On-demand PrEP – Powerful HIV protection when you decide

You’ve probably heard about PrEP — the highly effective HIV prevention strategy that combines using medicine with regular sexual health testing. But what if there was a way to achieve the same powerful, biomedical protection without needing to use medicine every day?

Now there is. Introducing on-demand PrEP — a way to maximise your protection against HIV when you decide!

If you’re not already familiar with the groundbreaking concept of using medicine to protect against HIV, check out Introducing PrEP – The little blue pill making a big impact for more information.

On-demand means you’re in control

An estimated 17,000+ people around Australia already find it highly convenient to take a single PrEP pill once a day, safe in the knowledge they’re protected against HIV no matter what the day brings.

But not everyone’s the same.

Maybe you’re not overly keen on the idea of using medicine every day, or the frequency of the sex you’re having simply doesn’t warrant paying to use PrEP all the time.

Or perhaps you just want to benefit from powerful HIV prevention when you decide you want it — you know… Christmas, birthdays, when there’s an awesome party coming up, or maybe just for a sexy night in with someone special.

What’s involved?

Similar to daily PrEP, on-demand PrEP also makes use of highly effective prescription medicine to protect you against HIV. Where it differs from daily PrEP is how many you pills you take and when you take them.

Daily PrEP is as simple as using one pill every day for as long as you choose to be protected, which makes it useful for anyone who prefers ongoing protection for an extended period.

On-demand PrEP involves using exactly the same highly effective anti-HIV medicine as daily PrEP but with a different dosing schedule, which uses fewer pills in a shorter space of time. This makes it useful for occasions where you know you’re likely to be having sex at least a few hours beforehand.

“Similar to daily PrEP, on-demand PrEP also makes use of highly effective prescription medicine to protect you against HIV.”

Here’s an overview how on-demand PrEP dosing works.

  • take two PrEP pills at once — a double dose — between (no less than) two and (no more than) 24 hours before you have sex; then
  • take one more PrEP pill precisely 24 hours after your first dose; then
  • take one final pill precisely 24 hours after the second dose

That’s a total of four PrEP pills used over three days, starting with that critical double dose to boost the amount of medicine in your body before you have a possible sexual exposure to HIV.

As always, it’s best to follow the dosing recommendations advised by your doctor. When used as advised, on-demand PrEP provides highly effective protection against HIV. Check out this video that helps explain it.

On-Demand PrEP – Thorne Harbour Health

Is on-demand PrEP for everyone?

We know from the research that on-demand PrEP works for cisgender men who have anal sex with other men. We also know it works just as effectively as daily PrEP. So if you’re a guy who has sex with other guys, on-demand PrEP could be right for you.

Research for other populations and other types of sex has yet to emerge, but existing research shows that on-demand PrEP isn’t suitable for people having vaginal or front hole sex. In these cases, daily PrEP is recommended instead.

Lastly, on-demand PrEP is not recommended for anyone with an active Hepatitis B infection. While safe for use when Hepatitis B is not present, stopping the use of PrEP can cause adverse events affecting the liver when Hepatitis B is present. Discuss your Hepatitis B status or being vaccinated against Hepatitis B with your doctor.

Is on-demand PrEP right for me?

There are many reasons why on-demand PrEP could be right for you:

  • you have receptive anal sex (bottoming)
  • you want HIV prevention for a single act of sex, or for any amount of sex that happens during a short period of time
  • you don’t always use a condom
  • the amount of sex you’re having doesn’t warrant using PrEP every day
  • you’d rather not use PrEP every day
  • you’re not sure about possible side effects from daily PrEP
  • you just want peace of mind about being protected against HIV when you decide

What now?

On-demand PrEP works. But to be effective at protecting you against HIV you’ve got to use it properly.

Before you start using on-demand PrEP it’s important to make sure you’ve got access to all of the pills you need. And it’s extremely important to follow the dosing schedule carefully without missing any doses. Missing a dose means on-demand PrEP may not be able to offer you protection against HIV.

“On-demand PrEP works. But to be effective at protecting you against HIV you’ve got to use it properly.”

Any registered doctor or sexual health nurse practitioner can prescribe daily PrEP or on-demand PrEP, though not all might be familiar with the concept of PrEP, the different ways to use it or the evidence supporting its effectiveness. To assist with this, resources to help clinicians, including Australia’s clinical guidelines for prescribing PrEP are available online, including letters you can print to share with your doctor, providing information on testing, how to prescribe PrEP and where to access it.

Don’t forget that using on-demand PrEP involves checking in with a doctor once every three months for routine HIV and STI tests. Those STI tests are important because PrEP protects against HIV and doesn’t protect against other STIs. Common bacterial STIs are straightforward to treat and using a condom every time you have sex is a great way to help protect against most STIs.

If you feel either daily PrEP or on-demand PrEP could be right for you, start a conversation with your doctor or sexual health specialist.

Where to find help and support

If you’d like to discover more before you decide if PrEP is right for you, information and support for anyone choosing and using PrEP in Australia is available.

You can find Emen8 on Facebook and contact us through Messenger. Alternatively, visit one of our partner organisations in all states and territories.

If you’ve got a question, would like to find out how others are using PrEP or just want to share your experience, check out PrEP’D For Change online and on Facebook or PAN online and on Facebook.

How to get PrEP in Australia

Wherever you’re based in Australia, here’s everything you need to know about finding a doctor, PrEP on the Pharmaceutical Benefits Scheme (PBS), buying PrEP online and accessing free PrEP for anyone who cannot afford it.

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    1. Hey Slindile,
      Thanks for your comment. It seems you’re asking about how to stop using PrEP. Australia has different recommendations for safely stopping PrEP based on your circumstances.

      For cisgender man who has sex with men: To stop using daily PrEP, keep taking PrEP once a day for two consecutive days (24 and 48 hours) after your last possible exposure to HIV. Clinical evidence now supports this faster stopping method for cisgender men who have sex with men only — the 28 day stopping period still applies for everyone else.

      For trans and gender diverse people, cisgender women and heterosexual men, stopping PrEP is different. To stop using daily PrEP, keep taking PrEP once a day for 28 days after your last possible exposure to HIV.

      It’s always best to check in with your doctor before stopping or changing the way you use PrEP. Using daily PrEP might mean you’re used to being protected against HIV no matter what happens. So, it’s important to use alternative HIV prevention options in the event you stop daily PrEP and do have sex.

      You can discover more about safely stopping, (re)starting or switching to a different PrEP regimen in I’m not hooking up. Should I stop taking PrEP every day?

      Best wishes — the Emen8 team

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