I had sex with a guy and I was the top. I came inside him and the condom broke. Should I get PEP? This was anonymous sex and I don't know this man. How much does PEP cost?
If the condom broke then there is a risk of contracting HIV. While the risk is greatest for the bottom, it is still high-risk for the top because if the bottom has HIV it can be highly concentrated in the lining of his ass which can then enter the tip of your penis.
PEP is free under certain circumstances, for example if you know that the person you were having sex with is HIV positive. If you aren't sure about his status then you may have to pay. In either case, we recommend visiting your local sexual health clinic or the emergency department of your nearest hospital as soon as possible to find out about your options.
For PEP to be effective it needs to be started as soon as possible and no later than 72 hours after exposure to HIV.
I had sex with a prostitute (sex worker). She said she is healthy but I'm stressed. Can I get HIV?
The rates of HIV among sex workers in New Zealand are very low compared to other countries. The risk of getting HIV from having unprotected oral sex with any person, including sex workers, is very low. It's also very low risk if you've had anal or vaginal sex with a condom. If you didn't use a condom for anal or vaginal sex then the risk is higher.
Why is unprotected anal sex more dangerous than unprotected vaginal sex?
The inside of the rectum is like a sponge, absorbing nutrients into the bloodstream from food passing through, meaning it can also easily absorb HIV from semen. The cells of the vagina are much less absorbent and not as vulnerable to HIV. However it is still possible to contract HIV through unprotected vaginal sex.
How long does an HIV test take and when can I get the test results? I had sex without a condom a few weeks ago and I'm really worried.
Wondering if you could be at risk? Use our tool to find out your risk.
A rapid test for HIV at one of our clinics will give you results in just 20 minutes. Book a free and confidential test now.
Or you can order a self-test and get your results at home in 20 minutes.
Keep in mind evidence of HIV can be detected by some tests as early as 2 weeks after exposure, but it may take up to 3 months. Everyone responds differently to the virus.
Is an HIV test done through a GP 100% accurate? What kind of test are they?
GPs send people off to a lab and blood is taken there. People then have to wait a few days for results, but these tests are 100% accurate.
Our rapid HIV tests are 100% sensitive to HIV, they are FDA approved and 98.9% specific to antibodies, and you will get your result in a few minutes.
How much does HIV treatment cost? Does it cost more if you are not a citizen?
HIV treatment in New Zealand is publicly funded and free, regardless of immigration status. However visits to a GP or other health professionals are likely to incur costs. More information can be found on the Ministry of Health website
In Aotearoa, people living with HIV need to be seen by an infectious diseases department or sexual health clinic to initiate medication, as only specialists are able to apply for a special authority for subsidised HIV medication. We advise people to continue to have medication prescribed by their specialist at regular appointments.
Can I apply for a visa to visit or live in New Zealand if I am living with HIV?
Yes. Recently, NZ has changed some of the rules and HIV is no longer automatically considered a condition deemed to impose significant costs to public health system. We believe this means that it is now easier for people living with HIV to be granted visas and migrate to NZ. However, each applicant’s health status may still be considered by Immigration NZ on a case-by-case basis, especially when there are other health considerations. HIV screenings are part of immigration medicals in some, but not all cases, so it is a really good idea to work closely with an immigration adviser that will be able to recommend the best course of action.
Is it ok if I have sex with a boy while I have a girlfriend to see what it is like?
It’s okay to have sex with a guy.
Always use condoms in order to prevent contracting a sexually transmitted infection and spreading an STI to anyone else. It’s best to first talk to your girlfriend about having sex outside of the relationship so that you don’t hurt her feelings. You may find it useful to speak a bit more about sexuality. You might want to consider accessing our or another counselling service.
Started having sex? Here's some things you might want to know
I had sex with sex worker about a month ago, and I used a condom as protection. However I also realised that I had a small cut on my knee which was exposed to the bedding and her skin although there was no blood or any fluid contact on the cut. Now I have a bit of diarrhoea and feeling tired through this weekend not sure of why. With the situation I described, am I at risk for HIV?
No. There would have been no risk of HIV infection as there was no bodily fluid contact and the HIV virus dies within minutes of being outside the human body anyway. You may have picked up a stomach bug in some other way or sometimes the stress of worrying about these things can cause us to feel unwell.
