PREP

Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) involves the use of a daily (or on-demand) oral HIV medication (called antiretrovirals or HAART) by people who are HIV-negative to prevent HIV infection.

PrEP is different from PEP (post-exposure prophylaxis), as PrEP is taken before exposure to HIV and may be taken on a long-term basis.

You may also hear of HIV PrEP by its brand name, Truvada.

How does it work?

PrEP usually comes as a combination tablet that contains two medications called tenofovir and emtricitabine (under the brand name Truvada®). It can be taken every day (called daily dosing) or around the time of sexual activity (called intermittent dosing). Daily dosing is recommended for PrEP, as it has been the most widely evaluated in research studies.

PrEP usually comes as a combination tablet that contains two medications. The medication works by blocking HIV from spreading in the body.

A number of studies have looked at the use of PrEP to see if it is effective in lowering the risk of HIV infection. Research has shown that when PrEP is used properly, it is more than 90% effective in preventing HIV.

Who is PrEP for?

PrEP is for anyone who has a higher chance of getting HIV. You must be HIV negative to be on PrEP. 

PrEP may be right for you if you live, report or experience any of the below:

1. You are a cis-or transgender man who has sex with men (MSM) or a transgender woman (TGW) and you are having condomless anal sex along with any of the following:

• You had infectious syphilis or a bacterial sexually transmitted infection in the rectum (like chlamydia or gonorrhea), especially if diagnosed in the past 1year.
• You have used post-exposure prophylaxis (PEP) more than once.
• You have an ongoing sexual relationship with an HIV-positive partner(s) who is not on ART and/or does not have an HIV viral load < 200 copies/ml.
• You have an HIV Incidence Risk Index for men who have sex with men (HIRI-MSM) score of ≥10

2. You are a person who injects drugs (PWID) and you share injection equipment with an HIV-positive injecting partner who is not receiving stable ART and/or does not have an HIV viral load <200copies/ml.
3. You don’t meet the above criteria but have:

• An ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200copies/ml.
• Unprotected vaginal/anal sex with partners that are either MSM or PWID and of unknown HIV status; transgender men; gender diverse; or engaging in sex work.
• Talk to your healthcare provider if you feel PrEP might be right for you.

If PrEP isn’t for you right now

It is best to continue regularly testing for STI and HIV as needed.

Proper use of condoms can help to prevent HIV, but you can also consider some other prevention strategies like increasing your knowledge around sexual health and healthy relationships. Check out the CATIE website for some good tips on preventing HIV.  Talk to a health care provider if you have any questions or need support.

Circumstances are always changing, so review your PrEP eligibility and HIRI score (if relevant) on an ongoing basis with your health care provider.

Getting PrEP

Who can prescribe PrEP?

Any doctor that is licensed to practice in BC can prescribe PrEP for you. Nurse practitioners who have taken the Treatment for HIV Prevention program at the BC Centre for Excellence in HIV/AIDS (BC CfE) can also prescribe PrEP. 

If you have a primary care provider (family physician, primary care centre, etc.), ask your provider if they will prescribe PrEP for you. If your provider has any questions, they can visit our HIV PrEP Toolkit page or call the BC CfE directly at 604-806-8515.

Cost

Provincially-funded PrEP is available through the HIV Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS.

To be eligible for free PrEP, you need to be:

• HIV-negative
• At risk for HIV infection
• Living in BC with Medical Services Plan (MSP) coverage or Interim Federal Health coverage (e.g., refugee status)

If you are First Nations or Metis and living in BC, you can get free PrEP through the HIV Drug Treatment Program at the BC Centre for Excellence.

If you are Inuit, you can get free PrEP through the Non-Insured Health Benefits (NIHB) program, just like every other prescription. For more information, contact Health Canada at 1-800-232-7301. The prescription can be filled at any pharmacy in BC. The pharmacy will fill the prescription at no cost and there is no pre-approval form or process needed. Inuit people can also access PrEP through the HIV Drug Treatment program.

If you are living in BC and don’t have MSP or Interim Federal Health coverage, you can still get PrEP, although it will not be free. To access PrEP, you will need to either:

• Pay for it yourself
• Get it covered through a private insurer or extended health care
• Buy it through the Davie Buyers Club

Starting PrEP

Your first PrEP prescription is limited to a 30-44 day supply.

If you decide to continue on PrEP, you will need to be monitored regularly by a health care provider.  This includes a clinic visit with STI, HIV and kidney testing before each prescription can be renewed.

A maximum of 90 days (3 months) will be given for each PrEP prescription.

Where do I pick up my PrEP?

If you live in Vancouver or the Greater Vancouver area, you can pick up PrEP directly from the St. Paul’s Hospital Ambulatory Pharmacy.

If you live outside the Greater Vancouver area, you can make arrangements to have your medication delivered to your health care provider’s office, a Health Unit, pharmacy, or other location, as long as the location is agreed on by your health care provider and the HIV Drug Treatment Program.

Things to consider

What else should I know before starting PrEP?

If you would like to start on PrEP, you may want to read some additional information first. Have a look through our Frequently Asked Questions about HIV PrEP brochure. This brochure is also available in Spanish, Simplified Chinese and Punjabi.

It’s important to take PrEP correctly and under the care of a health care provider. Though the medication is fairly safe, taking PrEP does require regular medical visits and blood and urine tests.

PrEP is not meant to replace other methods of HIV prevention. PrEP does not protect against other STIs. Condoms and other barrier methods are still recommended during penetrative sex to prevent HIV.

For detailed information on HIV PrEP, visit our HIV Prevention page or download our Frequently Asked Questions about HIV PrEP brochure (also available in Spanish, Punjabi and Simplified Chinese).