PrEP

Numerous studies have demonstrated that PrEP is highly effective at preventing HIV transmission (greater than 99%), when taken correctly. 

Different studies have looked at different ways of taking PrEP, whether that is daily dosing or events based, and both have been shown to be highly effective in the right circumstances.  

• Daily dosing, where people take a pill every day, is suitable for everyone.  
• Events-based dosing, where people take pills at set times before and after they know they’ll be having sex, has mostly been studied for gay and bisexual men, and men who have sex with men. 

As part of PrEP assessment, your sexual health clinic can talk to you about the right dosing option for you. 

PrEP is available to anyone who is at an increased risk of HIV, regardless of their sexuality, gender or ethnicity.  

Factors that could indicate an increased risk of HIV could include: 

• If you have, or anticipate having, multiple sexual partners. 
• If you prefer to not use condoms during sex. 
• If you are in a relationship with a partner who is HIV positive with a detectable viral load 

Although HIV disproportionately affects specific populations (including gay and bisexual men, and trans and non-binary folk), it would be wrong to assume that everyone who identifies with these populations is at risk. 

Assessment for PrEP should always be based on an individual’s personal circumstances to ensure it’s available to anyone who could benefit from it. 

PrEP is available for free in Scotland via local NHS sexual health clinics. Each area will have their own procedures for making PrEP available, but will typically follow the following process: 

• Initial assessment – a clinician will discuss PrEP with you to identify if you are eligible. They will also ask you to take tests to confirm you don’t have HIV and to check your kidney function.
• Prescribing – provided you are eligible, you will be prescribed PrEP on either a daily or event-based dosage (see ‘How do you take PrEP?’ below). Prescriptions are generally issued directly by the sexual health clinic.
• Monitoring – you will be offered regular monitoring appointments to check that PrEP is still suitable for you. As part of this, you will be offered regular HIV and STI testing. 

At the moment, PrEP is only available in tablet form in Scotland. Depending on your circumstances, you may be recommended to take PrEP in one of the following two ways: 

Daily dosing

Most people who are prescribed PrEP will take it on a daily dose.  

• You take one tablet a day, every day 
• Provides effective protection from HIV across all kinds of sex 
• Provides protection 24 hours a day, seven days a week 
• Provides protection from HIV after seven days of treatment. 

Event-based dosing

Event-based dosing is suitable for people who know when they are having sex and can plan ahead. At the moment, event-based dosing is only recommended for people whose risk of HIV is through anal sex.  

• You take two tablets between two and 24 hours before sex 
• You then take one tablet every 24 hours until you’ve had two sex free days 
• Provides protection for specific sexual encounters 
• Not suitable for trans women who are taking feminising hormones 

Most people who take PrEP will not experience any side effects. Around one in 10 people may experience mild symptoms, including nausea, diarrhoea, headaches and bloating but these usually go away after a month or so. 

There is evidence that PrEP can sometimes affect kidney function. For this reason, kidney tests are carried out as part of the initial assessment, and ongoing monitoring of people taking PrEP.