Breakthrough as research shows that ‘on-demand PrEP’ works in gay men

A promising new study suggests that PrEP could be used as an as-needed ‘before and after’ sex pill, instead of a daily medication.

Results from Prevenir, an ongoing French observational study, provided further evidence that on-demand PrEP is an effective strategy for preventing HIV infection in at-risk MSM (men who have sex with men).

PrEP currently requires users to take a daily pill to stay protected from HIV infection. On-demand PrEP involves taking pills before and after sex, rather than daily.

Prevenir used data from a group of 1628 at-risk, HIV-negative individuals, nearly all of them MSM, in the Paris region. At enrollment, 44% of participants chose to use PrEP daily and 53% chose to use it on demand.

The on-demand PrEP group took a double dose of PrEP (two pills) two to 24 hours before anticipated intercourse and then, if sex did occur, took one dose 24 hours afterward and a second dose 24 hours after that.

Jean-Michel Molina, of the University of Paris Diderot, reported that, so far, the study had found no HIV infections among men taking PrEP “on demand” or those taking it daily. This means that PrEP could be used as and when required.

The first year preliminary findings of the ongoing three year study were presented by Molina at the International AIDS Conference in Amsterdam (AIDS 2018) last week.

Molina pointed out that for the on-demand PrEP to work the men have to take it as required. “…it’s important to remember to take the pills both before and after sex,” he said, reported Bhekisisa. “After you’ve taken these dosages, you are good, you don’t have to worry about HIV.”

The study is one among other similar studies that are very much in the research phase. Scientists are keen to see if the protection from daily vs on-demand PrEP remains the same over time and how its usage impacts people’s behaviour.

It is important to note that these results to not apply to women. It’s been shown that it takes considerably longer for PrEP (including with daily use) to build up in sufficiently protective quantities in the vagina as compared to the anus.

PrEP for gay, bi and other MSM is available for free from selected clinics in Pretoria (call 012 430 3272), Johannesburg and Soweto (071 683 3226) and Cape Town (071 683 3226). If you live in other areas of South Africa, you will have to go to a private doctor to ask for a script and pay for PrEP.

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