Frequently asked Questions about PrEP

Our short answers to frequently asked questions about PrEP.

What is PrEP?

PrEP means taking medication to avoid getting HIV. The abbreviation stands for pre-exposure prophylaxis. PrEP is a pill that contains two active ingredients: emtricitabine and tenofovir. These active ingredients prevent HIV from replicating in your immune cells.

Who can take PrEP?

PrEP is recommended for people who are HIV-negative and more at risk of HIV infection. In the Netherlands, this is mainly men who have sex with men. PrEP is not suitable for everyone. Your kidneys must function well and you need to be able to take the pills on schedule. You will also need to have regular medical checkups.

How well does PrEP protect you against HIV?

PrEP will provide sufficient protection from HIV as long as you take the pills at the right time; then and only then will there be enough PrEP in your body. When taking PrEP on a daily basis and on demand (before and after sex), the level of protection is about 99%, according to CDC. PrEP only protects people from HIV, not from any other STIs.

Is PrEP safe?

Yes, the active ingredients in PrEP are safe. Serious side effects are very rare. 1 in 100 people may show decreased bone density. 1 in 200 experience kidney function problems, which is a good reason to stop taking PrEP. Less serious side effects are more common: 1 in 10 experience headaches, nausea or stomach problems, which disappear within two weeks.

Is taking PrEP responsible?

Yes, people who take PrEP are responsible. They want to protect themselves from HIV as well as they can. They are also tested for HIV and other STIs on a regular basis which means that they won’t transmit HIV or STIs to their sex partners. PrEP does not provide protection against any other STIs and therefore it is still recommended to use a condom when having anal sex.

Can you still get HIV while taking PrEP?

If you take PrEP as prescribed, the risk of getting HIV is extremely low. However PrEP does not provide 100% protection. One person had already gotten HIV before he started PrEP. Someone else was infected with such a high quantity of HIV that the PrEP he took was not enough to stop all of the virus particles that had entered his body. Another person contracted a strain of HIV that was resistant to the active ingredients in PrEP.

What is the difference between PEP and PrEP?

PEP and PrEP are both methods of preventing HIV with medication. The difference is that you take PEP after exposure to HIV (post exposure profylaxis). You must take PEP within at least 2 hours and at most 72 hours after exposure through risky sex, via the GGD (local Public Health Service) or the ER at a hospital. PEP is a 28-day course of treatment with three HIV drugs.You take PrEP before exposure to HIV.

What is the difference between PrEP and HIV treatment?

PrEP contains two active ingredients that prevents the HIV virus from attaching itself to immune cells. HIV treatment consists of three HIV inhibitors, each of which stop HIV spreading throughout the body in different ways. Two medications on their own are not enough if you have HIV. PrEP is not enough to treat HIV. For this reason it is very important to get tested for HIV before and during PrEP use. 

What is the difference between PrEP and PEP?

PrEP or PEP, which is better?

How much for PrEP via your family doctor?

The costs consist of medicines and the necessary medical checkups. PrEP is available at some pharmacies for as little as 27 euros per month (30 pills). PrEP is not yet reimbursed. From August 1 2019, a national PrEP scheme will start at the GGD. Within this scheme you pay a maximum of 25% (approximately €7.50) for the pills. The GGD takes care of the medical checkups (free of charge). The number of places within this scheme is limited. The GGDs try to get the scheme to reach those who need it most. If you can't apply for this scheme, you can still arrange PrEP through your family doctor.

Questions on using PrEP

How to get PrEP?

Your own doctor and pharmacy can prescribe PrEP. Your doctor will determine whether you are eligible for PrEP based on a national guideline. A five-year program for the provision of PrEP via GGDs will start from 1 August 2019. Within this scheme you pay a maximum of 25% (approximately € 7.50) for the pills and the GGD takes care of the medical checks (free of charge). The number of places within this scheme is limited. The GGDs try to get the scheme to reach those who need it most. Contact your GGD if you are interested in this program.

GGDs are busy implementing the scheme. Not every GGD will be able to provide PrEP care directly on August 1. On the website of PrEPnu you can see how far your GGD is. If you want to start with PrEP and you can afford it, don't wait for the GGD. Your own family doctor can help you with PrEP right now! 

Read more on how to get PrEP.

How do you use PrEP?

There are two ways to take PrEP: one daily pill, or on demand: 4 pills in total, taken before and after sex. If you follow the dosage scheme faithfully, both methods will protect you against HIV. You and your doctor will discuss which dosage scheme best suits your sex life.

How long do you need to take PrEP?

You don’t have to keep taking PrEP your whole life. You only need to take it while you are at risk of being exposed to HIV. If you take one daily pill, it takes seven days for the amount of PrEP in your body to reach a level that will protect you.

Which PrEP prescription should I ask for? 

Ask your family doctor for emtricitabine/tenofovir disoproxil. Have him/her state on the prescription that you must have the generic drug and not the brand Truvada. If not, you will be paying much more than you need to for the pills. Are you only going to take it on demand? Ask your pharmacy which affordable variety of PrEP they carry that has a shelf life of longer than 30 days.

What is the shelf life of PrEP?

You can take PrEP up to the expiration date on the packaging. Store the pills according to the instructions on the patient information leaflet in the box. If you keep PrEP too long or don’t store it properly, it won’t work as well. Some varieties of PrEP are sold in pots and some in blister packs. Is your PrEP in a pot? Check the patient instruction leaflet to see how long the pills can be taken after opening. Read more on the shelf life of PrEP.

Can you start PrEP on your own?

It is not advisable to start taking PrEP without a doctor’s supervision. PrEP cannot be taken if you have certain conditions such as liver disease or take certain medications. You need medical checkups before starting and during the whole time you are using PrEP. You must be certain you do not have HIV and you need to get your kidney function tested regularly. 

What medical checkups and tests are necessary?

While taking PrEP you will need a doctor’s checkup every three months. Talk to him/her about side effects and whether you think you will be able to follow the prescribed dosage schedule. Have your kidney function tested every three months and get tested for HIV and other STIs.. 

Is PrEP covered by insurance?

No, not yet. Even if a doctor prescribes PrEP, you will have to pay for the pills at the pharmacy. You will also need to take into account the costs for doctors visits and lab expenses for STI and kidney function tests, which will be covered by your insurance but usually you will need to pay the amount of your deductible.

Can you take drugs and drink alcohol while taking PrEP?

The efficacy of PrEP is not affected by drugs or alcohol. However, certain drugs may affect you more when taking PrEP. It is always advisable to be careful with drugs and alcohol taking medication. Start with a lower amount than you usually take.

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