It’s called Event-based PrEP or PrEP On-demand, and it’s when you take two PrEP pills on the day you plan to have sex and then one pill every day for two days after you’ve had sex.
The World Health Organisation currently recommends that taking PrEP every day as usually prescribed is the best way to use PrEP, but a French Study called IPERGAY as well as another study called the Prevenir Study presented at The AIDS Conference 2018 in Amsterdam, which has discovered that PrEP On-demand still prevents HIV transmission by 86% for men who have sex with men (there is no data yet to support event-based PrEP for women).
Why would you use PrEP On-demand if the more traditional use of PrEP has been proven to be so effective in preventing transmission, even for condom-free sex? Well, there are a few reasons:
Despite the fact that many people now access PrEP for free from clinics like Anova’s Ivan Toms Centre for Men’s Health in Greenpoint due to scale up by the Department of Health, and others get them as part of progressive medical aid schemes, others need to pay for their PrEP every month and this can cost anything between R300 and R800 per month.
Popping a PrEP pill every day of the month when you’re only having sex once or twice a month seems expensive and excessive to some guys.
PrEP On-demand is a more cost-effective way to use PrEP to prevent HIV transmission, but there are some other things to consider: compared to daily PrEP, where daily pill-taking becomes a habit and protection is always “in-place” when you need it, event-based PrEP requires planning as you would need to anticipate when you might have sex and ensure that you have pills available at that time. Most of us don’t always know when we will be having sex next, which is why taking it every day could be a good idea, just in case. Also, event-based PrEP has not yet been studied or proven to work for women, and young women are a major target for PrEP in South Africa. Many people who do not have sex often or who do not have sex with more than one partner are on PrEP, so no assumptions should be made about people who take PrEP. PrEP-shaming feeds stigma, which is unnecessary and dangerous as it may influence those who would benefit from PrEP to not want to take it. PrEP is a form of prevention, which is responsible.
A factor to consider is that PrEP is only indicated for use by HIV-negative people. If people are using infrequent On-demand PrEP, they would need to test themselves for HIV frequently to ensure that PrEP is right for them, especially if there have been any sexual encounters that were not protected by PrEP or condoms.
No matter how PrEP is taken, it does not protect against other STIs like syphilis, gonorrhoea and chlamydia, but these are easily treated with a visit to the clinic. If you don’t take PrEP as prescribed it may not effectively prevent the transmission of HIV, but if you do, PrEP is a fantastic way to ensure that you remain HIV-negative if you are having sex frequently with more than one partner.
How to use PrEP On-demand
If you know you’re probably going to have sex on a specific night, take two PrEP pills (Truvada or a generic) at least two hours before you have sex. 2 to 24 hours, before you have sex, is effective.
After you’ve had sex, take one PrEP pill every day for another two days, so you will have taken 4 tablets in total.
It’s probably easier to just take PrEP every day as prescribed as part of your daily routine, but PrEP On-demand or Event-based PrEP has also been found to be an effective way to minimise your risk of HIV if you are a man who has sex with other men.
If you’d like to get more information or get access to HIV prevention or treatment you can call, text or send a ‘please-call-me’ to Call4Care, weekdays 9 AM to 4 PM on 071 683 3226
PrEP is available for free at Ivan Toms Clinic, 1 Portswood Rd, Greenpoint Cape Town as well as at the Health4Men Services Clinic in Yeoville, Corner Kenmere Rd and Hopkins Str, Yeoville, Johannesburg.
Bruce J. Little is the Content Creator for Anova Health Institute.