Last week I ended up in a massage parlor/brothel and had unprotected sex in the spa. The next day I found a small cut on the end of my penis. A week later I have pain at the end of my penis and a sore throat. I'm worried I have an STI or HIV. What should I do?
Your risk of HIV or STI transmission is increased if you had a cut on the end of your penis during unprotected sex, particularly if it was raw or bleeding, as this could allow infected fluid to get into your bloodstream.
It's impossible to say whether your symptoms are related without having a test, so we would encourage you to have a full STI screening and HIV test through your GP or nearest sexual health clinic. It's important to note that with HIV has a window period of up to three months and is detected in a test after this period.
Where in New Zealand can I get free condoms?
How risky is oral sex for HIV transmission?
Extremely low. Risk only increases if there are open and bleeding cuts in the mouth. Read more about why oral sex has such a low risk of HIV transmission.
Read more about what sexual activities place you at risk of contracting HIV.
What’s the difference between HIV and AIDS?
HIV stands for Human Immunodeficiency Virus and is a virus that attacks the immune system, killing off healthy immune system cells that normally fight off infection. HIV is transmitted through blood, semen, anal mucous, vaginal fluid and breast milk.
AIDS stands for Acquired Immune Deficiency Syndrome and is the term used to indicate complete deterioration and destruction of immune function - the final stage of HIV. People with HIV who are on consistent antiretroviral (ARV) treatment can expect to lead long and healthy lives and may never progress to AIDS.
How long can I expect to live if I contract HIV?
Remember that an HIV diagnosis doesn’t have to stop you living a full and healthy life. With the right treatment and care, you can expect to live just as long as someone who doesn’t have HIV. HIV shouldn’t stop you doing the things you want to do in your life.
Is HIV present in pre-cum?
Yes. It is possible for pre-cum to transmit HIV via unprotected anal sex. Transmission through pre-cum during unprotected oral sex is extremely low.
What are the chances of developing resistance to my HIV treatment?
Antiretroviral Therapy uses three different types of drugs to fight HIV – targeting the virus at different stages of its life cycle. The risk of developing resistance to treatment is low as long as you are adherent and do not have a strain of HIV that is resistant to the treatment that you are on.
Resistance to treatment most often arises when the level of HIV treatment in your blood is not high enough to fully suppress the virus. This can happen if medication is not taken as prescribed resulting in a spike in viral load. When this happens, newly replicated viruses that have genes that make them resistant to treatment are selected to survive and continue to replicate. Another way of developing resistance is if you have unprotected sex or share needles with another person who has a resistant strain of HIV and is not undetectable. The strain of HIV that they have would have to be resistant to the treatment that you are on for it to be able to replicate in your body, even if you are taking your medication as prescribed.
What’s the difference between a CD4 count and viral load count?
A viral load count is a measure of the number of HIV particles in your blood at a given point in time. Low and undetectable viral loads reduce your chance of passing HIV on.
A CD4 count is a measure of the number of CD4 cells in the blood. HIV attacks these cells so they are no longer able to do their job fighting infection and therefore conversely to viral loads, the fewer CD4 cells a person has, the more susceptible they become to a wide range of infections.
Can I still enjoy a drink while on treatment?
What’s the difference between PrEP and PEP?
PrEP and PEP are both HIV medications taken by people who do not have HIV.
PrEP (Pre-Exposure Prophylaxis) is an HIV medication for people who are HIV negative - taken to reduce the risk of acquiring HIV by up to 99%.
PEP (Post-Exposure Prophylaxis) is a medication given to people who may have been exposed to HIV. Although PEP is not foolproof, if taken within 72 hours of being exposed to HIV, it is likely to reduce the chances of contracting HIV. For PEP to be most effective, it needs to be taken as soon as possible after an episode of unprotected anal sex.
Should I be worried about the toxicity levels found in HIV treatments?
Treatments for HIV these days are far less toxic than they once were and side effects much less of a concern. There are some side effects associated with treatment that will be experienced differently by different people. Managing any side effects that do arise is something your HIV specialist will help you with. The research now shows that the benefits of being on treatment, and preferably as early as possible, far outweigh any issues related to toxicity. If you are worried about this, talk to your HIV specialist.
