12 myths and facts about PrEP for gay & bi men

Although organisations such as Health4Men have been educating gay men and other men who have sex with men (MSM) about various HIV prevention strategies for several years, one such option has recently made headlines: pre-exposure prophylaxis, commonly known as PrEP.

The fuss was all about PrEP finally being approved for use in South Africa. So, now that it’s been given the go-ahead, here are all the facts you need to protect yourself:

1. MYTH: PrEP cannot protect me from getting HIV.

FACTS:

• Multiple clinical trials and research studies have proven that PrEP can safely add up to 92% protection against HIV when taken daily.
• In real life settings, PrEP has prevented 100% of HIV infections among large populations of gay men.
•  The World Health Organization (WHO) fully supports gay and bisexual men using PrEP to prevent getting HIV.

2. MYTH: Using PrEP will make me feel unwell because of side effects.

FACTS:

• For most people, PrEP will not cause side effects at all. A small proportion of men taking PrEP may get minor side effects such as nausea but these generally go away after a few weeks.
• PrEP can cause a very rare but serious side effect which could negatively affect kidney function but your medical provider will check to see if you are susceptible to this side effect before you are allowed to take PrEP.

3. MYTH: Taking PrEP means that if I ever do become HIV positive ARV drugs won’t work for me.

FACTS:

• If you take PrEP daily, you have very little risk of being infected with HIV. Regular testing will ensure that if you should become infected, it will be detected early, which will decrease your risk of developing resistance to the drugs used in PrEP.
• It is important to ensure that you are HIV negative when you start taking PrEP. There is a risk of developing resistance to the drugs in PrEP if you start taking them when you are HIV positive but still testing negative (in your window period, during which available tests are not sensitive enough to detect your infection).
• Even in the case of resistance, there are many other drugs that can work to treat HIV besides the drugs used in PrEP.

4. MYTH: If I start PrEP I will have to take it for the rest of my life.

FACTS:

• When you are taking PrEP it is very important for you to take it everyday; however, you can stop taking PrEP all together if you no longer think that you need it.
• This is similar to how women can take the birth control pill; they have to take it everyday while on it but if they aren’t worried about getting pregnant can go off of it.

5. MYTH: I can take PrEP only when I need it on the days when I think I will have sex.

FACTS:

• PrEP should be taken once daily in order to get the most protection from it.
• Daily dosing is recommended based on the best available evidence from clinical trials.
• Good HIV protection has been demonstrated if pills are taken 4 or more days days per week, however the best level of protection occurs with daily pill taking.
• If you take PrEP less than 4 times a week and are exposed to HIV, you risk becoming infected.
• PrEP takes between 7-10 days to reach its highest level of protection.

6. MYTH: I can safely stop using condoms if I take PrEP.

FACTS:

• If you take PrEP and do not use condoms when you have sex you will still have up to 92% protection against HIV; however, PrEP does NOT protect against other STIs, such as syphilis, chlamydia and gonorrhea or HPV. Some of these STIs are treatable but others can require life long treatment.
• If you are taking PrEP and not using condoms, you should increase the frequency of your STI testing This should include tests for STIs around your penis, anus and in your throat, as these are typical locations where gay men may be infected.

7. MYTH: PrEP gives people permission to be sexually reckless and promiscuous.

FACTS:

• Taking PrEP means being responsible and taking ownership of your health and well-being.
• PrEP can be used for many different reasons in addition to to providing protection against HIV when not using condoms.
• Other reasons for taking PrEP:
  • Some HIV negative people may use PrEP because they are with an HIV positive partner and they want to add more protection.
  • Many guys are not consistent about using condoms; sometimes a condom can break or slip off during sex. PrEP can function as a back up plan and protect them from being infected with HIV.
  • Other guys are in sexual relationships where their partners refuse to use condoms or pressure them into having bareback sex.

8. MYTH: Taking PrEP means I will have to visit my healthcare provider often.

FACTS:

• PrEP does not require extensive follow up with your health care provider.
• You will need to be screened prior to starting PrEP to make sure that you are eligible and then you will be required to have at least three follow up visits every year depending on your health care provider.

9. MYTH: Taking PrEP will make me test HIV positive.

FACTS:

• The medications used in PrEP (Emtricitabine and Tenofovir) will not make you test HIV positive.
• You will only test HIV positive if you have been infected with HIV and your body is producing anti-bodies.
• Taking PrEP will require you to have regular HIV tests.

10. MYTH: Taking PrEP is expensive.

FACT:

• PrEP is not yet available for free through public clinics or covered by medical aids but it can be purchased for approximately R260 – R500 per month from a pharmacy, with a doctor’s script.

11. MYTH: PrEP is only needed for guys who bottom (receptive anal sex).

FACTS:

• PrEP should be used by men who bottom, top, or who are versatile.
• PrEP will provide protection against HIV regardless of your sexual positioning.

12. MYTH: PrEP is a pharmaceutical company conspiracy to make money from HIV.

FACTS:

• The development of PrEP was driven by activists, scientists and community leaders from the gay community in each of the countries where it was tested, including South Africa.
• Gilead, the pharmaceutical company which developed Truvada, was not allowed to actively participate in the research used to prove that PrEP works other than to provide the drug.
• All procedures, products, method, and results for all of the trials used to prove that PrEP works have been made available transparently and are accessible for detailed examination online should individuals have any questions.