Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV transmission.
If you do not have HIV, taking PrEP as prescribed can reduce your risk of acquiring HIV by more than 99%. PrEP is a highly effective and well‑researched form of HIV prevention used by people around the world.
In Australia, the only Pharmaceutical Benefits Scheme (PBS)‑approved PrEP medication is emtricitabine/tenofovir.
Is PrEP for me?
PrEP is for people who do not have HIV but may be at risk of acquiring it. A doctor or sexual health clinician can help you decide if PrEP is a good option for you, based on:
- the types of sex you have (oral, anal, vaginal)
- if and how often you’re using condoms or other barrier methods
- if you’re having casual sex or sex with multiple partners
- if the person you have regular sex with is having sex with other people, and the type of sex they have
- if you’re having sex with someone whose HIV status is unknown
- if you’re having sex with someone who is living with HIV and their viral load is not undetectable (U=U)
- if you share injecting equipment with someone living with HIV or unsure of their HIV status
- if you’re injecting drugs or using methamphetamines during sex.
Using PrEP is a personal choice. You can talk to a doctor about PrEP even if you are not ready to start it yet. They can provide personalised advice based on your body, health history, hormones, sexual practices and routine.
It might feel intimidating or awkward to talk about sex, intimacy and sexual behaviours with your doctor, but speaking to a doctor who respects and understands your identity can make this conversation empowering and affirming.
If you would like to discuss if PrEP is for you, contact Meridian on 02 6257 2855 or the Canberra Sexual Health Centre on 02 5124 2184.
How do I take PrEP?
There are two ways to take PrEP: daily and on demand. Both ways use the same medication, just taken differently. When taken correctly, both methods are highly effective at preventing HIV transmission.
Not everyone can use both options. Talk to a doctor about which PrEP option will suit your life, but keep in mind that not all options may be suitable depending on your gender or other health experiences.
PrEP can occasionally have side-effects, usually in the first few weeks of taking the medication. You can talk to your doctor if anything concerns you.
Daily PrEP
Daily PrEP involves taking one pill at approximately the same time every day. This provides continuous protection against HIV. Daily PrEP:
- suits people who have sex regularly or unpredictably
- can be easier to remember as part of a routine
- is recommended for all people at risk of HIV
Daily PrEP is the only recommended option for:
- people assigned female at birth (AFAB)
- trans, non-binary and gender-diverse people who were assigned male at birth and are not using estradiol-based hormone therapy/HRT (like patches, pills, or injections containing estradiol)
- people who inject drugs.
Starting and stopping Daily PrEP
If you’re a cisgender man or person assigned male at birth and not using estradiol-based hormone therapy/HRT:
- To start: Take 2 pills at once between 2 and 24 hours before sex that may put you at risk of HIV, then continue with one pill daily.
- To stop: Continue taking one pill daily for 2 days after your last potential HIV exposure.
For everyone else, PrEP needs more time to build protective levels in the body:
- To start: Take one pill daily for 7 days before sex that may put you at risk of HIV.
- To stop: Continue taking 1 pill daily for 28 days after your last potential HIV exposure.
If you are unsure which starting or stopping schedule is right for you, talk with a doctor or sexual health clinician. If you’ve taken a break from PrEP, you can start again. Check in with your doctor for a sexual health test and more pills.
Missed a dose?
If you miss a dose of daily PrEP, it can reduce how well it works*. Contact your GP or sexual health clinic for advice as soon as possible.
You may need PEP (post‑exposure prophylaxis), an emergency medication that must be started within 72 hours of a possible HIV exposure. PEP is available from hospital emergency departments and some sexual health clinics.
* Exception: For cisgender men and people assigned male at birth who are not using estradiol‑based hormone therapy/HRT, evidence shows that missing no more than one or two daily PrEP doses per week still provides high protection. Keep taking PrEP as soon as you remember and contact your GP or sexual health clinic if you are worried about exposure. If missing doses is an ongoing issue, speak with your doctor.
On-demand PrEP
On‑demand PrEP provides protection over a short, planned period. It is sometimes called 2‑1‑1 PrEP.
This option may suit people who:
- have sex less than twice a week
- can plan sex at least 2 hours in advance
- experience side‑effects with daily PrEP
- have kidney health considerations
- have financial constraints.
On‑demand PrEP is only recommended for cisgender men and trans, non‑binary and gender‑diverse people assigned male at birth who are not using estradiol‑based hormone therapy (like patches, pills, or injections containing estradiol).
How to take on-demand PrEP
- Take 2 pills at the same time, between 2 and 24 hours before sex. Make a note of the time you took this double dose.
- Wait at least 2 hours before having sex.
- You’re protected. You can have sex during this time until your next dose.
- Take one PrEP pill 24 hours after your double dose.
- Take none PrEP pill 24 hours after your last dose.
In summary: Take two pills between 2 and 24 hours before sex, and then one tablet daily after that. Continue to take one pill daily for at least 48 hours after your last sexual contact.