Do I still have to disclose my HIV-positive status even if my viral load is undetectable?
New Zealand law requires people living with HIV to take ‘reasonable precautions’ to avoid passing on HIV. The only case to ever come before the courts in New Zealand was for vaginal intercourse. It found that condoms are needed to be used as a precaution. That means that legally, if you are not using condoms during penetrative sex, you must disclose your HIV status. There has not been a case in New Zealand to test whether an undetectable viral load would be considered ‘reasonable precaution.
How long does it take to get to undetectable?
Everyone responds uniquely to treatment. If you have been on treatment for 6 months or more, and you are taking your medication as prescribed, you have a good chance of significantly reducing your viral load. However, the exact amount of time it takes to get to undetectable will be different for everyone. Not everyone will be able to obtain an undetectable viral load.
What if my partner and I are both positive and undetectable? Can we have sex without condoms?
Yes, however having sex without a condom always carries the risk of STIs, particularly if you are having sex with other guys as well as your regular partner.
There is also a very small risk that when two people living with HIV have sex without a condom that reinfection will occur, if one partner has a strain of HIV that is resistant to the treatment that the other guy is on. However, if you’re taking HIV medication and have an undetectable viral load you can’t pass on HIV, and therefore this won't be an issue.
If my viral load is undetectable, can I stop taking my meds?
No. Remaining on treatment is key to keeping your viral load under control and stopping the HIV virus from replicating. If you stop taking your medication even for a week or two, you give HIV the opportunity to replicate more quickly, increasing your viral load and the risk of developing resistance to your treatment.
Is it possible to become undetectable if I am not on meds?
By far the majority of people need HIV medication to get their viral load down and keep it there. A very small percentage of people living with HIV have successfully managed their viral load without medication. This group, referred to as ‘elite controllers’, are estimated to make up less than half of 1% of all people living with HIV.
Once the viral load is undetectable, does it stay that way forever?
No. Viral loads can go up and down. Small blips are not uncommon even if you are taking your medication as prescribed. Regular monitoring of your HIV viral load is an important part of your treatment regimen.
If I do start HIV treatment and can’t tolerate it, can I stop?
There are a range of treatment options, so if you are experiencing issues it is very likely that there will be another treatment that is better for you. This is something you will want to discuss with your HIV specialist. Always keep in mind that not adhering to your treatment carries the risk of developing resistance to certain HIV drugs – meaning your treatment options may be reduced. Any changes to medication need to be managed carefully under the guidance of your specialist.
Does having an STI impact on viral load?
Being undetectable does not protect you or your partner(s) from other STIs and if an HIV-negative person has an STI they are at higher risk of getting HIV. There is also evidence that STIs can increase the viral load of someone living with HIV who is not on treatment. However, the presence of an STI does not increase the possibility of transmission if the HIV-positive person is on effective antiretroviral therapy.
What are the signs/symptoms of having HIV?
Not everyone who gets HIV will experience any short-term symptoms. So, symptoms or not, it's important to test twice a year - or more often if you haven't been playing safe. In some people, symptoms may occur from two to four weeks after HIV infection and may include flu-like symptoms that are easily confused with other infections, such as fatigue, fever, night sweats, sore throat, swollen lymph nodes, headache, loss of appetite or skin rash. These symptoms usually last less than two weeks although they can last as long as 10 weeks. If you‘ve recently had unprotected anal sex and experience any of these symptoms, you should have an HIV test with NZAF, your emergency room, GP or sexual health service.
Also, keep in mind that not all doctors will recognise the symptoms of HIV. If you see a doctor because you have one of the symptoms listed above, it’s important to explain that you feel at risk of HIV and ask to be tested, even if they don't suggest it. Don't assume you will be tested for HIV just because they take your blood. Ask to be sent a copy of the results.
How long does it take for PrEP to be effective?
If you're using daily PrEP to provide protection during anal sex, you need to take it daily for 7 days prior to any sex without condoms to ensure that the levels of the drug have built up to provide enough protection. You also need to continue taking it daily for 28 days following the last episode of anal sex without condoms for maximum protection.
