Wow! What a weekend… I’ve been locked away working on helping ensure that PrEP is an international language!
The PrEP consent video is now updated to meet the current 2018 guidelines but more exciting is that they have been translated into 26 different languages including captions on the video! Check it out 🙂
Now while I wish I spoke all these languages, I have had to start with using machine translations, so I ask if you seen anything funky could you please send me an email and let me know?
Hi guys, it’s Dr. George Forgan-Smith. Today, I wanted to talk about what you should expect in a PrEP appointment. I’ve had a few patients who have come to me who are wondering what actually happens in a PrEP appointment. So I just wanted to explain to you what you can expect when you go to see a doctor.
PrEP is a medication that is used to help reduce the risk of HIV infection. When taken as instructed, it can reduce the risk of HIV significantly, by up to 99%. So it’s important that you have a full understanding of what PrEP is and how it works. In you’re first appointment with a doctor about PrEP, you should have the opportunity to be able to talk about all of the potential side-effects of PrEP, how to take it, how to fill your PrEP prescription or to import it if you wish to do it that way, but also to have all of your questions answered in a way that helps you feel confident and able to move forward understanding what is going to be happening. It’s also a good chance to be able to discuss strategies to help you take the tablet on a regular basis and to also talk about what can happen when you first start taking PrEP.
When you have a good understanding of the risks, the side-effects, the benefits, and how to take it, if you are still happy to go ahead, then your doctor will be able to provide a prescription for PrEP. It’s important that you get specific testing done as well. So for PrEP, you do need to have a full sexual health screening, and this is to ensure firstly that you’re HIV negative before starting PrEP. But it’s a great chance to also check that all the rest of your sexual health is in great condition. It’s also important to do a check of kidney function. PrEP can affect kidneys in some people, so it’s important that we keep a close monitoring of your kidney function.
Finally, it’s great chance to be able to talk with your doctor about the follow-up, and that is every three months you do need to come back for kidney function testing, HIV testing, and sexual health screening as well. At this point, you’ll be able to get your next prescription for PrEP. So it is a regular routine at every three months you do need to come back. The subsequent appointments can be a little bit shorter and can usually be done in a 15-minute appointment because once you have an understanding of PrEP, we don’t need to go through the consent every single time. However, if you have questions or if you have side-effects, it’s important you bring them up with your doctor so you can talk about it.
This is what I wanted to basically teach you guys as to what to expect in a PrEP appointment. If you do see a doctor and they’re unsure about PrEP but willing to learn, there are many resources that can help them. However, if you experience a doctor that may not be fully aware of what to do, there are many doctors who are happy to help. Pen or PrEP access now has got a fantastic map that shows doctors who are willing, ready, and keen to prescribe PrEP, and I will put a link to that map here with the video as well. So I hope this is helpful and given you a bit of an idea about what to expect in a PrEP appointment when you go to see your doctor. I hope that was helpful. Have a great day. See you guys.
Hey guys. It’s Dr. George here, and I’ve had a few inquiry from patients as well as people mentioning online, so I thought I’d make a quick video just to explain and answer these questions.
PrEP now that it’s available on the PBS. There have been some concerns about a change in the colour and the shape of the tablet.
So, there are three different versions of PrEP that are available under the PBS here in Australia.
There’s the Truvada brand, but the most common one I’m seeing is the Mylan brand. What’s actually happened is that the Mylan that is available under the PBS is a slightly different colour. It’s a more greenish-blue colour, and the pill shape is just a little bit different. However, what I want to reassure you is that just because it’s a generic medicine, just because it’s changed shape, it still contains the exact same active ingredients, the tenofovir and the emtricitabine, it’s just a slightly different shape. Think about the difference between say Panadol brand and, I don’t know, Herron Paracetamol. They’re both exactly the same medicines, it’s just that they’re in a slightly different presentation.
But with all generic medicines, they still contain the same active ingredient, the same effect taking a generic form of the Truvada will still give you the same protection against HIV when taken as instructed by your doctor.
