Daily or on-demand PrEP? — How to choose what’s best for you

By Chris Williams, updated 6 months ago in Health / Sexual health

clock prep pills in heart shaped container pill bottle on yellow background

Eight years ago, the United States FDA approved a game-changing pill that protects against HIV. It’s known as PrEP. And among guys into guys, it’s become a well-established new normal across Australia and beyond. It’s influenced the ways we think about our health, how we hook up, and it’s helping us curb the spread of HIV in ways we’ve never witnessed before.

You’re probably familiar with PrEP as a program that combines the use of daily medication with regular testing. But if you’re HIV negative, using PrEP once a day for round-the-clock protection isn’t the only way it can help you avoid HIV. There’s also On-demand PrEP – Powerful HIV protection when you decide.

Instead of taking one pill a day, doing it on-demand follows a carefully timed dosing schedule using fewer pills in a shorter space of time. When used as advised, on-demand PrEP is equally effective at protecting someone against HIV as daily PrEP — making it another appealing choice in the HIV prevention toolkit.

In this article:

On-demand is in demand

If you’re curious about other guys’ thoughts of on-demand PrEP, Aussie researchers are already on it. Their findings show almost half the guys surveyed were interested in giving on-demand PrEP a go.

Since the COVID-19 crisis, researchers also gathered evidence to show casual sex is down Down Under, guys aren’t seeing their fuckbuddies as much and more than 40 per cent of those surveyed had stopped using PrEP altogether. See I’m not hooking up. Should I stop taking PrEP every day? for more on stopping and restarting PrEP safely.

“…on-demand PrEP is equally effective at protecting someone against HIV as daily PrEP — making it another appealing choice in the HIV prevention toolkit.”

As parts of the country re-open for business, right about now would be timely to know your options… because sooner or later, sex will be back on the table. If you’re in demand, now’s the time to know about on-demand!

Sticking to physical distancing rules in your state/territory is still recommended, but if you’re getting it on, choosing either on-demand or daily PrEP is better than choosing neither — especially if condoms or a partner’s undetectable viral load aren’t in the mix.

Is on-demand PrEP suitable for you?

As with all good decisions, it’s about equipping yourself with enough information to choose what’s best. Your best HIV prevention options will always be the ones you can make work for you.

Before changing your current situation, check in with a doctor or sexual health centre to make sure on-demand PrEP is right for you. Australia’s PrEP guidelines indicate on-demand PrEP is a suitable choice if:

  • You’re a cisgender man who has sex with other men
  • You’d prefer to use on-demand PrEP instead of daily PrEP
  • You have sex less than twice a week
  • You can plan ahead or delay sex for at least two hours
  • You don’t have chronic hepatitis B

Even if on-demand PrEP isn’t a suitable match, daily PrEP is still available for anyone at risk of HIV. Discover more about HIV transmission, testing and prevention in HIV 101.

While the above points can help you figure out if on-demand PrEP is suitable, there are other factors to think about before you decide.

PrEP pill bottle on blue background with strong arms in shadow

Choosing between on-demand and daily PrEP

Can you follow the schedule?

On-demand PrEP involves a carefully timed dosing schedule — check out the section below on how to use it. It might be easier than you’d imagine.

However, if sticking to the dosing schedule might not work for you, daily PrEP could suit you better. Missing a dose of on-demand PrEP could mean it’s not able to protect you against HIV.

“Your best HIV prevention options will always be the ones you can make work for you.”

Can you swallow the cost?

On-demand PrEP involves using fewer pills compared to daily PrEP, so it works out more affordable than paying to use medication every day. If you have Medicare, it costs no more than $31.60 for 30 pills, or $7.70 with a concession card.

Community organisation PAN (PrEPaccessNOW) offers free PrEP to anyone who can’t afford it — whether you do or don’t have access to Medicare.

For thrifty shoppers, community group PrEP’D For Change issues a monthly price comparison and buyers guide for the most affordable PBS and personal importation options.

How do you feel about taking pills?

Not everyone’s comfortable using medication every day — and that’s OK. On-demand PrEP might be more appealing because you decide when you want to use it and when you don’t.

As long as you can plan ahead or delay sex for at least two hours while the medication gets to work in your body, on-demand PrEP can maximise your protection while minimising the amount of medication you use.

If you’re comfortable taking one pill a day, daily PrEP is a great choice for as long as you want to be covered by its always-on protection.

How often are you having sex?

A common reason guys stop daily PrEP is down to not having enough sex to warrant using it. With on-demand PrEP, you can still benefit from powerful protection just for those times when you do have sex without having to use or pay for medication you don’t need.

For anyone having sex twice a week or more, daily PrEP is the recommended option — you’ll be ready for action whenever it comes your way.

What are your thoughts on long-term PrEP use?

For some guys, the thought of using medication for a long time can be daunting. Even after many years of real-world PrEP use combined with evidence from studies on its safety and effectiveness, it’s OK to be thoughtful about the impact of using PrEP long-term. Wondering about the effects of something that isn’t ordinarily in your body is a natural part of wanting the best for your overall health and well-being.

“…on-demand PrEP can maximise your protection while minimising the amount of medication you use.”

What’s also important to consider is the long-term impact of getting HIV. Much like PrEP, modern HIV treatments are also safe and effective. The difference is, until the science of treatment advances, there’s currently no option to stop using HIV treatment medication every day without damaging your health if you were to acquire the virus.

On-demand PrEP offers a short-term HIV prevention solution that supports a desire for intimacy and pleasure while balancing consideration for your long-term well-being.

red haired man in glasses biting prep pill on blue background

How to use on-demand PrEP

Using on-demand PrEP involves following this carefully timed dosing schedule:

  • First dose: take two pills (a double dose) between two and 24 hours before sex
  • Second dose: take one pill 24 hours after the first double dose
  • Third dose: take one pill 24 hours after the second dose

Timing is an important factor for ensuring on-demand PrEP delivers effective HIV prevention. The initial double dose is essential for boosting the amount of medication in your body before you possibly come in to contact with HIV.

This video from Thorne Harbour Health provides more details.

On-Demand PrEP – Thorne Harbour Health

How to get PrEP

Accessing PrEP starts with a visit to a doctor or sexual health centre. Wherever you are in Australia, options are available to you.

Here’s everything you need to know about finding a doctor, buying PrEP on the PBS or online for personal importation, and free PrEP for anyone who can’t afford it.

Support for choosing and using PrEP

Want to chat with someone for non-judgmental support and advice about what’s best for you? Check out our guide for finding support with PrEP: Got a PrEP question? Here’s where to find support.

You can also check out our PrEP selector tool! Answer a few questions and you’ll receive a recommended PrEP regimen that could work best for you.