Cisgender gay and bisexual guys can also start it with a double dose (two pills at once, and continue with single pill every 24 hours), and the protective effect should kick in after two hours. Learn more about how to take non-daily PrEP. If you keep having sex then keep taking a PrEP pill each day. After you’re done having sex, keep taking a pill each for two days after the last episode of sex.
I was chatting to a guy on Grindr and he said it's safe to have sex without a condom because he's on PrEP. Is it really safe?
It's great that he's taking action to reduce his risk of getting HIV by using PrEP, but him being on PrEP is not a 100% guarantee that he hasn't got HIV.
He may, for example, have stopped taking it for a period of time and unknowingly acquired HIV. So you're still at risk unless you're taking action to protect yourself either by using condoms or taking PrEP yourself.
Keep in mind that PrEP doesn't protect against other STIs like syphilis, gonorrhoea or Hep C, and you won't always know if someone has another STI because they can have no symptoms. Using condoms is the best option for protecting against both HIV and other STIs, but if you struggle with condoms then PrEP at least will provide protection from HIV.
What's the deal with cock piercings and condoms? Is it still safe to have sex with a cock piercing if you use a condom?
That's an interesting question as piercings are quite common these days. The best advice we can give on this is that you or your partner should remove the piercings before having anal sex. This is because there is a chance that the metal might break through the latex of the condom. Some might argue that the jewellery is smooth and won't tear the condom, but we reckon with metal against latex it's not worth the risk. Be aware too that piercings need time to heal after you first get them so sexual activity during the healing period should be avoided.
Is it very easy to get HIV if I have ulcers in my mouth and give a blow job to a guy I just met? Assuming he is positive...
Oral sex is very low risk for HIV transmission, find out more about why here. It's important to manage the risks as much as possible, and still enjoy sex.
A couple of things to consider to keep that risk to a minimum is not letting them cum in your mouth and checking for cuts or ulcers either in the mouth or on the penis, as they become potential entry points for HIV to enter into your blood stream. So yes, if you have ulcers in your mouth and you get his cum or pre-cum on those ulcers there is some risk.
What should you do if you rip your foreskin during rough anal sex?
Ouch! Any trauma should be checked out by a medical professional.
Whenever I see guys pumping themselves in cruise clubs or porn movies they seem to have no problem in gradually masturbating successfully with a load of jizz cumming out. I tend to find that the only way for me to cum is to use lubricant. Is it normal to only be able to cum after lubricating?
It is really important to remember that everybody is different when it comes to sex. What is 'normal' for one person doesn't necessarily relate to everyone, and the guys on the screen are the exception and not the rule. Bodies will produce different amounts of cum and can take time in 'refilling'.
The use of lube can increase the sensation and sensitivity and ultimately the level of arousal, so experiment with different amounts. Try not to measure yourself on the quantity to determine your quality.
I have just started to finger myself. I tried it once without lube and once with shower gel in the shower. Is it normal if I feel irritated afterwards? The only thing is I didn't get pleasure out of it? How deep am I meant to go?
Firstly, go buy some lube or get us to send you some. The shower gel you're using could have harsh chemicals in it which might be why your asshole feels irritated - soaps can interfere with natural bacteria and irritate sensitive membranes.You should get some pleasure from rubbing around the anus, and then from the prostate, which is about a thumb's length inside your ass towards your bellybutton.
If both partners have tested negative for HIV and other STIs, is it safe to have bareback sex?
Relying on negative HIV status to prevent HIV is risky. It requires constant, open communication with your partner(s), and regular testing. And even then, it won't necessarily work.
If you're HIV negative and struggle with consistent condom use, you could consider taking PrEP to stay safe. But remember that while PrEP is great at preventing HIV transmission, it won't protect you against other STIs like gonorrhoea, syphilis or chlamydia.
The short answer is that it's not very safe - because you can never be 100% sure of somebody's HIV status (or even your own status), for the following reasons: First, it can take up to three months from the date of infection for HIV to show up in a test. So, even if you both tested negative yesterday, it's possible that one of you does have HIV and it hasn't shown up on the test. Second, HIV is most infectious in the few weeks after somebody catches it. So if a guy caught HIV a few weeks ago he won't know it yet because it often has no symptoms and it my not show up that early on a test. He'll also be highly infectious at this stage, with a very high chance of passing it on. This is actually how most HIV in New Zealand is passed on - from guys who don't know yet that they have it yet.
