Do you need to take PrEP every day if you’re self-isolating because of coronavirus?

A bottle of Truvada and PrEp pills

If coronavirus-related self-isolation means you won’t be getting any for a while, the advice is that it’s safe to alter your PrEP routine. Here’s how.

Amid the coronavirus pandemic, government advice in the UK and many other countries is to practice social distancing for the foreseeable future.

One of the side-effects of this is that many are finding themselves having less sex than they usually do.

For LGBT+ folk who take PrEP daily to protect them from HIV, this poses the question of whether they should continue their regimen.

Matthew Hodson, executive director of HIV awareness and knowledge charity NAM, said that one of the advantages of PrEP is that it can be taken “when you need it”.

“It’s for those times in your life when you may be at risk of acquiring HIV,” he told PinkNews.

“This means that if, as a result of the coronavirus, you’re not having any sex, it’s OK to pause your PrEP too.”

Advice for queer cis men and AMAB non-binary people taking PrEP on demand.

If you are a cis man or AMAB non-binary person who isn’t taking gender-affirming hormone treatment (GAHT) then you can take PrEP on demand.

Any trans (including non-binary) person on hormone treatment should stick to a daily routine.

When switching on demand, you should take two pills after your most recent sexual encounter, meaning you’ll come off PrEP 48 hours after sex.

“If it’s already been more than two days since the last time you had sex, you can stop straight away,” said Hodson.

If you need to start taking PrEP again the advice is to take two tablets at least two hours, but ideally 24 hours, before sex.

Another dose should be taken 24 hours after sex, and another 24 hours after that. This is referred to as the 2-1-1 strategy.

Hodson said: “The evidence suggests that ‘event based’ PrEP, adopting a 2-1-1 strategy, is as effective for cis men as daily PrEP.”

If you continue to have sex you should take PrEP daily for as long as you are, and then for 48 hours afterward your last encounter.

Simon Collins, co-founder of the HIV treatment activist group i-Base, notes that “even with best intentions, sometimes sex can be unplanned or unexpected”, meaning its wise to cary a double dose with you “just in case” you need to restart.

Advice for trans people taking PrEP on demand.

For trans people, the advice is slightly different.

Because clinical trials have not included trans and non-binary people, there is no official recommendation for them to use PrEP on demand (though Hodson says it is safe for AMAB non-binary people who aren’t on hormones to do so, see above).

Hodson explains that this is because the drugs used in PrEP are metabolised differently in AFAB bodies and can also interact with hormone therapy.

If trans people – including AFAB non-binary people and AMAB non-binary people on hormones – want to stop taking PrEP for any reason, they should continue taking it for seven days after sex, according to the Terrence Higgins Trust.

Everyone should be tested for HIV regularly.

Hodson says it’s important to note at all times that if you’ve had sex which could have exposed you to HIV acquisition while off PrEP, it’s essential you get tested before you start taking it again.

If you have acquired HIV and begin taking PrEP, you may develop a resistance to certain drugs used as treatment. Those on NHS England’s Impact Trial are required to take a HIV test every three months.

If you are living with hepatitis B, be aware that PrEP can suppress the virus. Take this into account if you are considering coming off the drug.

Will I still be able to get PrEP during the coronavirus pandemic?

With social distancing measures disrupting everyday life and coronavirus placing a strain on the NHS, some are naturally worried about obtaining PrEP in the coming weeks and months.

Collins said that right now, there are no concerns about access to medications.

In a worst case scenario, “there might be less access to routine monitoring – if NHS resources are being shifted to responding to coronavirus”.

Were this to happen – and at the moment, it is purely hypothetical – Collins said “PrEP clinics should publish information about whether or not this is affected”.

“It might mean monitoring less often is needed.

“So long as someone is good at taking PrEP as prescribed, the risk of becoming positive is so close to zero that clinics are already discussing whether less frequent monitoring might be a good idea anyway.”