So don’t be disturbed if the version of PrEP that you receive is in a slightly different bottle, slightly different shape, slightly different colour. As long as you’re getting it from your pharmacy and the same supply chain, you will still have the exact same protection and medication you have been taking in the past, whether that be part of a trial or whether that be from importation from overseas. PrEP will work and all of the medicines being sold under the PBS have been very carefully vetted.
I hope that helps clarify any questions that people may have. Happy to answer questions if you place them in the comments below.
Hey, guys. It’s Dr. George here. Today I’ve been asked the question: What is the difference between treatment as prevention and PrEP? These are two important concepts when it comes to HIV, but also HIV prevention. It is important that people are aware of the differences between the two.
PrEP is pre-exposure prophylaxis, a single tablet taken every day that reduces the risk of HIV infection in a person who is HIV negative, somebody who is not living with HIV. What it does is it blocks HIV from being able to take hold in the body.
It is very different to treatment as prevention, or TasP. What TasP is is when a person is living with HIV. Successful treatment over HIV is the use of medications to bring the replication of the HIV virus in the body down to a point where it can no longer be detected in the blood. That’s called a non-detectable viral load. And, as we know, a person with a non-detectable viral load is not able to transmit HIV full stop. Treatment as prevention is allowing people to get onto HIV treatment that greatly improves their own health benefits but also the health benefits of their partners by blocking the transmission of HIV as well.
You may have seen a previous video that I did which was about U=U, or undetectable viral load is untransmittable. That’s what TasP is about. I hope this is helpful and helps clarify the difference between PrEP, or a tablet taken every day to block HIV from being able to take hold in the body of somebody who’s negative, versus TasP, or treatment as prevention, which is a medical intervention for people living with HIV that stops the replication of HIV to a point where it can not be detected in the blood. What this means is great health benefits for the person living with HIV and their sexual partners because HIV cannot be transmitted.
That’s the difference between TasP and PrEP. I hope that was helpful. If you have any questions, please by all means send me a message and I’ll make sure I get an answer for you. Have a great day, guys
When HIV is Undetectable, then it’s Untransmittable. Zero risk, and that’s a fact.
While the evidence has been out for a long time we know that successful treatment with HIV medications not only has huge health benefits for the person living with HIV, we also know that it makes HIV impossible to be passed on.
Other advances include PrEP, a single daily tablet that reduces the risk of HIV infection by more than 99%.
The combination of U = U and PrEP is our keys to stopping HIV in it’s tracks. As noted by ACON’s Gavin Predergast, with treatment as PrEP “HIV has nowhere to go now.”
As part of the campaign executive director and cofounder of Prevention Access Campaign (PAC), Bruce Richman will be speaking across Australia to help share the message of U = U
Hey, guys. It’s Dr. George here. I’ve just been part of a thread on Facebook where we were talking about the storage of Truvada, the drug that’s used for HIV treatment, but also for HIV prevention. I just wanted to share some tips when it comes to the best way to store your medications.
Now the manufacturers, Gilead, have recommended that the drug be stored in a temperature-controlled environment, preferably around about 25 degrees centigrade, or between 15 degrees centigrade and 30 degrees centigrade. The reason for that is that the extremes of temperature could lead to degradation of the drug within the tablet and they’re not able to guarantee its safety. It’s best don’t store it in the car, don’t store it in the fridge. You can leave it on the table. Assuming that your room is of those temperatures, then it should be all okay.
Another thing that I did want to share, though, is when you have your bottle of Truvada, inside the bottle is one of these little fellas. It’s a little plastic container that’s filled with silica.
The reason is there is to absorb moisture that’s in the air. Because in a very humid environment, air with lots of moisture in it, the tablets can actually degrade. This of course can lead to issues with the medication. We’re not 100% sure it can be effective if the tablet’s all mushy and yucky. You may not get all of the full dose of the tablet or the medicines. It is very, very important that, one, don’t store the medicine in a humid environment such as in the bathroom, because that steamy air could lead to the tablets breaking down. The other thing is keep that little silica thing inside the jar. When you’re closing the jar, make sure it’s really nice and tight. That will prevent the moist air getting into the jar, and then you’ve got the little silica thing inside to absorb the moisture so your tablets will stay intact.
