Thanks to today’s therapeutic options, HIV infection in Switzerland has changed from a fatal disease to a chronic one that can be well controlled with medication. However, this requires daily medication for those affected. So it’s still worth protecting yourself from HIV infection – PrEP gives you another prevention option.
The most important thing about PrEP
PrEP means “pre-exposure prophylaxis”, i.e. prevention of infection in the event of risk contact. PrEP is a safer sex method in which HIV-negative individuals take a combination of two HIV agents (tenofovir and emtricitabine, found in the drug Truvada or equivalent generics) to protect themselves from contracting HIV. The drug must be prescribed by a doctor and is not covered by health insurance in Switzerland. You can take PrEP every day or on a schedule. Those taking PrEP must be regularly screened for HIV, other STDs, and kidney function. Good medical support is part of PrEP. PrEP protects against HIV, but not against other STIs.
How does PrEP work?
PrEP prevents the HIV virus from replicating once it has entered the body. However, for this to happen, a sufficient amount of the active ingredients must be present in the blood and mucous membranes. If PrEP is discontinued, the active ingredients in the body disappear and so does the protective effect.
In extremely rare cases, the transmitted viruses are already resistant to the PrEP combination. Then infection can occur despite correct PrEP use. However, only a handful of such cases have been reported worldwide to date.
Who is PrEP for?
The reasons for use of PrEP are very different and highly individual. PrEP is aimed primarily at people who have an increased risk of HIV infection and cannot – or do not want to – protect themselves consistently with condoms.
The German-Austrian PrEP guidelines recommend PrEP for all people at increased (“substantial”) risk of HIV. These include, for example:
- Men who have sex with men (MSM) and have had anal intercourse without a condom in the past three to six months and/or are expected to have anal intercourse without a condom in the next few months.
- MSM who have had an STD in the past twelve months.
- Partners of people living with HIV who are not on HIV therapy, for whom HIV therapy is not working properly, or for whom HIV therapy has not worked for at least six months.
- People who have sex without a condom with partners from a population that is particularly affected by HIV infection (prevalence of undiagnosed or untreated HIV infection >1%).
- IV drugs users who do not use sterile injecting equipment.
How well does PrEP protect me?
Effectiveness depends on taking PrEP correctly. If taken daily, the protection is practically equal to condoms. PrEP therefore offers a high level of protection, but not one hundred percent.
How do I take PrEP?
Basically, there are 3 different approved regimens for PrEP:
Daily PrEP
Here you take one tablet daily (preferably always at the same time). It is important that you have already built up an active substance level in your body before the first unprotected sex. For men we recommend 7 days – or at least 2–3 days in advance. For women in any case at least 7 days in advance. When PrEP is stopped, the combination is taken for another seven days.
Event-based / on demand PrEP
Here, you take PrEP according to a standardised schedule for one or more planned sexual contacts. This option is a bit more complicated and requires a good counseling session, and the data is not yet as solid as for Daily PrEP. This intake is not suitable for women.
Holiday – PrEP
This is actually a Daily-PrEP – the only difference being that it is started and stopped specifically for a defined point in time. Again, sufficient lead time and taking the medication after the last unprotected sex must be taken into account. We recommend 7 days in advance and 7 days after the last unprotected sex for this.
How and where can I get PrEP?
Use of PrEP should be accompanied by a physician who has experience with HIV. In this consultation, we will discuss individually which option is best for you. Before starting, an existing HIV infection must be excluded and further blood tests must be performed. During the course of PrEP treatment, regular check-ups including HIV tests are performed. You are welcome to arrange a first, non-binding consultation with us.
If you have decided to take PrEP, we can provide you with addresses where you can obtain safe and affordable medication.
*quote adapted from www.myprep.ch**
Lectures 11/8/19, PS11:
Dominique Costagliola, “PrEP persistence and associated factors: ananalysis from the ANRS Prevenir study.”
Jessica Deblonde, “Monitoring PrEP implementation in Belgium: nationalsurveillance results, 2017-2018.”