I have trouble staying hard when I top with a condom on. I'm also circumcised and with a condom I can't feel a lot. Can you suggest some ways to increase the feeling / keep me hard longer?
There are lots of ways to help with this; number one, have you got the right size?
We have 49mm, 56mm (standard size) and 60mm condoms we can send out, so if you would like to try some different kinds for free, flick us an email or dm.
Secondly, thickness can play a part. Have a play around with some non-latex condoms, as they're super thin and may make a difference for you. The final thing to do is simply put a small bit of lube on the head of your penis before rolling on the condom. Better lubricating the inside can make a huge difference; just have a play around first before you fuck, as you want to make sure you don't use too much and risk your condom slipping off. If you're still struggling after trying these options you could consider PrEP, the daily pill that prevents HIV. It's as effective as condoms for preventing HIV but it doesn't provide any protection from other STIs like gonorrhoea or syphilis.
He spat on the condom as lube - is there a risk of HIV infection?
HIV is not spread through saliva, even when used as lubricant for anal sex. However, if he had oral herpes this could be transmitted to your anus.
Spit is generally not a great lubricant though, so this could lead to anal bleeding. We'd recommend getting a water-based lube from the pharmacy or supermarket or we can mail them to you for free!
Can you contract HIV from kissing?
No. Kissing on the mouth is extremely low risk for HIV transmission; The only time it would be possible is if both people had open wounds in their mouths that were bleeding and kissed for a long, long time
I have met a new man and he is HIV positive. I'm HIV negative. If I wear a condom to have anal sex with him is it safe for me?
Yes. Condoms and water based lube, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV.
Also, people living with HIV who are on antiretroviral treatment and maintain an undetectable viral load (U=U) for at least six months do not sexually transmit HIV.
What type of condom is inside the free condom packs that you provide?
I just got diagnosed with an STI and I'm really nervous about telling a guy I recently hooked-up with, how do I tell him so he won't get mad?
It's totally normal to feel anxious about telling someone you have an STI. To help, we have made a tool to make it easier! This Tool write the message for you, it lets you pick from a range of options such as what STI you've been diagnosed with and if you'd like to hook up with them again and It will generate a message for you to copy and send.
I don't want anyone to find out I'm testing for HIV & STIs
If you test at our clinic anything you share is completely confidential. You don’t even need to tell us your real name.
You can also order a self-test which will arrive in discreet packaging so you can test privately.
I’m afraid of the results of a HIV test
We promise you, it’s better to know. If the result is positive, your life isn’t over. You will be connected to care and support and can live your life with the same dreams and goals. You’ll also likely get to an undetectable viral load and then HIV won’t be transmitted through sex – even without condoms.
Why should I test?
Testing is one of the most important things you can do to help end HIV transmissions in New Zealand. Most new HIV transmissions occur when people don’t know they are living with HIV and aren’t on treatment.
I don’t have any symptoms, do I really need to test for HIV & STIs?
Testing should be a part of a regular sexual-health schedule, not just something you do when things hurt or pustules pop up. Not having any symptoms is pretty common with HIV and a lot of other STIs – you should still be testing regularly.
Do I still have to get checked for STIs every 3 months in order to get PrEP?
Yes. Being on PrEP (both daily and 2-1-1) still requires three monthly check-ins for HIV and STI testing as well as tests to ensure PrEP continues to be safe for you. These other tests include things like checking your kidneys.
I’m a top. Can I get PrEP now?
Yes, basically, as long as you are HIV-negative and are eligible for publicly funded healthcare in Aotearoa, you should now have access to funded PrEP.
Have costs changed with these new criteria?
The cost to be on publicly-funded PrEP should be $5 plus the cost of a GP visit every three months. This cost isn’t different for folks who were on already PrEP before the rules changed. But it does mean more people who are now eligible can get PrEP for much cheaper than they would have previously.
Can I get PrEP and PEP from any prescriber now?
Yes. Both PrEP and PEP can be prescribed by any ‘relevant prescriber’. This simply means all GPs, sexual health physicians, infectious disease specialists, and many nurse practitioners are now able to prescribe funded PrEP and PEP.