That’s pretty much for all medicines. If there’s a little silica thing inside there, keep it inside the bottle. I know it’s frickin’ annoying to get the tablets out past that thing, but it’s there for a reason, so keep it inside the bottle.
Main points are, try and keep your medicines in a dry, warm environment, somewhere between 15 and 30 degrees. They’re great tips and it’s a good idea. Don’t store your medicines in your car. Don’t store your medicines in the fridge. Keep them in an environment where it’s a bit more temperature and weather-controlled. That way you can be sure that there’s no potential damage to your medications. I wish you the best and I hope that was helpful.
Reported at Avert.org, PrEP has now included in the World Health Organization’s (WHO) essential medicines list.
Earlier this month, the World Health Organization (WHO) updated their list of medicines deemed ‘essential’ as part of a well-functioning health system. That is, the drugs that every person should have access to, should they need it, no matter where they are.
Notable was the inclusion of pre-exposure prophylaxis (PrEP), taken as either tenofovir monotherapy, or in combination with emtricitabine or lamivudine, to prevent HIV infection. The addition supports current WHO guidelines for HIV prevention, treatment and care released at the end of 2015, which recommend PrEP for HIV-negative people who are at-risk of HIV infection. These include populations who are unable to negotiate condom use, those in a relationship with someone living with HIV, and people who do not use condoms.
Recognition by this world body stands tall in acknowledging the important role PrEP plays in breaking the transmission of HIV world wide.
Also notable is the inclusion of HIV treatment dolutegravir, a potent agent with a strong barrier to the HIV developing resistance.
Here in Australia I hope this news may help bolster the application for PrEP to be included as a government funded medication.
Currently PrEP users not part of one of the Australian trials must import generic PrEP from overseas. Simplifying access and reduced cost for PrEP will be a great step towards reducing HIV infections Australia wide.
I am fascinated at the response, or even that a response was required, by the editor of Attitude Magazine’s article on having a 3 month trial of PrEP.
What concerns me is the almost puritanical responses of people that reinforce slut shaming, “sex is bad” messaging infused with blaming of men choosing to control their own HIV status through medical means.
One of the more choice examples:
But PrEP allows extends the fiction that gay men can live in denial of risky casual sex. Sex is not a game and as typical PrEP users make it just that, it has consequences for us all.
I am honestly confused as to what this person has to say… The general vibe I am getting is that sex, in particular gay sex, is a mine field and that anyone who dares to choose to protect themselves mean that there are more mines for people who don’t?
We need to get past this.
Sex is natural, sex is part of the human experience. HIV is not. Why is there such great opposition to reducing the chance of perpetuating HIV’s legacy?
PrEP has been recently discussed in The Age newspaper after a recent PrEP user seroconverted to HIV positivein Melbourne Australia. Seroconverstion is when a person becomes infected with HIV, going from HIV seronegative to HIV seropositive.
Hundreds of thousands of people use PrEP worldwide, but there have only been two confirmed cases of infection with a drug-resistant strain of the virus by someone taking the medication properly. A third case was reported in Amsterdam this year, and is still under investigation.
The finding sent shockwaves through the gay community, where experts say between 10 and 15 per cent of men in Melbourne and Sydney are using PrEP.
Victoria AIDS Council chief executive Simon Ruth tried to quell those fears, by stressing PrEP’s importance in the fight against HIV.
“The vast majority of people taking PrEP in this country and around the world continue to be protected by this powerful HIV prevention tool,” Mr Ruth said.
“It is important that gay men and all people at risk of HIV infection consider and decide on the best way to protect themselves from the range of safe sex options available to them.”
While PrEP – a daily pill called Truvada that contains two HIV medications – is not 100 per cent effective, studies show it can reduce the risk of HIV transmission by up to 99 per cent.
In people taking Truvada or it’s generic equivalent on a daily basis, HIV infection is rare.
I must admit when I first stated prescribing PrEP I was concerned about whether or not the generic versions of these drugs were safe.
What I can now tell you is that the manufacturers of generic Truvada are doing so under licence from Gilead. To be able to do this there is stringent testing to ensure that they are producing a product that is equally as good as Truvada.
