Let’s PrEP well

India has 2.1 million people living with HIV/AIDS and our country alone sees around 88,000 new cases annually. With the advent of newer effective anti-HIV drugs and research in HIV prevention, Pre-Exposure Prophylaxis (PrEP) came as one of the game changers to stop ongoing HIV transmission. And although it has shown phenomenal success in Africa, the US, Australia and Europe, India still hasn’t reaped similar benefits of PrEP. This may be because of the poor knowledge of PrEP among the general population and health workers. Also, PrEP is still not being offered by the National AIDS Control Organisation. If we really need to end HIV/AIDS in our country, PrEP will have to enter our armamentarium. And educating ourselves is the first step towards that. Here are a few PrEP facts we all need to know:

What is PrEP?

PrEP is an HIV prevention method where a medicine is taken by an HIV negative individual who is at risk of HIV acquisition from sex or injection drug use. PrEP currently comes as a single tablet that contains two antiretroviral drugs that act against HIV and is supposed to be taken daily.

Is PrEP really effective in
preventing HIV?

What is really important to understand is that to be really effective, PrEP requires high levels of adherence i.e., taking the medicine daily and as prescribed. For sexual transmission, PrEP can decrease the risk of HIV acquisition by almost 99% when the medications are taken as prescribed. For HIV transmission among people who inject drugs, we do know from a few studies that PrEP reduces the risk of getting HIV by at least 74% when taken as prescribed.

Is it really safe to take a pill every
day to prevent HIV?

PrEP has not shown serious short or medium-term safety concerns. In fact, the drugs that are included in the pill for PrEP are drugs that HIV positive individuals take for years and even decades together without too many side effects.

What is the cost of PrEP in India?

The pills for PrEP cost between 1,200-2,000 per month.

Can one take PrEP just once, if they think they might have recently been exposed to HIV?

PrEP needs to be started days before the exposure for it to be effective. Therefore, PrEP is not the right choice for those who may have been exposed to HIV in the last 72 hours. What such individuals urgently need is to contact an expert who will assess the risk and may then prescribe PEP or post-exposure prophylaxis (which is a 30-day course of certain antiretroviral medications).

How does one know if PrEP is right for them?

PrEP may be appropriate for a sexually active individual if he/she tests negative for HIV who has sexual partner/s whose HIV status is unknown or whose partner is HIV positive (especially if the partner has an unknown or detectable viral load) and does not consistently use a condom with such a partner. PrEP is also a great preventive technique for an HIV negative woman with HIV positive partner who is considering pregnancy. PrEP can protect her and her baby from getting HIV while she tries to get pregnant.

If one uses PrEP, can they stop using a condom?

PrEP only offers protection against HIV and not against other sexually transmitted infections (STI) or pregnancy. PrEP is a part of a comprehensive prevention plan that also includes condom use, and other risk reduction methods for other STIs.

(The author is a physician, infectious disease specialist.)

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