PrEP stands for Pre-Exposure Prophylaxis, it is the use of anti-HIV medications to keep HIV-negative people from becoming infected.
PrEP has been shown to be safe and effective at preventing HIV infection when taken correctly. You MUST consult a doctor before starting PrEP.
It is NOT:
-A magic pill that prevents you from other sexually transmitted infections.
-A morning after pill, and requires you to follow a strict timetable.
If you, your sex partner or your friend often finds himself in a situation where he forgets to use a condom, don’t have a condom on him all the time, prefers to not use a condom or wants additional protection on top of condom use, why not talk to him about PrEP?
Let him know how simple and effective PrEP is, and encourage him to speak to a Pink Carpet volunteer or make an appointment with a doctor.
PrEP comprises of 2 anti-viral medications: tenofovir and emtricitabine (TDF and FTC) and is highly effective in reducing the chances of contracting HIV infection. The use of PrEP is now recommended in national guidelines in many countries. The World Health Organization recommended in 2015 that PrEP should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches, and in 2017 published an implementation tool to guide countries on the introduction and implementation of PrEP. HIV transmission among men who have sex with men (MSM) has been rising in Singapore as it has in most other countries, indicating the need for additional methods at HIV prevention, such as PrEP.
For MSM, heterosexual men and women, sex workers, trans persons
Daily dosing of co-formulated TDF/FTC. Needs to be taken for 7 days before high levels of protection are achieved for both vaginal and rectal exposure to HIV.
For MSM only
A double dose (two tablets) of co-formulated TDF/FTC to be taken 2-24 hours before potential sexual exposure, to be followed by single doses 24 and 48 hours after the initial dose
FOLLOW-UP WITH YOUR DOCTOR
Taking PrEP medicines will require you to follow up regularly with your doctor. You will have blood tests for HIV and tests to see if your body is reacting well to the medication. You will also receive counselling to reduce the risk of acquiring HIV. You should take your medicine as prescribed, and your doctor will advise you about ways to help you take it regularly so that it stands the best chance to help you avoid HIV infection. Tell your doctor if you are having trouble remembering to take your medicine or if you want to stop PrEP.
PrEP is offered as part of a comprehensive HIV/STI prevention package. PrEP does not protect you against other sexually transmitted infections (STI) like syphilis or gonorrhoea. If you have started taking PrEP, it is important for you to return for regular STI screening. Condoms provide the most effective barrier to HIV and are also the best way of reducing your chances of picking up or passing on other STI.
Use 4th generation HIV test (either conventional HIV EIA or rapid blood test). If there was recent high-risk exposure, it is advisable not to rely on a rapid test as these are less sensitive than conventional EIA. If their last high-risk exposure is within the last 4 weeks repeat HIV test after 4 weeks .
The Health Care Professional will check kidney function and conduct tests for syphilis, HBV, HCV, gonorrhoea and chlamydia.
Subsequent visits (Quarterly is advised)
The following tests will be conducted:
-HIV, Syphilis, HBV, HCV, gonorrhoea and chlamydia tests.
-Kidney function tests every 6 to 12 months.
WHAT ARE THE OPTIONS FOR OBTAINING PrEP?
If you are considering PrEP, you should discuss this with a doctor with experience in HIV or sexual health to help decide if PrEP is right for you.
This fact sheet explains your options for obtaining PrEP through the local health system. Your doctor can prescribe Truvada, which is the original brandname combination of tenofovir and emtricitabine (TDF and FTC) manufactured by Gilead. The cost is approximately $400 per month for Truvada, which will be too expensive for many people. Another option is to purchase a generic version of tenofovir and emtricitabine (TDF and FTC) from a reliable online supplier. Generics are copies of brandname drugs. The cost of generic tenofovir and emtricitabine (TDF and FTC) is much less than the brand-name.
You are allowed to bring in or import medicines for personal medical use if the quantity is less than or equal to 3 months’ supply.
