PrEP Consent Guide For Women, Heterosexual Men & People With Trans Experience

Thank you for your interest in PrEP

PrEP (pre-exposure prophylaxis) is a medicine you take to prevent HIV. This guide is for women, heterosexual men, and people with trans experience having vaginal or neovaginal sex. It walks you through what to know before you start and how to take it, as part of the informed consent process. Take your time, and bring any questions to your doctor.

Before you start: the key points

  • You need to be HIV negative to start PrEP. Your doctor will confirm this with a test before you begin, and you’ll be tested again every 3 months while you’re on it.

  • PrEP is very effective when you take it as prescribed. Research shows daily PrEP reduces the risk of getting HIV from sex by more than 99%. A small number of people worldwide have acquired HIV while on PrEP. These cases are rare and have usually involved either a drug-resistant strain or not enough medication in the body. Taking it as directed is what makes it work.

  • PrEP only protects against HIV. It does not protect against other STIs like syphilis, gonorrhoea or chlamydia. Condoms reduce the risk of those, and regular STI testing is part of being on PrEP.

  • PrEP can affect your kidneys. Rarely there can be a reduction in kidney filtration. This effect is usually small and reverses when PrEP is stopped. Tell your doctor if you’ve had any kidney problems or take other medicines that affect the kidneys. Your doctor will check your kidney function before you start and at your regular reviews.

  • There’s a small effect on bone density. Tell your doctor if you have osteoporosis, brittle bones, or a family history of either.

  • Your doctor will check your hepatitis B status with a blood test before you start, because the medicines in PrEP also act on hepatitis B.

  • Some people get mild stomach upset when they start (nausea, bloating, looser stools). This usually settles within the first few weeks.

  • Pregnancy and contraception. If you can become pregnant and you’re having sex without condoms, remember you could fall pregnant. Think about contraception if you’re not trying to. The TDF/FTC form of PrEP is recommended as suitable to continue while trying to conceive, during pregnancy, and while breastfeeding, and current guidelines do not treat it as a barrier to starting a family. If you’re pregnant, planning a pregnancy, or breastfeeding, tell your doctor so they can confirm the right option for you.

  • Regular review matters. Plan on a full sexual health screen and check-in with your PrEP doctor every 3 months.

If you develop any symptoms that worry you at any point, talk to your doctor.

For vaginal and neovaginal sex, daily PrEP is the recommended way to take it in Australia. Tenofovir takes longer to build up to protective levels in vaginal and neovaginal tissue than it does for anal sex, so daily dosing gives you the most reliable protection.

  • Starting

    Take one tablet every day. After about 7 days of daily tablets, you have protective levels for vaginal and neovaginal sex. Unlike for anal sex, a double-dose “quick start” does not shortcut this, so give it the full 7 days.

  • Continuing

    Take one tablet every day. It doesn’t have to be the same time each day, though picking a set time makes it easier to remember.

  • Stopping

    If you want to stop, keep taking one tablet every day for 28 days after your last time at risk. The longer tail keeps protective levels in place to cover any recent exposure. Then you’re done.

Event-based dosing: a newer option to discuss with your doctor

Daily PrEP is the standard, recommended option for this group in Australia. Newer international guidelines (BASHH, UK, 2025) also support event-based dosing for some people having receptive vaginal or neovaginal sex. This is not yet part of the routine Australian offer, so treat it as something to raise and plan with your doctor, not to start on your own. The right schedule depends on which part you play in sex:

  • If you are the receptive partner (vaginal or neovaginal sex), the supported schedule is 2 then 7: take 2 tablets 2 to 24 hours before sex, then 1 tablet every day for 7 days after the last time you had sex. The longer 7-day tail accounts for how slowly the medication clears from this tissue.

  • If you are the insertive partner (for example, a man having vaginal sex), the supported schedule is 2-1-1: 2 tablets 2 to 24 hours before sex, 1 tablet 24 hours later, and 1 more 24 hours after that.

Event-based dosing only works with the tenofovir disoproxil/emtricitabine (TDF/FTC) form of PrEP (Truvada and its generics), not the tenofovir alafenamide (TAF/FTC) form (Descovy). If event-based dosing interests you, talk it through with your doctor, who can tell you whether it’s a sensible fit for your situation.

When to see your doctor

Book in if you develop any symptoms that worry you, if you think you may have been exposed to HIV without protection in place, or if you’re due for your 3-monthly review.

This information is general in nature and not a substitute for personalised medical advice. PrEP is a prescription medicine. Speak to your doctor about whether it’s right for you and which option suits your situation.

— Dr George Forgan-Smith, GP, practising in Sydney and Melbourne