This is a fact sheet answering the questions you might have about PrEP (pre exposure prophylaxis) in Scotland.
If you have any questions about the regulations and decision making processes of PrEP contact HIV Scotland on 0131 558 3713.
If you have concerns about using PrEP or your sexual health and wellbeing you can contact SX in Edinburgh on 0131 652 3250 or Terrence Higgins Trust Scotland, 0141 332 3838.
If you want to find your nearest sexual health clinic or support organisation visit the HIV Scotland service finder.
1. What is PrEP?
- An HIV prevention measure where HIV-negative individuals use medication to protect themselves from getting HIV.
- The drug that has been approved for use as PrEP on the NHS in Scotland is called Truvada. The same drug has been used for many years as a treatment for people who are living with HIV.
2. What does taking PrEP involve?
- Taking a pill, usually daily, and regularly getting tested for HIV and other sexually transmitted infections. Before starting PrEP, it’s important that you know your HIV status.
3. How does it work?
- Once PrEP reaches protective levels in the body, it prevents HIV from staying in the body.
- It takes 7 days to reach protective levels in rectal tissue and 20 days to reach protective levels in vaginal tissue.
4. Is PrEP effective?
- Yes, PrEP is extremely effective when taken as directed.
- There have been a number of clinical trials, including the PROUD study in the UK, which demonstrates that PrEP is highly effective in preventing HIV transmission. (You can find out more information about the trials here: iPrEX, PROUD, Ipergay)
5. Who is PrEP for?
- People who are at risk of acquiring HIV may find PrEP is suitable protection for them, but it is not for everyone, and you should only take it if you feel it is right for you, and have discussed its suitability for you with a health professional.
- In Scotland, criteria were recommended by the Short Life Working Group on PrEP, however it still needs to be confirmed by health boards. The criteria are:
- Aged 16 or over.
- Test HIV negative in a clinic.
- Able to attend for regular 3 month reviews.
- Willing to stop taking PrEP when no longer eligible.
- Resident in Scotland.
- Plus, one or more of the following criteria:
- Current sexual partners, irrespective of gender, of people who are HIV positive and with a detectable viral load.
- Gay and bisexual men, other men who have sex with men*, and transgender women with a documented bacterial rectal STI in the last 12 months.
- Gay and bisexual men, other men who have sex with men*, and transgender women reporting condomless penetrative anal sex with two or more partners in the last 12 months and likely to do so again in the next three months.
- Individuals, irrespective of gender, at an equivalent highest risk of HIV acquisition, as agreed with another specialist clinician.
*This includes transgender men who have male sexual partners
6. Is it safe?
- Yes, the drug approved for use as PrEP, Truvada, is used as treatment for HIV and was selected for use as PrEP because of its low side effect profile.
- There is significant evidence indicating that side effects are infrequent, mild and temporary.
- Some people report side effects such as nausea, headaches, dizziness and vomiting. These can be short term or more persistent.
- There is a small risk of kidney function or bone mineral density depletion so these are monitored in all patients. (You can read more information here)
- If you are worried about any of these side effects, you can discuss them with your healthcare provider.
7. Does PrEP mean I can stop using condoms?
- PrEP does not prevent transmission of other sexually transmitted infections.
- PrEP is not intended as a replacement for condoms and they are still an integral part of the HIV and sexual health response.
8. Can I get PrEP on the NHS?
- Yes, PrEP has now been approved to be provided by the NHS in Scotland for people who reside in Scotland.
- All NHS Boards will make it available but will take approximately three months to have systems in place – services should be ready approximately by July 2017.
- PrEP is not suitable for everyone and there will be criteria in place to help doctors assess who will most benefit (see question 5.)
- PrEP is a new approach to HIV prevention for Scotland and we encourage community members and service providers to keep working together, and learning from each other. If you encounter any obstacles, first try discussing them with your service provider.
9. Where can I get PrEP?
- PrEP will be available in sexual health clinics throughout Scotland from approximately July 2017. However you can act now to get ready and keep preventing HIV transmission by getting in touch with your local service, getting tested for HIV, stocking up on condoms and water based lube, or speaking with a peer support worker about your concerns. Details of services are at the top of this page.
10. Isn’t there evidence that shows that there’s been an increase in STIs because of PrEP?
- A number of studies of PrEP and STIs found higher rates of STIs among gay men using PrEP compared with gay men not using it. However, this does not directly mean that PrEP users are taking more risks because of PrEP; PrEP users are testing more regularly for STIs, therefore services are able to diagnose more STIs that otherwise may have been missed; higher risk of STIs may also be a determining factor in why a person is taking PrEP. (You can read more information here).
11. How much does it cost?
- PrEP is available on the NHS in Scotland, and therefore people living in Scotland will not be charged when accessing it.
12. Why should the NHS pay for PrEP?
- PrEP is highly cost-effective and over time, preventing new cases of HIV will save the NHS money.
- This is about more than just cost, people report that PrEP has changed their life by improving their physical, mental and sexual health and wellbeing.
13. Is PrEP just for gay men?
- Gay and bisexual men, and other men who have sex with men will significantly benefit from the availability of PrEP, but it will also be useful to other people.
- Although around half of new cases of HIV in Scotland are in men who have sex with men, PrEP is not just for gay men.
- Trials have demonstrated that PrEP is effective for heterosexuals, transgender men and women, and injecting drug users. However, some of these studies were conducted in a setting where existing prevention methods differ from Scotland.
14. What if I don’t want to take PrEP?
- Then you don’t have to. PrEP is not for everyone and it is your choice whether you would like to take PrEP. If you can identify and manage risk without PrEP, then it probably is not for you.
15. What about the people who were taking PrEP and became HIV positive?
- Experts have indicated that this is extremely rare- only two reports in the context of perhaps 100,000 people having taken PrEP. Very few people with newly acquired HIV have transmitted resistance to Truvada. (You can read more information here)
16. What’s the difference between PrEP and PEP?
- Whilst PrEP is taken before possible exposure to HIV; PEP (post-exposure prophylaxis) is given to people in an emergency when a person after someone has had a likely exposure to HIV.
- PEP requires individuals to access the drug within 72 hours of the exposure (ideally within the first 24 hours) and adhere to a regime for a month- which can have significant side effects.
17. I’m not eligible for PrEP on the NHS, what are my options?
- If you don’t meet the criteria for PrEP on the NHS, then it might not be a good idea to take it. Taking PrEP means taking a drug daily and you probably don’t want it in your body if experts think you don’t need it.
- The best thing to do is to keep talking to your healthcare provider because HIV risk changes over your lifetime.
- If you don’t meet the criteria but want PrEP, it can be purchased online from generic suppliers. If you get, or intend to get your PrEP online, talk to your healthcare provider about it. Stay connected to your sexual health clinic as well, because you can still have your monitoring done and test done there. (More information here and here).
- SX and THT Scotland can also give you advice on PrEP and whether it is an option for you.