Do I still have to tell my prescriber if I use any drugs, like meth?
You may not have to share it to qualify for funded PrEP under the new criteria. However, it is really important to be open and honest with your prescriber about any drugs you may be using in order to make sure that PrEP is safe for you to use, and that the recreational drugs don’t interact badly with your prescription drugs, so that you get the best health outcomes possible. Remember, prescribers have to keep what you share confidential.
What if my doctor does not know about PrEP or how to prescribe it?
If your doctor hasn’t heard about PrEP or doesn’t know how to safely prescribe it for you, you download a letter to take to your doctor here. You can also direct them to us at Burnett Foundation Aotearoa. We have resources that can support prescribers to learn about PrEP. If they are open to learning then we can help them get up to speed so they can support you.
Otherwise, you have the right to see another provider that does know about PrEP. Check out this map of PrEP-friendly providers around Aotearoa.
Some prescribers are not following the guidelines for testing and ordering bloods every three months. Besides asking for HIV, Syphilis and STI testing, what other testing/bloods should GPs be offering their clients?
Below are some of the standard tests your prescriber should be doing when you go on PrEP and timelines we’d expect for follow-up/ongoing testing. It’s important to remember, PrEP isn’t just a pill – it's a health programme – think of it as a journey rather than a destination. Everybody’s health journey on PrEP might look slightly different, and that’s okay! So the tests and monitoring your prescriber thinks are right for you may look slightly different than what is listed here.
Before starting PrEP, we would expect your prescriber to carry out the following checks:
After the first three months on PrEP, we would expect your prescriber to carry out the following checks:
Every subsequent three months, we would expect your prescriber to carry out the following checks:
Every six months, we would expect your prescriber to carry out the following checks:
Is the three months prescription of PrEP given to me all at once?
Yes, the new rules enable your prescription for a three-month supply of PrEP to be provided all at once.
If I only do 2-1-1 dosing, and my PrEP supply lasts me more than three months, do I still need three-monthly HIV and STI check-ups?
Even if you are on PrEP 2-1-1, the recommendation to test every three months for HIV, STIs and kidney function remains the same. The fact that you might not need a new prescription because you have plenty of tablets using PrEP 2-1-1 does not mean you should delay your PrEP follow-ups – these check-ups are about your ongoing health, not just to get more PrEP. We strongly recommend that you do get the required testing every three months, even if you still have PrEP pills left.
I am going on an overseas trip, can I get a prescription for more than a three-month supply of PrEP to take with me?
It is unlikely that you will be able to get access to more than three months of PrEP to take with you if you are going to be out of the country for more than three months. Many countries impose limits on the quantity of medication you may bring with you for your personal use, and quite often this restriction is up to 90 days. If you are travelling for a long time, it is a good idea to find out how to access PrEP in the country you are visiting.
I’m on a working Visa can I get funded PrEP now?
If you are a work visa holder who’s eligible to be in New Zealand for two years or more, then you are likely eligible for publicly-funded PrEP. Unfortunately, most other temporary migrants are still not eligible for publicly-funded PrEP. Click here to find out if you are eligible to access publicly funded health services in Aotearoa.
However, even if you are not eligible, you can still consider paying for PrEP yourself. This involves getting a prescription from a local prescriber as well as other costs you will need to be able to cover ongoing.
Potential costs include:
Burnett Foundation Aotearoa continues to advocate for decision-makers to improve access to HIV prevention, including PrEP, for those who are not otherwise eligible for publicly funded healthcare in Aotearoa.
I don’t have anal sex, should I still take PrEP?
While the risk of HIV transmission is highest for those having anal sex, there are some other scenarios in which PrEP might be beneficial.
For example, if you have condomless vaginal sex, there is still some risk of HIV transmission from infected semen, pre-cum or vaginal fluids. PrEP would likely be of significant benefit to you if you are having vaginal sex with gay, bisexual, or other men who have sex with men outside of a monogamous/exclusive sexual relationship.
