Pre-Exposure Prophylaxis | PrEP

What is PrEP?

PrEP is an acronym for Pre-Exposure Prophylaxis. It is a highly effective medication that can significantly reduce your chances of getting an HIV infection.

PrEP does not protect against other sexually transmitted infections (STIs), nor does it prevent unwanted pregnancies. STIs can be viral (Hepatitis, Herpes, Papillomavirus, etc.) or bacterial (Gonorrhea, Chlamydia, Syphilis, etc.) PrEP must be used in combination with condoms or other physical barriers, vaccinations, regular testing and treatment for STIs, pregnancy tests, and contraception.

PrEP protects the person taking it from HIV only! Only people who are not HIV-positive can take PrEP.

Who should be taking PrEP?

PrEP is recommended for individuals at a higher risk of contracting HIV, regardless of their gender or sexual orientation, including but not limited to:

• People who have multiple partners.

• People who practice unprotected sex.

• People who have sexual partners living with HIV.

• People who inject drugs.

PrEP can be taken by adolescents who weigh at least 35 kg.

Various Methods of taking PrEP

Daily PrEP:

People of diverse identities and practices can follow this effective method.

Method: take 1 pill, once a day, every day.

People assigned male at birth:

PrEP reaches maximum protection against HIV (99%) after 7 days of taking the pill daily.

People assigned female at birth:

PrEP reaches maximum protection (99%) 21 days after taking the pill daily.

For trans* individuals: so far studies suggest that gender-affirming hormones do not affect the efficacy of PrEP. However, it is always advised to consult your healthcare provider before starting.

There is limited information about its effectiveness, but for now, it reduces the risk of getting HIV by at least 74% when taken as prescribed.

What should I do in case I forget to take my daily pills?

As a general rule of thumb, take the daily dose as soon as you remember to. However, if the next dose is less than 8-12 hours away, skip this dose and continue your regular dosing schedule. If you have just recently started taking PrEP, there might not be enough medication in your system to cover protection in case you missed a dose. So, we recommend you consult your healthcare provider in such cases.

Relying on the claims of others that they are on PrEP as a method of prevention is not an effective strategy on its own. The best way to protect yourself is to use protection and test regularly for HIV and other STIs and/or start taking PrEP.

Only the Daily PrEP method is recommended by Marsa as it is the most effective.

PrEP reaches maximum coverage for injection drug use around 21 days after daily use of pills.

On-Demand PrEP:

aka intermittent/non-daily/event-driven/off-label PrEP

Method: the “2-1-1” Schedule, 2 tablets taken at least 2 hours

and ideally 24 hours before having sex, 1 tablet 24 hours after

the first dose, 1 tablet 24 hours after the second dose.

This method is not recommended for natal females (assigned females at birth) and works most efficiently for natal males (assigned males at birth) who practice anal sex.

Periodic PrEP:

This method can be used when you are expecting a period of sexual activity such as in an event, on a holiday, etc.

It starts with the 2-1-1 schedule followed by one pill to be taken every 24 hours after the initial dose. Continue to take a daily dose for two days after the last sexual exposure.

Long-Acting Injectible PrEP:

Apretude is the only shot approved for use as PrEP. In this method, two doses are taken a month apart, then once every 2 months.

Long-acting injectable PrEP is not available in Lebanon.

There are two pills approved for use as PrEP: Truvada® and Descovy®:

• Truvada is for people at risk through sex or injection drug use.

• Descovy is not recommended for people assigned female at birth, who are at risk for HIV through receptive frontal/vaginal sex.

Method: Taking daily PrEP is recommended because it offers the highest level of protection, but on-demand PrEP may be an option if you are unable (ex. impaired kidney function) or unwilling to take PrEP every day. (ex. Experience periods of sexual inactivity, unable to commit...)

If you seem to be missing your doses regularly, advise your healthcare provider.

PrEP ≠ PEP

PrEP should not be mistaken for Post-Exposure Prophylaxis (PEP), also known as “emergency treatment”, which must be taken no later than 72 hours after unprotected sexual contact or other potential exposure and then daily for 28 days.

If you are on PrEP, PEP can still be useful if you have not taken your PrEP correctly (the section above explains the various methods of taking PrEP).

PEP is provided for free by the National AIDS Program.

PrEP Side Effects

The majority of people taking PrEP do not experience side effects. In general, most of the side effects occur at the start of PrEP intake and usually go away within 2-4 weeks.

The most common short-term side effects are headaches, fatigue, dizziness, nausea, vomiting, diarrhea, and abdominal pain or discomfort. If the symptoms are severe, are getting worse, or do not go away, you must contact your healthcare provider.

Long-term side effects are much less common but could affect the kidneys, liver, and bone density. That is why it is essential to follow up periodically with your healthcare provider. These rare occurrences are generally reversible after stopping treatment.

Seek medical help right away if you have a fever and chills along with:

• Sore throat

• Cough

• Rash

• Other signs of infection

Taking a tablet during or soon after a meal may help reduce nausea and diarrhea.

Healthcare providers may recommend medication to alleviate headaches.

If you are experiencing some dizziness, try taking your daily tablet before going to bed.

Where can I get PrEP?

PrEP is provided for free at Marsa. Contact us to know more about the required tests and to book an appointment with our medical specialists.

Required Tests:

The tests required for your medical consultation before starting PrEP are:

Creatinine levels.

HIV-negative result (preferably Hepatitis B, Hepatitis C, and Syphilis as well), 7 days before your medical appointment.

PrEP Follow-Up and Aftercare

The prescription of PrEP must be associated with regular clinical monitoring.

Your healthcare provider will specify the needed tests and frequency for testing depending on your case, such as:

• HIV test every 3 months.

• Syphilis, Gonorrhea and Chlamydia, and Hepatitis C (for people who inject drugs) every 3-6 months.

• Creatinine levels every 6-12 months.

• Hepatitis C, Hepatitis B for non-vaccinated people, Cholesterol and Triglyceride levels (depending on PrEP composition) every 12 months.

PrEP Stopping

PrEP can be stopped after 28 daily doses from the last sexual exposure. Consult a healthcare provider first.

For those at risk of HIV through anal sex (mainly cisgender men who have sex with men) resume taking 1 pill a day for 2 days after the last sexual exposure, then stop.

If you seem to be missing your doses regularly, advise your healthcare provider.

PrEP & Reproductive Health

PrEP can be taken while trying to get pregnant or breastfeeding if the partner is living with HIV.

It is important to consult a healthcare provider to be prescribed the proper and safer molecules.

There are no known interactions between PrEP and hormone-based birth control or hormone therapy.

So far, they can be taken together. Always consult a healthcare provider first.

Written by:

Fatima Khalil | Sexual health coordinator

Fatima Khalil is the coordinator of sexual health education and outreach at Marsa Sexual Health Center and is currently pursuing a degree in child education. With more than 7 years of experience in the field of Sexual and Reproductive Health and Rights, she has developed several guidelines and educational materials on proper services provision, sexually transmitted infections, and women's health.