PrEP & Prejudice
What is PrEP?
Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that uses antiretroviral drugs to protect HIVnegative people from HIV infection. People take antiretrovirals (ARVs) when they are at risk of exposure to HIV, in order to lower their risk of infection. PrEP is highly effective in preventing the sexual transmission of HIV, as long as the drugs are taken regularly, as directed. However, PrEP does not prevent other sexually transmitted infections or pregnancy.
What drug does PrEP contain?
Currently, people take PrEP as a pill which contains two drugs: tenofovir disoproxil fumarate and emtricitabine. Several different companies produce this pill, under different brand names. The original, patented version is called Truvada and is manufactured by Gilead. Other brand names for PrEP include Ricovir-EM (produced by Mylan), Tenvir-EM (Cipla) and Teno-EM (GPO). These are generic medicines which are much cheaper than Truvada but contain exactly the same active ingredients.
What does PrEP do?
The principle of PrEP is similar to that of antimalarial tablets used to prevent malaria when travelling in tropical countries. PrEP works in the following way. A person who does not have HIV takes enough antiretrovirals for there to be high levels of the drugs in their bloodstream, genital tract and rectum before any exposure to HIV. If exposure occurs, the ARVs stop the virus from entering cells and replicating. This prevents HIV from establishing itself and the person remains HIV negative.
Who is PrEP for?
National and international guidelines generally recommend that PrEP users should be HIV-negative, with no suspicion of acute (recent) HIV infection, be at substantial risk of HIV infection, have no medical reasons why they should not take PrEP drugs (such as kidney problems) and be willing to use PrEP as prescribed, including regular HIV testing. The question of who is considered to be at sufficiently substantial risk of HIV infection for public health agencies to recommend PrEP depends on the characteristics of the HIV epidemic in a particular place. The World Health Organization defines substantial risk of HIV in terms of an incidence of 3% or more. In other words, that in a particular group of people, at least 3 in 100 people would become HIV positive each year, if PrEP was not provided.