This is where you'll find out all you need to
know about this modern alternative
way to protect yourself.
What does 'safer sex’ mean in 2019? Has the condom had its day? Not at all, as it still offers reliable protection against HIV. These days, however, there are also other ways of protecting yourself. None is better or worse than a condom – just different. This means that every individual can choose the type of protection that best suits them. Ultimately, it doesn't matter how you protect yourself against HIV – be it with a condom, PrEP, or treatment as prevention. Each of the options has its pros and cons, but each is fine for the person using it. The main thing is to protect both yourself and your partner. But remember: neither a condom nor PrEP offers reliable protection against other sexually transmitted infections (STIs). If you’re sexually active, and change partners frequently, get tested, and if necessary treated, for the most common STIs on a regular basis.
PrEP stands for pre-exposure prophylaxis:
- pre: in advance
- exposure: potential contact with HIV
- prophylaxis: a preventive treatment to avoid infection
PrEP is medication which HIV-negative men who are at a higher risk of contracting HIV can take to protect themselves. It is a tablet containing two active agents - tenofovir and emtricitabine - as found in the branded Truvada© or a generic alternative. Taken properly, the drug offers protection against HIV that is at least as reliable as a condom. However, PrEP does not protect against other sexually transmitted infections (STIs) such as ghonorrhea, chlamydia, syphilis or hepatitis. You can be immunised against hepatitis A and B, but where other STIs are concerned, you need to be tested regularly, whether you have any symptoms or not. Remember, too, that the same applies to condom-users, because they do not offer full protection against STIs either. In this respect, PrEP users are acting responsibly by signing up for frequent, regular check-ups in which their tests also cover STIs, for which they can be treated if necessary. Anyone taking PrEP under medical supervision, and having anal sex without a condom, is practising safer sex.
PrEP is an additional means of protection for HIV-negative men who have difficulties using a condom during sex. These might be caused by erectile problems when putting the condom on, a new partner, or alcohol and drug use (at chemsex parties, for example). Sometimes the condom simply gets forgotten in the heat of the moment. Where anonymous sex is concerned, it can also be a relief for passive men not to have to rely on their unknown sexual partner. A condom might be removed unnoticed, for example, or in a darkroom situation there might be several encounters using the same condom. Thanks to PrEP, whether or not sexual partners really are being honest, and staying safe, is no longer a matter of trust. PrEP offers all of these men a way to protect themselves from HIV, and to feel safe, even without a condom. That can be a huge mental and physical relief, thus encouraging a free and active sex life. Anyone taking PrEP properly is reliably protected against HIV, and doesn't have to worry about their sexual partner's status. Protection also extends to PrEP users' partners, but remember that you'll be risking HIV having anal sex without a condom unless you're sure that your partner is taking PrEP correctly. And you can't always rely on that. If you want to have sex without a condom, it's therefore best to take the responsibility and opt for PrEP yourself. PrEP makes particular sense for men who have lots of sexual partners. It is not recommended for couples in which one partner is HIV-positive, the other HIV-negative.
For HIV to multiply in the body, the virus's RNA has to be copied constantly into human DNA. To do so, it must first transcribe this RNA into human form. HIV has its own tool with which to do this - the reverse transcriptase enzyme. The active agents in PrEP block this process by transcribing RNA into DNA incorrectly. This stops the virus multiplying. HIV is no longer able to transcribe its RNA into human cells, and is eliminated from the body.
Various options are available at present:
You start taking the drug seven days before first having sex without a condom. It is then taken daily for a defined period. When a clear decision has been made to end PrEP treatment, the drug must be taken for a further seven days before you finally stop. With the exception of the first and last seven days of the cycle, the individual decides for themselves how long to take the drug. It might cover a period of particularly high sexual activity, an extended holiday, or a lifetime.
Going out partying in Zurich or Lausanne? Enjoying a weekend in Berlin, Barcelona or Paris? Then on-demand PrEP is the right choice for you. Between 24 and two hours before first having sex, take two tablets, followed by one tablet daily at the same time (within +/- 2 hours). After having sex for the last time, take one tablet a day for a further two days. On-demand PrEP makes sense for weekend trips on which you might have sex, for example. Although the data collected to date looks promising, there have been fewer studies done for this way of taking PrEP than for long-term PrEP. As a result, on-demand PrEP isn't necessarily the right choice for very spur-of-the-moment, immediate dates (via dating apps, for example).
Holiday/chem sex PrEP:
Some parties last for longer than 24 hours. If you're at a chemsex party, it's easy to forget the time. And if you've been drinking or doing drugs, it can be difficult to stick to the proper schedule or even remember to take your medicine. In cases like these, it makes sense to go for long-term PrEP. In other words, you start taking the drug seven days before first having sex without a condom, continue taking it for longer, and stop seven days after you last had sex without a condom (see above). This guarantees that the level of drug in your blood is higher, and remains constant. If you're at all unsure, get advice. The counsellors and doctors at your nearest Checkpoint will be happy to help.
Both the IPERGAY study (France/Canada) and the PROUD study in the UK concluded that PrEP is 86% effective. What does that mean, exactly? Here, 86% is the average rate for how well a means of prevention reduces transmission within a given group. None of those participating in either study and taking PrEP as prescribed became HIV-positive. This shows that PrEP offers a very high level of protection if an individual is taking the drugs as prescribed.
Before starting PrEP, you need to be examined by a doctor, preferably a specialist or at a specialist practice, such as a Checkpoint. As part of this examination, you'll be tested for STIs, bloodwork will be done (including kidney function), and your HIV status will be determined. The latter point is important, because for men who are (unknowingly) HIV, PrEP would not be enough to reduce the viral load sufficiently, therefore running the risk of infecting someone else, and developing resistance. This would mean that certain drugs would no longer be effective against HIV. If all of your levels are OK, you can start PrEP. After that, bloods will be taken at regular three-month intervals, and you will also be tested for the main STIs, regardless of whether or not you are showing symptoms. In Switzerland, the tablets are relatively expensive. One alternative is to buy them via the internet, but on no account should you take PrEP without medical supervision. It's worth getting advice from the specialists at a Checkpoint, or a specialist doctor. Basic health insurance covers your doctor's costs and the costs of the examination, but the costs of the PrEP drugs themselves are not covered. Click here for addresses of doctors and practices specialising in PrEP
PrEP drugs can be ordered from abroad from the following sources (subject to a doctor's prescription for personal use for 30 days):
- Dynamix International
- Green Cross Pharmacy
- Pulse Clinic
- All Day Chemist
- In House Pharmacy
- Generics in Germany (also available to collect close to the border)
Generic PrEP drugs are also available in certain Swiss pharmacies at a lower price. For detailed information, please contact one of the checkpoints.
The PrEP drug Truvada® (and its generic forms) contains two of the three active agents which are approved in Switzerland to treat HIV. Truvada® is not approved for PrEP, but can be prescribed by doctors for what is known as 'off-label use'. The 'off-label use' of a drug refers to the use of an approved, ready-to-administer drug in a way other than that which has been approved in its licence. This refers, for example, to indications, administration options, dosage, the nature of use or even use for particular groups of patients. This means that the drug can be prescribed for a purpose for which it was not originally intended, if its effectiveness has been proven. Providing you have a prescription from a doctor, you are allowed to order the drug via the internet. Swissmedic permits medication to be imported both by post and in luggage, providing it is for personal use for one month at at a time. This corresponds to 30 tablets. Recommendations on the off-label use of medication.