When I first was bringing the drug into Australia for myself, one of the things that I did do was talk to a number of pharmacists in Australia, closely related to HIV treatment. They were able to explain to me that a lot of patients who are not eligible for Medicare here in Australia, depend on imported generic drugs to treat their HIV. Each of these patients does have very good non-detectable viral load, which shows that the generic versions of these drugs are just as safe, just as effective, and will protect you in the same way that the standard Truvada will.
Here in Melbourne as part of the PrEPX study we’re actually using an imported generic and this has been tested thoroughly and is equally the same and effective as Truvada.
“Which generic version do I bring into Australia?”
There are a number of different choices of generics, and what I would recommend is making sure that you buy through a website that is well-established and has a good relationship with a number of providers of generic drugs. The one site that I recommend as the best place to start is PrEP Access Now, http://pan.org.au.
As you can see, I am at the PrEPaccessNOW website, pan.org.au, and there are a number of different options you can use to import the drug Truvada into Australia. So, you go to “How to get to PrEP,” and then “Buy PrEP online.” And it is a three step process, as they’ve said, to decide that you want to go on PrEP, find a GP to get your script, and then ordering PrEP online. So you can click on that, and it will take you down to the “Order PrEP online” section.
So, there are a number of different places that you can buy, Green Cross, Freedom Health, Dynamix, All Day Chemist, Silom, and Aids Drugs Online. But you’ll notice here that they actually say, “Ricovir EM” or “Tenvir EM,” or “Tenvir EM” or “Ricovir EM”. So, these are the main ones that you want to be getting. Currently, here, in the study, here in Melbourne, we’re using the Ricovir EM, but I’ve used both Ricovir and Tenvir, and they’re both equally as good. As always, I do remind you, you do need a script, and do not order more than 90 tablets at a time, otherwise customs could take them off you. But if you’d like to be able to do this whole process, pan.org.au, get PrEP, and you’ll be heading in the right direction.
Do I need a prescription to import PrEP into Australia?
Currently to import PrEP into Australia, you do need a prescription. You need to do is talk with your doctor and they supply you with a script for 90 days worth of PrEP.
Most of the companies that supply PrEP from overseas do require you to upload a copy of your prescription to enable the transaction to happen. Also, keep your script with you, as when the medications arrive, customs may ask you why you’re importing the drug into Australia. With your doctor’s script in hand, you are able to say, this was prescribed by my doctor and that’s why I’m importing it.
There should be no problems as long as you have your script from your doctor.
What was the biggest “side effect” I personally noted on PrEP?
By far the biggest side effect I have had with PrEP has been a monumental shift in my own belief structures.
I grew up in the “bad old days” of HIV. Days where there was only one highly toxic treatment available. Days where funerals were common. Days of whispering in clubs with people wondering “does he have ‘it'” when someone lost weight.
For me this set up a sense of fear, a sense of paranoia, the constant worry that with one wrong step, I too could be infected with an incurable disease.
Over time and training my mindset around HIV changed. I understood how HIV comes to be transmitted and most importantly how it could not.
Despite this conscious understanding, the heart wasn’t always a believer. There was always that overhang of anxiety when it came to sex, the “what if” factor.
What if I brushed my teeth too close to oral sex, what if that condom did break. You may be familiar with this situation?
When I learned about PrEP I knew this was not only important for myself but also for our community. We have an opportunity to be able to block HIV in a way that we can control on an individual level, independent of when we have sex or even how we have sex.
For me that shift has been life changing. I am no longer worried about HIV, I am open, I am welcoming.
In some ways I do feel some shame in how my own anxiety and worries had blocked my abilities to embrace friends and lovers living with HIV. Today those anxieties are gone.
For me PrEP has gifted me the ability to live life without the shroud of anxiety. I hope this is contagious. I hope this shift impacts my friends living with HIV. I hope my friends may no longer feel shunned or rejected.
I am mortified to think if I have ever done this on a conscious level, I know that on an unconscious level I’ve had times where worry has taken over. Today I know this is in the past.
If even for this one change, I am grateful for PrEP.