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Fitness and body

I’m not hooking up. Should I stop taking PrEP every day?

Dear Emen8: Until the COVID-19 situation is over I’ve decided to stop hooking up. The thing is, I’m not sure if it’s OK to just stop taking my PrEP every day or if there’s something else I should do. Can you help? — TAKING A BREAK, SOMEWHERE IN AUSTRALIA

DEAR TAKING A BREAK: Well done on your choice to do the right thing to protect yourself and your partners against COVID-19. And you’re certainly not alone in thinking about your PrEP use after choosing to stop casual sex for the time being.

For many people across Australia, PrEP has become a normal part of daily life. While our lives are being disrupted by the COVID-19 pandemic, continuing to use daily PrEP could offer a semblance of normality.

Of course, if you’re not having sex at present, then it’s OK to take a break from using PrEP. While daily PrEP can offer confidence in being protected against HIV all day, every day, we know that taking it might seem an unnecessary use of medication as well as a reminder of the sex you’re not having.

There are different ways to stop using daily PrEP depending on your situation. We’ve also provided alternative options should any circumstances change and you need to continue being protected against HIV.

Stopping daily PrEP safely

If you’re a 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.

If you haven’t had any sex in the last two days you can stop using PrEP immediately.

If you’ve heard about needing to keep using PrEP for 28 days before stopping, don’t worry. This was the previous advice from doctors before the Australian PrEP guidelines changed in September 2019. Clinical evidence now supports this faster stopping method in cisgender men who have sex with men only — the 28 day stopping period still applies for everyone else until more evidence is available.

“Switching to on-demand PrEP could be a suitable alternative to using daily PrEP for some people.”

If you’re anyone 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.

If you haven’t had any sex in the last 28 days you can stop using PrEP immediately.

For everyone stopping PrEP:

Using daily PrEP means 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. Other options include using on-demand PrEP, condoms and starting a conversation about relying on a partner’s undetectable viral load if they’re living with HIV and using treatment.

Switching to on-demand PrEP

Current Australian guidelines include two options for using PrEP: daily PrEP and on-demand PrEP.

If you’ve stopped using daily PrEP but an opportunity for sex arises — perhaps with a regular partner — on-demand PrEP is an equally effective way to protect yourself against HIV when you decide.

On-Demand PrEP – Thorne Harbour Health

Switching to on-demand PrEP could be a suitable alternative to using daily PrEP for some people. On-demand PrEP involves following a carefully timed dosing schedule, which uses fewer pills in a shorter space of time. On-demand PrEP is only suitable for cisgender men who have sex with men who can plan in advance or delay sex for at least two hours.

To use on-demand PrEP:

  • 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 24 hours after your first dose; then
  • Take one final pill 24 hours after the second dose

When using on-demand PrEP, it’s important to stick to the dosing schedule precisely and take your pills at the right time to ensure you’re protected against HIV.

Discover more about on-demand PrEP in On-demand PrEP – Powerful HIV protection when you decide.

Restarting daily PrEP safely

If you’ve had any possible exposure to HIV since you stopped using PrEP, it’s important to check in with a doctor for comprehensive sexual health testing before you restart PrEP. This is to make sure you’re still HIV negative. Using PrEP after acquiring HIV could limit your treatment options.

If you’re a cisgender man who has sex with men:

To restart daily PrEP, 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 continue taking one PrEP pill every day.

If you’ve heard about using PrEP for seven days before you’re protected, it’s OK. This was the past advice from doctors before the Australian PrEP guidelines changed in September 2019. Clinical evidence now supports this faster starting method in cisgender men who have sex with men only — seven days of daily use to reach optimal protection against HIV still applies for everyone else.

If you’re anyone else:

For trans and gender diverse people, cisgender women and heterosexual men, restarting daily PrEP is different.

To restart daily PrEP, take one PrEP pill every day for seven consecutive days before you have sex. Then continue taking one PrEP pill every day.

Other HIV prevention options

If you’re taking a break from PrEP, it’s good to know about other options available to you. If it’s suitable for you, on-demand PrEP is a great way to protect yourself, but relies on you knowing you’re going to have sex at least two hours in advance. This gives your body time to build up protection against HIV from the initial double-dose.

Other HIV prevention options can be used immediately, including:

  • Using condoms
  • Discussing relying on a partner’s undetectable viral load if they’re living with HIV and have maintained an undetectable viral for at least six months using HIV antiretroviral treatment — a sustained undetectable viral load means there is no risk of HIV transmission

In an emergency, there’s PEP — a one-month course of anti-HIV drugs that can prevent someone from acquiring HIV after possible exposure to the virus. If you think you may have been exposed, act fast — PEP is best started within 72 hours and the sooner the better.

Exposed to HIV? Get PEP (Post-Exposure Prophylaxis)

Getting help

At Emen8, we’re here to help guys all over Australia look after their sexual health and wellbeing. So if you’d like to get in touch about anything, feel comfortable to hit us up via email, or reach out on Messenger.

We also know about community groups dedicated to supporting people choosing, using and taking a break from PrEP in Australia. Check out the Facebook groups for PrEP’D For Change and PAN (PrEPaccessNOW).

Alternatively, contact your local HIV/AIDS organisation for support and information in your state or territory.

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