A Beginners' Guide to Going on PrEP

PrEP (pre-exposure prophylaxis) is a wonder drug that, if you take it as directed, will stop you getting HIV. It’s been a huge game-changer when it comes to the battle against HIV infection and a huge game-changer for my own sex life. For me, PrEP took the concern out of sex. 

I’ve always been pretty on it with condoms, but a while ago I was fucking a guy whose name I didn’t even know and the condom broke. I woke up wearing the bleak cloak of anxiety; I wasn’t sure exactly how long the unprotected sex had gone on for before I noticed. Even worse, I forgot to ask his HIV status before he left. I didn’t know anything about him, in fact, other than the fact that he was really good at rimming. (Like, really good.)

For weeks my brain turned inside out with worry while I waited for my HIV results to come back. What I didn’t know then was that I could have taken PEP, a short course of meds taken soon after possible exposure to HIV, to stop the virus from taking hold. The closer to the exposure, the more likely it is to work, so you’ve got to take it within 72 hours of a possible exposure. If you’re ever in my position, head to your local sexual health clinic (or if it’s the weekend, A&E) and they will sort you out with PEP. 

Once you’ve been through this traumatic process – your heart skipping a beat when you eventually receive the automatic text message from NHSNoReply – you’re never keen to repeat it. Which is how, for me, taking PrEP became as important as packing lube, my ID and MDMA when I’m preparing for a good night out. So for anybody looking to indulge their slutty side – no judgment here – or simply wants to know more about their options, here’s a guide to getting on PrEP.

“If you take PrEP as directed, it works almost 100 percent,” says Greg Owen, a man whose activism has prevented thousands of HIV infections. His journey to becoming "one of the UK’s most vocal proponents of PrEP" began when he wanted to go on the treatment in 2015. It wasn’t available on the NHS back then, but he managed to get hold of some and took a HIV test as part of the process – only to find out he was positive. 

Believing he could have avoided the situation if PrEP had been available, he and a friend launched the website IWantPrepNow, which connected users to vetted online pharmacies where they could buy a generic version of the drug. Around that time HIV infections amongst gay men dropped by 40 percent in London, which one HIV researcher directly attributed to Owen. Finally, in 2017, the NHS faced a legal challenge forcing them to offer PrEP on demand.

The reason Owen took the test before PrEP was because you don’t take PrEP if you’re HIV-positive. Instead, you start antiretroviral treatment which will bring your viral load down to undetectable levels, meaning you can’t pass HIV on. (The science is very clear on that.)  

“When taken as prescribed,” says Dr Luke Purwar, a clinician working at a GUM/HIV clinic in London, “PrEP is extremely effective at preventing new HIV diagnoses amongst gay and bisexual men – people who were assigned male at birth – practising unprotected AKA condomless anal sex.” 

He adds: “When taken correctly and consistently, studies have demonstrated PrEP's efficacy to be over 99 percent – virtually 100 percent.”

These days it’s easy to get PrEP on the NHS: If you are in any higher-risk group when it comes to acquiring HIV (a man or nonbinary person who has sex with men, a sex worker, someone who goes to sex parties, someone who’s into chemsex, a HIV-negative person with a HIV-positive partner, etc) you can have it. You just need to get a full sexual health check-up (it’s astonishingly efficient via the post these days), take the results to a clinic and ask for PrEP. 

There are two main ways of taking the drug right now. (An injectable version of PrEP is due to be made available in England and Wales later this year.) The first is daily dosing: one pill a day and after seven days, you’ll be fully protected as long as you keep taking it. “The thing with daily PrEP is it's one pill a day,” Owen says. “If you take it every day, as part of your routine, like when you're brushing your teeth or just before you go to bed, that's a good thing to get into.” 

Why is that? “For cisgender MSM [men who have sex with men], if you're established on daily PrEP and you forget to take one or two doses – say you're out partying on a bank holiday weekend, you’re high and you hadn't taken your PrEP that day – there's quite a big forgiveness bracket with missing doses if you're on daily.” 

Then there’s events-based or on-demand dosing; that’s two pills 24 hours before you fuck, a pill 24 hours after your starter dose, and then a pill every day afterwards until two days have passed since your final fuck. “Daily PrEP is really good if you're a little bit chaotic or you don't always remember to take pills,” Owen explains. “It’s great for most people as it has that extra forgiveness. But some people don't want to take a pill every day if they have sex like once every six weeks. It's about knowing when you're going to have sex.” 

On-demand dosing doesn’t offer the same margin of error. As Owen points out, if you’ve been partying and hooking up for three days, you’ll probably sleep through your pill deadline once you finally wind down – so it’s probably best to go with daily PrEP unless you just go to specific sex-positive events every so often. 

“There are no specific pros or cons to choosing to use PrEP daily or event based,” Dr Purwar adds. “It's a personal choice and people choose whatever works best for them depending on their schedule, sex-life and all sorts of other factors.” 

Just make sure you know the ins and outs of events-based dosing, which can be confusing for some: “Whenever someone tells me they are using event-based PrEP I always check they know how to take it correctly,” Dr Purwar says. “Most do but you get some varied answers.”

A word of warning: Even if you’re on PrEP, you can still catch every other STI, especially if you don’t use condoms. It’s a good idea to get a sexual health check-up every three months and get vaccinated to protect yourself from HPV (men who have sex with men can get the HPV vaccine on the NHS), Hepatitis A and B, and monkeypox. 

“There's also a misconception that PrEP is only available for gay and bi men,” Dr Purwar adds. “If you're of any gender or sexual orientation and attending group sex events or parties, or you're having sex with queer men, you can also consider using PrEP.”

Trust me, those who’ve perfected the art of being a slut – the people who unapologetically love sex with multiple partners, sometimes all at once – are some of the ones who take the most responsibility for having safer sex. That means getting regularly tested, and getting on PrEP.

@oldspeak1