How to use PrEP

Different ways to use PrEP

There are different ways to use PrEP based on your preferences and circumstances.

If you have sex regularly or want 24 hour protection against HIV, daily PrEP could be right for you. Daily PrEP involves taking a PrEP pill once a day, every day for as long as you decide. There is also an option to use PrEP every day for 24 hour protection just for a while — this is called periodic PrEP.

Both daily PrEP and periodic PrEP are suitable for anal, and vaginal or front hole sex, and injecting drug use.

If you have sex less than twice a week and you're able to plan ahead or delay sex for at least two hours, on-demand PrEP could be right for you. On-demand PrEP involves using PrEP for a short period when you decide you want protection — perhaps for an evening or weekend. On-demand PrEP is only suitable for anal sex and doesn't provide adequate protection for vaginal or front hole sex, or injecting drug use.

For an overview of the different ways to use PrEP, this guide provides more details: Same PrEP, new choices: on-demand, periodic or daily

Remember, using PrEP doesn't have to be forever. Talk to your doctor before stopping, restarting or changing the way you use PrEP to make sure it's right for you and your circumstances.

Daily PrEP and periodic PrEP

Both daily PrEP and periodic PrEP are suitable for anal, and vaginal or front hole sex, and injecting drug use.

 

The only difference between daily PrEP and periodic PrEP is the amount of time you choose to use each option — daily PrEP is sometimes considered a longer-term option, while periodic PrEP may only be used for a holiday, party, festival or other short to medium-term duration.

Using daily or periodic PrEP is as simple as taking one PrEP pill a day, every day. It doesn't matter what time of day you take your PrEP pill and it's OK if it's not exactly the same time every day. Just be sure to take one PrEP pill every 24 hours.

If you accidentally take two PrEP pills in one day, it's OK. Taking two PrEP pills is not harmful.

Starting daily or periodic PrEP

Starting daily or periodic PrEP is different for different people. For cisgender men who have sex with men, start daily or periodic PrEP with a double dose (two pills) at least two hours before sex.

For everyone else (trans and gender diverse people, cisgender women and men who have sex with women), it takes seven days of daily dosing for PrEP to protect your body. Consider using other forms of HIV prevention for any sex during your first week starting daily or periodic PrEP.

Missing a dose of daily or periodic PrEP

Although it's best to use daily or periodic PrEP every day, missing a dose sometimes happens. If you do miss a dose, you don't need to take extra PrEP pills. Simply start your routine again as soon as you remember later that day or the next day.

For people having anal sex, PrEP still offers extremely high levels of protection even if you miss one dose. However, if you're missing more than one dose and taking less than four pills a week, PrEP may not be able to protect you against HIV.

For people having vaginal or front hole sex, using PrEP every day is especially important. This is to ensure sufficient levels of drug concentration in vaginal/cervical tissues.

Stopping daily or periodic PrEP

If you want to take a break, or discontinue daily or periodic PrEP for any reason, it's recommended to consult your doctor first.

Stopping daily or periodic PrEP is different for different people. For cisgender men who have sex with men, stop daily or periodic PrEP by continuing to take one PrEP pill every day for two days after your last possible exposure to HIV.

For everyone else (trans and gender diverse people, cisgender women and men who have sex with women), it's recommended to keep taking one PrEP pill every day for 28 days after your last possible exposure to HIV.

Before restarting PrEP, check in with your doctor for routine tests, especially if you have had any possible exposures to HIV in the meantime.

 

On-demand PrEP

On-demand PrEP is only suitable for anal sex and doesn't provide adequate levels of protection for vaginal or front hole sex, or injecting drug use. For vaginal or front hole sex, or injecting drug use, daily PrEP or periodic PrEP are recommended instead.

Australia's clinical guidelines for PrEP advise on-demand PrEP is only suitable for cisgender men who have sex with men. Daily PrEP or periodic PrEP are recommended for everyone else (trans and gender diverse people, cisgender women and men who have sex with women).

Using on-demand PrEP requires good understanding of the dosing schedule and following it carefully. Timing is important when using on-demand PrEP. Having sex too soon after your first dose or missing a dose could affect your protection.

Using on-demand PrEP

  • take a double dose (two pills) between 2 and 24 hours before sex; then

  • take one more pill 24 hours after the first dose; then

  • take one final pill 24 hours after the second dose

For example: if you're planning to have sex on Friday at or after 7:00pm, take a double dose (two PrEP pills) on Friday by 5:00pm at the latest. Then take one more PrEP pill on Saturday at 5:00pm. Then take one final PrEP pill on Sunday at 5:00pm.

If you continue having sex keep taking one PrEP pill every 24 hours. Stop only once you've had two days of taking PrEP without any sex.

If you miss a dose of on-demand PrEP or have been unable to follow the dosing schedule for any reason, it's best to seek medical attention as soon as possible, as you may be offered PEP to ensure you stay HIV negative.

 

Side effects

As is the case with using any medicine, there could be side effects. But not everybody gets them. The small number of people who do may be surprised by how uneventful they are and how quickly they go away.

There’s a small chance you might experience very mild symptoms such as a stomach upset, tiredness or nausea for the first few days. None of these stay for long. Some people report vivid dreams or restlessness for a short time too. If you do experience mild side effects when first starting PrEP, taking your pill after a full meal may help avoid them.

A very small number of people have experienced challenges with kidney function and bone density while using PrEP. This is typically due to pre-existing medical conditions or other health factors. As a precautionary measure your doctor will regularly monitor your health while using PrEP. These side effects aren't common and are known to reverse when discontinuing PrEP.

PrEP is a very well tolerated medicine with minimal side effects. Start a conversation with your doctor about these or anything else you'd like to know. You can also ask Australia's largest online PrEP community in the PrEP'D For Change Facebook group.

 
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