If plans change
- If you have more sex, keep taking one pill every 24 hours to extend your protection window. Finish by continuing to take one pill every 24 hours until you’ve not had sex for 2 days.
- If you took the double dose but did not have sex, you do not need to continue taking PrEP. Just restart the next time you need it.
Missed a dose?
When taking on‑demand PrEP, timing matters. If you miss any part of the schedule and have sex, talk to a doctor urgently about whether you need PEP.
How do I get PrEP?
PrEP is available in Australia with a prescription. A sexual health check is required before starting PrEP.
Any doctor can prescribe PrEP. You could access it through a GP, a sexual health clinic or a university medical centre.
If your doctor is unfamiliar with PrEP, ASHM (Australian Sexual Health Medicine) has developed clinical guidelines. You can also download a client letter to take to your doctor which explains what PrEP is used for and how they can prescribe it for you.
Talking to a doctor about PrEP
Before starting PrEP, it’s important to tell your prescribing doctor about:
- any existing health conditions
- any medications, supplements or drugs (legal or illegal) you are using.
This helps your doctor make sure PrEP is safe and appropriate for you. Doctors should help to keep you safe and be free of judgement.
Many people choose to access PrEP through sexual health clinics, where doctors and nurses are experienced in sexual health care and work in a non-judgemental, supportive way. If you don’t feel comfortable with your regular GP, a sexual health clinic may be a good option.
Some sexual health clinics, university medical centres and GPs offer free or low-cost (bulk-billed) appointments, including Meridian's monthly STRIP Clinic. PrEP Access Now (PAN) also has a Find a PrEP doctor tool to help you locate PrEP-experienced prescribers across Australia, as well as information about online prescriptions and pharmacies.
Prescriptions and ongoing care
If you’re taking daily PrEP, you’ll usually receive a one-month supply and two repeats.
This covers around 3 months before you need a follow-up appointment.
At every appointment you get a prescription, your doctor will:
- test for HIV
- screen for other STIs
- check your kidney function.
If you’re using on-demand PrEP, your doctor will advise how often you need follow-up testing and prescription reviews.
How much does PrEP cost?
Doctor’s appointments
The cost of a prescription appointment depends on where you go. Some clinics bulk‑bill, including public sexual health clinics and Meridian's free monthly STRIP Clinic. Some GPs don’t bulk bill, so it will cost money to have an appointment. You can find out if a practice will bulk bill for an appointment by looking at their website or contacting them.
Paying for PrEP
If you have Medicare, PrEP is subsidised through the PBS:
- $25 per month
- $7.70 per month with a concession card
If you are not eligible for Medicare, you can self‑import PrEP through online pharmacies with a prescription. Find out more about buying PrEP online in this article from Emen8 or at the PAN website.
In Canberra, Meridian’s STRIP Clinic and Canberra Sexual Health Centre can help with prescriptions, self‑importation and ongoing sexual health care.
Can’t afford PrEP?
Getting access to PrEP isn’t easy for everyone. If cost is a barrier, you may be able to get a free PrEP coupon through Free PrEP.
This program might be for you if you:
- are not eligible for Medicare
- are a student
- are not able to work
- are experiencing some financial stress.
You will need a current prescription and photo ID. In your application, write briefly why you need support to access PrEP.
Each coupon can be used once and you can reapply as needed.
Do I still need condoms?
PrEP only prevents HIV. Condoms help protect against other sexually transmissible infections (STIs).
We encourage open conversations with sexual partner(s) about testing, prevention and what protection feels right for everyone. Regular sexual health testing is important for anyone who is sexually active.
Travelling with PrEP
If you’re travelling, plan ahead so you don’t miss any doses. Missing PrEP doses can reduce how effective it is at protecting against HIV.
Australian pharmacies usually dispense one month of PrEP at a time. If you need more than this for travel, ask your doctor in advance for a Regulation 49 prescription, which allows you to receive up to 3 month's supply (one month plus two repeats) before you leave.
Before travelling, check the medication and entry laws of the countries you’re visiting. For short-term travel, most countries allow people to carry up to a 3-month supply of prescription medication for personal use.
Take extra care when travelling to countries that restrict entry or residency for people living with HIV. In some cases, PrEP may be mistaken for HIV treatment medication by customs officials, which could cause difficulties when entering the country.
To reduce the risk of issues:
- Carry a copy of your PrEP prescription.
- Consider carrying a letter from your doctor stating that PrEP is used for HIV prevention, not HIV treatment.
Planning ahead can help you stay protected and avoid unnecessary stress while travelling.
Other ways to prevent HIV
You can prevent acquiring HIV by:
- using condoms or other barrier methods during sex
- knowing that people living with HIV who are on effective treatment and have an undetectable viral load cannot pass HIV on through sex (also known as ‘Treatment as Prevention’ or U=U), and how this might relate to your sexual partners or sex life
- taking emergency PEP if you may have been exposed to HIV
- keeping the conversation open with your sexual partner(s) about what HIV prevention strategies you’re all taking to stay protected.