on PrEP. You might be at high risk if in the last 3 months

  • You were a man who has sex with men and you use methamphetamines or ice
  • You were been diagnosed with syphilis or rectal gonorrhoea or rectal chlamydia
  • You were the bottom and a condom wasn’t used with someone whose HIV status you can’t be 100% sure about
  • You were the bottom and a condom wasn’t used with someone who definitely has HIV and also has a detectable viral load.

What about those people who always use a condom but want the extra benefit of PrEP? This should probably be decided on a case by case basis but it isn’t a bad idea. Condoms are still important for preventing STIs that aren’t HIV after all. The answer will depend on whether or not you usually top or bottom, if you use drugs or a lot of alcohol when you have sex, and whether you might slip up occasionally and not use a condom.

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