PrEP – Pre-Exposure Prophylaxis for HIV

PrEP is most commonly used daily, by taking one tablet orally every day at around the same time. Daily medication should be started seven days before possible HIV exposure. If you want to stop or pause the medication, you can stop taking it seven days after the last exposure situation.

As an alternative to daily use, PrEP can be taken on-demand. On-demand use means taking PrEP situationally, when there are sexual contacts that may involve a risk of HIV transmission.

Currently, on-demand use is only possible for people who have had a penis since birth. PrEP does not yet protect the vaginal mucosa adequately during penis-vagina intercourse.

On-demand PrEP may be suitable for a person who meets the following criteria:

• has had a penis since birth,
• has risk situations, such as anal sex without a condom or sex in high HIV prevalence countries, less than twice a week,
• is able to anticipate sexual encounters, since the tablets must be taken at least 2 hours before sex,
• is able to commit to situation-specific medication, since the tablets must be taken every 24 hours.

In on-demand PrEP, two tablets are taken 2–24 hours before a sexual situation where HIV exposure is possible. After this, one tablet is taken every 24 hours for as long as there are sexual contacts with HIV risk. After the last sexual contact, one tablet is taken daily for two more days.

• Two pills at the same time 2–24 hours before having sex
• One pill each day at approximately the same time for as long as there are sexual contacts
• One pill for two days after the last sexual contact

Globally, longer-acting injectable forms of PrEP have been developed and are currently under development. These are not yet available in Finland.

In Finland, PrEP treatment, including the medication and follow-up, is free of charge for those who have access to public healthcare and meet the criteria for PrEP treatment. Free PrEP treatment is available in all well-being services counties.

There’s not yet a solid national practice for starting and organizing PrEP treatment. PrEP should be provided by healthcare personnel with expertise in HIV, sexually transmitted infections, and sexual health. Most often, treatment is arranged at infectious disease clinics or STI clinics. In some municipalities, treatment can also be arranged at health centers. In some areas, a doctor’s referral is required for PrEP assessment, while in other areas you can access PrEP assessment directly by contacting the clinic.

If you are interested in starting PrEP, you should contact your local well-being services county and ask how to access PrEP assessment in your area.

If a referral is required for PrEP assessment in your area, you can request it from your local health center or occupational healthcare. Any doctor with sufficient knowledge about PrEP can write the referral.

If you face difficulties in accessing PrEP or getting a referral, you can ask for help from Hivpoint’s PrEP counselling.

PrEP can also be prescribed by any private healthcare doctor with sufficient knowledge of PrEP treatment and HIV. In private healthcare, the client pays for the prescribed medication, doctor’s visits, and laboratory tests.

You may consider private PrEP treatment if, for example:

• you do not have access to public healthcare in Finland,
• you are already on a waiting list for a PrEP assessment in public healthcare, but need PrEP urgently while waiting, or
• you otherwise want PrEP urgently and are willing to pay for it, for example before a trip abroad where unprotected sex is expected.

PrEP treatment always includes medical follow-up, and the medication should not be used without a doctor’s supervision. In public healthcare, follow-up visits are free of charge.

Before starting PrEP, it must be certain that you do not have HIV. PrEP medication includes same substances as HIV treatment, but PrEP alone is not sufficient for treating HIV infection. If a person who is unknowingly HIV-positive starts PrEP, it may cause drug resistance, making it harder to find effective HIV treatment. An HIV test is always done when starting PrEP.

PrEP follow-up includes HIV and other STI tests every three months. When starting PrEP, HIV is tested already one month after starting the medication to exclude a recent HIV infection. After that, HIV is tested every three months, just like other STIs. STI tests are needed because PrEP does not protect against other sexually transmitted infections.

PrEP follow-up is also important because of potential side effects. The doctor prescribing PrEP will discuss any existing kidney-related or bone-related conditions with the client before starting PrEP. Along with STI testing, a kidney function test (creatinine) is done every three months. In general, PrEP medication is well tolerated without side effects.

Attending the required laboratory tests every three months is a condition for receiving the next supply of free PrEP medication.

If you access PrEP through private healthcare, your health should also be regularly monitored by a private doctor. In that case, you pay for the laboratory tests yourself.

PrEP medication is generally very well tolerated, and significant side effects are rare. If PrEP is taken on an empty stomach, it may cause digestive issues such as nausea, stomach pain, or diarrhea. These symptoms are usually temporary and related to starting the medication. They can be reduced by taking the tablet with food.

In some occasions, long-term use of PrEP could affect kidney or bone health. For this reason, your doctor will discuss any kidney-related or bone-related conditions with you before starting PrEP and assess the safety of the medication individually. This is also why kidney function (creatinine) is monitored with blood tests during PrEP treatment. In this way, the doctor can notice right away if the medication is affecting kidneys.

Are you considering starting PrEP? Before starting PrEP, it may be helpful to think about the following:

• What is my safer sex strategy? Do I use condoms, or would I benefit from PrEP to protect against HIV?
• Do I often have sex with a risk of HIV transmission? Do I believe PrEP would benefit me?
• Is PrEP intended for me? Do I belong to any of the most common target groups?
• Which way of using PrEP would suit me best: daily use or on-demand?
• Am I ready to commit to PrEP medication and the required follow-up to ensure my treatment is safe and effective?
• Do I need hepatitis A and B vaccinations? If you are a man who has sex with men, or if you inject drugs, you are entitled to free hepatitis A and B vaccinations in public healthcare. It is recommended that these vaccinations are taken before starting PrEP.
• Do I feel I have enough information about PrEP? Would it be helpful for me to get more information or talk about it with someone, for example, at Hivpoint’s PrEP counselling?

You can discuss all questions about PrEP and starting it with a specialist at Hivpoint’s PrEP counselling. Counselling can be given face-to-face in Helsinki or remotely. You can also ask about PrEP through our chat, phone counselling, or by email: prep(at)hivpoint.fi.

• I use PrEP as instructed and under a doctor’s supervision.
• I do not share my PrEP medication with others.
• I understand that PrEP does not protect me from other STIs. I will treat possible STIs appropriately and inform my sexual partners about them.
• I attend the required follow-up visits and laboratory tests every three months.
• If I can’t make it to a follow-up appointment, I cancel my appointment and book a new one.
• I commit to PrEP treatment so that it protects me and does not lose its effectiveness.
• If I face challenges in using PrEP or its follow-up, or if I experience side effects, I will contact my healthcare provider.
• If I want to pause or stop treatment, I will contact my doctor.
• I know I can always ask for advice and support from Hivpoint’s PrEP counselling.