Buying Medicines Online
The Internet can offer consumers a convenient and less expensive way to access medicines. However, online purchases of medicines should be approached with caution. Medicines available on international websites are not regulated by the local authorities. You need to, as far as possible, ensure that the website is legitimate, otherwise there are possible risks, including that medicines are fake, past their use-by date or not manufactured to appropriate standards. Medical information from the Internet should also never replace consultations with your doctor, and should be interpreted with caution.
Treatment as Prevention
Evidence now shows that individuals on effective antiretroviral treatment (ART) with an undetectable viral load cannot transmit HIV to others.
WHO guidelines now call for ‘test and treat’ strategies – initiating all people diagnosed with HIV on ART as soon as possible after diagnosis – as a way to decrease community viral load and reduce the rate of new HIV infections.
Treatment as prevention (TasP) will only be effective alongside the scale up of testing programmes and ART adherence support.
Treatment as prevention (TasP) refers to HIV prevention methods and programmes that use antiretroviral treatment (ART) to decrease the risk of HIV transmission.
The effectiveness of ART as a prevention tool is now undisputed – and it is currently used as a public health intervention, as well as a patient-specific strategy.
If you think you might be living with HIV, come and speak to us or your doctor on how best to start treatment as soon as you can. With today’s treatments, you can enjoy a full life ahead of you.
What is PrEP?
PrEP stands for Pre-Exposure Prophylaxis, a daily oral regimen of 2 drugs Tenofovir and Emtricitabine; prescribed a single fixed-dose combination tablet to prevent HIV transmission. It is to be differentiated from PEP or Post exposure prophylaxis where the person takes a 3-drug regimen within 72 hours after a possible exposure to HIV for 28 days.
PrEP is an additional preventive tool for sexually active gay men who are at high risk of HIV acquisition; it is NOT meant to replace condoms, but to supplement them.
PrEP does not prevent other sexually transmitted infections viz. syphilis, gonorrhoea, infections with Chlamydia, herpes simplex, hepatitis B and C etc.
Is PrEP effective?
Strict medication adherence is critical to PrEP efficacy. In a study involving gay men (the iPREX study), PrEP was associated with an average 44% reduction in HIV acquisition. However, the protection can be up to 92% if medication was detectable in the blood of persons in the trial (compared to those with no detectable medication in the blood)
At current times, it is recommended that PrEP be taken on a daily basis.
reduction in HIV acquisition
protection can be up to 92% if medication was detectable in the blood
What is the time line to achieving protection?
What laboratory tests do I need to do before and after starting PrEP?
PrEP should be prescribed from a healthcare setting.
A baseline HIV test must be performed at least 3 months from the last high-risk sexual exposure. The test MUST be negative before starting PrEP. Subsequently HIV tests must be done every 3 months to exclude acute HIV infections.
Taking PrEP when you are newly infected with HIV is very dangerous. This is because you will be under-treated, this will lead to resistant HIV strains that will make future treatment more challenging.
Medications for PrEP can hurt the kidneys. Baseline tests for kidney function have to be assessed and monitored every 6 months.
Screening for other STIs is also recommended at regular intervals.
Baseline Hepatitis B screening is also recommended as Tenofovir has activity against the virus and the doctor will need to monitor liver function tests.
What is Acute HIV infection?
Many people develop this illness a few weeks after being infected with HIV. This is possible if there is suboptimal adherence to daily PrEP.
The most common symptoms are fever, malaise, sorethroat, diarrhoea and rash. You should report there to your doctor if you develop these symptoms. The usual HIV blood test will probably be negative at this time and a test to detect the HIV RNA in the blood will be necessary.
For how long should I continue PrEP and how do I stop it?
You should continue to take PrEP daily for as long as you are at risk. If the situation changes and you are no longer at risk, continue PrEP for one month from the last sexual exposure.
Where can I get additional information on PrEP?
More FAQs are available at