PrEP Talk!

PrEP Talk!
By: Jayson Celeste of The Love Yourself
(This article was originally published at The Love Yourself website)

You possibly might have heard about Pre-exposure Propahylaxis (PrEP) by now. It definitely has been creating some buzz in certain circles: in fact it was mentioned in the first episode of season two of the series, “How to Get Away with Murder”. However, if it’s your first time to hear of PrEP and what it means, then we invite you to read on.

So what is PrEP?
PrEP has been described as a promising biomedical intervention for HIV (Human Immunodeficiency Virus) infection, and Truvada (combination of tenofovir and emtricitabine) is currently the most common type of medicine used for PreP.

Prescription is started before possible exposure to HIV, hence the name “pre-exposure”. It’s pretty much like a contraceptive pill: as contraceptives keep the person taking it from getting pregnant unintentionally, PrEP keeps HIV infections at bay. Also, another important thing to note that is common to both contraceptives and PrEP is that their effectivity only depends on conscientious intake of the pill – that is, it is taken on a daily basis.

PrEP vs. PEP
PrEP is not a vaccine and is different from PEP (Post-Exposure Prophylaxis), where the medication is taken immediately after exposure to HIV and is continued only for 28 days. PrEP requires a commitment to regularly take the drug daily for a sustained period of time. Intermittent intake of the drug reduces its effectiveness.

Why is PrEP important?
While the rest of the world is reporting decreasing number of new infections, the Philippines is one of the few countries to have bucked this trend. In October 2015 alone, the HIV/AIDS & ART Registry of the Philippines (HARP) reported 651 newly diagnosed HIV cases, a significant increase from the same period last year (537 cases), and in 2013 (491).

Condom use has long been the primary HIV prevention tool, although its reliability is not absolute. There is a slight chance of ineffectiveness with using condoms due to a variety of reasons including breakage, slipping off, and leakage. In this light, PrEP is seen as a powerful supplement for HIV prevention.
The introduction of PrEP as a new preventative tool, along with consistent condom use, will hopefully help in tempering these increasing statistics.

Is PrEP Effective?
Several clinical researches on PrEP have shown that consistent use of the pill lowers the risk of HIV infection for up to 92% compared to those who didn’t use the pill. Using PrEP while practicing safe sex (i.e. proper use of condoms, lubricant, and safe sex practices) has been proven by studies to significantly lower the risk of HIV infection. Conversely, taking PrEP is not an excuse to resort to risky behavior. PrEP does not guarantee 100% protection from HIV infections, and offers no protection from other STIs. Again, the efficacy of the drug is intertwined with safer sex practices.
Use of PrEP requires regular tests for HIV and other Sexually Transmitted Infections (STIs), which coincides with the schedule for prescription refills and regular check-ups.

Are there any side effects?
PrEP such as Truvada can cause short-term side effects including nausea, tiredness, gastrointestinal symptoms and headache, for one out of ten people using it on their first week of using the drugs. Long-term effects include possible liver and/or kidney problems.
These known and published side effects should be taken with a grain of salt, and in which case, you should consult your physician so that your other health conditions will be carefully taken into consideration. Consultation with the right specialist will enable you to manage your health problems effectively.

Shoud I take PrEP?
While PrEP will surely lower the risk of HIV infection in high-risk sectors of the population, the Center for Disease Control and Prevention of the United States lists down the following as most in need of taking PrEP:
People who are in an ongoing relationship with an HIV-positive partner.
People who are not in a mutually monogamous relationship with a partner who recently tested negative for HIV.
People who have had unprotected sex with a person of unknown HIV status and who are in high risk of getting the infection (e.g. needle users or bisexual male partners)
Gay or bisexual males who have had unprotected sex or have been diagnosed with HIV in the past 6 months*
People who have taken illicit drugs that are administered through needles in the past 6 months* and or have shared needles
One should take note that these criteria are specific to the American setting. We have included this list primarily to give an idea who are the groups who should be taking PrEP. As PrEP is yet to be introduced into the Philippines, the qualifiers (e.g. 6 months window for needle usage and STD diagnosis) and the high priority groups are yet to be determined by the designated national government agency.

While no one is particularly prohibited from taking PrEP, what has been identified above are most-at-risk sectors of the population who will most greatly benefit from regular intake of PrEP insofar as HIV infection risk reduction is concerned.

How long do I have to take PrEP before it becomes effective?
Scientists are yet to issue conclusive results on how long PrEP attains its maximum effectiveness, but studies reveal that if taken everyday, it reaches its peak of protection in 20 days in the blood, in 7 days in rectal tissue, and 20 days in vaginal tissue. However, we would like to reiterate again that these studies are not final figures, and one should not use this time frame as an excuse to resort to risky behavior.

Where can I get PrEP?

PrEP will be available in the Philippines sometime in 2016. Also, intake of PrEP should not be done without proper consultation and counseling with professional medical practitioners. For now, the nearest country where the treatment available is Thailand. In Bangkok, one can head to the Anonymous Clinic of the Thai Red Cross AIDS Research Centre to receive the treatment.
For the meanwhile, while we wait for PrEP to be introduced into the Filipino setting, we invite everyone to understand and practice the Triangle of Self-Care, which will be essential in HIV prevention, with or without PrEP:
T: Timely Testing and Treatment
S: Safe and Satisfying Sex
C: Correct and Consistent Use of Condoms with Water-Based lubricant

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