Preventing HIV with medication

Preventing HIV with medication

HIV (human immunodeficiency virus) is a virus that damages the immune system.

This section focuses on ways you can use medication to avoid getting HIV, specifically:

• using a medication called pre-exposure prophylaxis (PrEP) before any HIV risk
• using post-exposure prophylaxis (PEP) if you’ve recently been at risk of contracting HIV

If you have sex with any people living with HIV who have an undetectable viral load (UVL) by being on treatment, they cannot pass it on to you through sex.

To learn more about HIV in general, check out our HIV explainer.

What is HIV risk?

There is a lot of misinformation about HIV transmission. In brief, HIV is usually passed through bodily fluids during condomless receptive anal (bottoming) or vaginal/front hole sex with a partner of an unknown HIV status. It’s possible, but less likely, for HIV to be passed through oral sex.

There could be an HIV risk if, for example:

• you have condomless receptive anal (bottoming) or vaginal/front hole sex with a man who has sex with men
• you are trans or gender diverse and have condomless receptive anal sex
• you share injecting equipment with someone who lives with HIV, or with a man who has sex with men

What is PrEP?

PrEP stands for pre-exposure prophylaxis. This means reducing your HIV risk by taking medication before sex, to prevent HIV transmission.

PrEP is an oral prescription medication that protects against HIV. Cis men can take PrEP daily or ‘on demand’. For anyone other than a cis man, PrEP must be taken daily as ‘on demand’ PrEP has only been proven effective in cis men. This means that women (cis and trans), trans men and gender diverse people are recommended to take it every single day while they’re having sex that can put them at risk of HIV.

Taken correctly, PrEP is better at preventing HIV infections than condoms alone (but unlike condoms, it doesn’t prevent other STIs). To guarantee that you are protected, for daily dosing (all non cis men) start PrEP at least seven days before any potential HIV risk and continue taking it daily for ongoing protection.

If you decide to stop taking PrEP, wait until it’s been 28 days since your last HIV risk.

Is PrEP right for you?

PrEP is recommended for anyone considered to be at risk of HIV. For example, it would be suitable for:

• A woman whose male partner lives with HIV but isn’t on treatment and/or hasn’t been able to achieve an undetectable viral load for more than six months.
• A trans man who has casual receptive anal and vaginal sex with queer men and doesn’t always use a condom.
• A trans woman who has casual receptive anal or neovaginal sex with bi+ men.
• A woman who’s in a non-monogamous relationship with a bi man who has unprotected sex with men and who’s not on PrEP himself
• A cis woman who has a uterus and wants to get pregnant using sperm from someone who has HIV.
• A non-binary person who shares injecting equipment with someone who lives with HIV.

This list is not exhaustive. It is intended to show different examples and scenarios where PrEP might be considered.

If you think PrEP could be right for you, get advice from a healthcare professional. You don’t need to see a specialist. In Australia, all general practitioners (GPs) can prescribe PrEP.

Talk to your doctor or visit PrEP Access Now for more information.

How much does PrEP cost?

If you have Medicare

If you have a current Medicare card, you can access PrEP at a subsidised cost. This means any doctor or general practitioner can write a script for PrEP, which can be dispensed at a pharmacy.

You can also visit the PrEP Access Now website for other cost-effective options.

Keep in mind that you’ll also have to pay the costs of seeing a doctor and getting routine tests while taking PrEP. These services are free at sexual health clinics, or at a bulk billing GP if you have Medicare.

If you don’t have Medicare

If you don’t have access to Medicare, while you will not be eligible to receive subsidised PrEP. You can consider personal importation, which can be an affordable alternative.

Many overseas importation options offer generic PrEP at a price comparable to subsidised PrEP on Medicare. You will still need a script from an Australian doctor, and a cost may be associated with your appointment or required testing.

To access PrEP via personal importation, we recommend visiting the PrEP Access Now website.

What is PEP?

PEP stands for post-exposure prophylaxis. PEP is an oral prescription medication that reduces the chance of getting HIV after a possible exposure to the virus. It must be taken within 72 hours of a potential HIV exposure – the earlier, the better.

Is PEP right for you?

PEP is only recommended for people who may have been exposed to HIV within the past 72 hours. If you think you’ve had an HIV risk, it’s important to act fast. PEP is more effective the sooner you start.

You can access PEP:

• at most sexual health clinics
• hospital accident and emergency departments
• and some doctors who specialise in HIV (called s100 GPs).

If you plan to visit a clinic or doctor, call ahead and check that they’re open.

If you’re exposed to HIV outside of regular office hours, go to the nearest hospital emergency department. This will help you start PEP promptly.

For more info about PEP and to find locations to access PEP in your area, visit Get PEP.

How much does PEP cost?

PEP is usually free, regardless of Medicare status, from:

• hospital emergency departments
• HIV and sexual health clinics
• hospital pharmacies

The cost of PEP from a community pharmacy can vary, and not all community pharmacies can give you PEP.

What is undetectable viral load (UVL)?

Many people living with HIV can easily manage the virus with medication. This treatment can suppress the virus to the extent that they have an undetectable viral load (UVL).

We now have years of research to show that people living with HIV who have a UVL can’t pass the virus on through sex, even if condoms aren’t being used. In other words: undetectable = untransmissible (U=U).

What sort of protection does UVL provide?

For people living with HIV, staying undetectable – through proper and consistent treatment – eliminates the possibility of passing the virus to other people.

Being undetectable helps protect your organs and nervous system, which can be damaged by untreated HIV. It also allows your immune system to work properly, protecting you from everyday infections as normal, and giving you a similar life expectancy as your peers without HIV.

People without HIV aren’t at risk of getting the virus from someone with a UVL, as long as they stay undetectable.

Remember: HIV is not contagious from a person with HIV on treatment who has a UVL. If the virus is undetectable, it’s untransmittable.