PrEP would also likely benefit:
If you are only engaging in oral sex, then you will likely not benefit from PrEP, as oral sex presents an extremely low risk of HIV transmission. Having an open and bleeding wound in your mouth does increase the risk of oral HIV transmission slightly, but there would need to be a significant amount of semen containing a high HIV viral load coming into direct contact with the wound. You cannot acquire or pass on HIV by rimming (licking or eating out someone's ass) and you cannot acquire HIV by receiving oral sex.
People who have shared needles in the past or anticipate sharing needles during injecting drug use in the future, especially in the context of chemsex, may also benefit from PrEP.
As an older guy is it safe to take PrEP?
Yes, generally speaking. Tenofovir disoproxyl and emtricitabine (the active ingredients of PrEP) are generally considered very well-tolerated (which means you are not likely to experience unpleasant or dangerous side effects) and safe for most people to use, including most older people. That being said, it’s important to remember there may be individual health issues that can make PrEP use less safe. Which is why, when taking PrEP – like any other medication – it is best to have an open and honest discussion with your prescriber about your health, as this will help them to give you appropriate advice on whether PrEP is safe and suitable for you to take.
Does PrEP have side effects?
While most people will breeze through taking PrEP without noticing any day-to-day side-effects, some may experience them. Some people experience: gas, bloating, diarrhoea, low energy and nausea. However, these side-effects are usually mild and go away after the first few days or weeks on PrEP. Your doctor should also offer you regular check-ups to make sure PrEP continues to be safe for you in the long run.
Read more about potential side effects here.
How effective is PrEP?
When taken as prescribed, PrEP offers nearly full protection from acquiring HIV. The cases where PrEP has failed to prevent HIV transmission when used correctly are very rare but these have been covered in medical reports.
This is why everyone using PrEP needs to be tested for HIV every three months. You should also remember that PrEP does not reduce your risk of contracting other STIs.
How long does it take for my doctor to get approval to give me subsidized PrEP?
These days, approvals should be instantaneous, and you should be able to get your script without delay.
These approvals, called an Electronic Special Authority are basically an electronic form that your prescriber fills out. The system should return a response instantly and this is a process that typically doesn’t involve you – it's just admin for your prescriber. There are still Paper Special Authority application forms, which are processed within 10 working days, but the vast majority of practices use electronic forms so you shouldn’t usually need to wait.
What are my options in NZ if I have issues with my kidneys or liver but still want to go on PrEP?
When taking PrEP – like any other medication – it is best to have an open and honest discussion with your prescriber about your health, as this will help your prescriber decide if PrEP is safe and suitable for you to take. In some cases PrEP can be used safely with additional monitoring but this needs to be a discussion with your prescriber to see if that would be the case for your circumstances. Overseas, a different version of PrEP may be available (pills containing ‘tenofovir alafenamide’) that may be better tolerated by certain people with kidney issues. However, these are not currently available in NZ.
Do I have to get blood tests to check liver and renal function every time I renew my PrEP prescription?
It depends, but some level of testing should be carried out every three months. The testing schedule is quite complex and, in some cases, may be tailored to your individual health circumstances. It’s important to have regular check-ups while taking PrEP, so your kidneys and liver can be monitored when appropriate and you should be doing HIV and STI tests every three months when you refill your prescription. While it is not common, PrEP can interfere with kidney function, and your prescriber may advise you to stop taking PrEP. The drugs in PrEP also suppress the hepatitis B virus, so starting and stopping PrEP can cause virus flare-ups and liver inflammation if you have a chronic hepatitis B infection.
I know people in Australia now have access to injectable PrEP - when will we get access to it here?
We don’t know yet. We would love for folks in Aotearoa to be able to access PrEP in as many ways as possible, but this will be conditional on PHARMAC providing public funding for it. This process may take time and the end outcome depends on how the price stacks up against other alternatives (including oral PrEP which is currently much cheaper than injectable options globally).
Should I be concerned about mpox?
Mpox is an ongoing health risk that our communities must be aware of. While mpox is a self-limiting illness (i.e., can resolve on its own) and most people recover in a few weeks, some symptoms can be very uncomfortable, and it currently requires an isolation period to prevent transmission.
Symptoms can be more severe in immunocompromised people.
A reminder: most people living with HIV and receiving treatment in Aotearoa are not considered immunocompromised.
Are people living with HIV at more risk from mpox?
People living with HIV are overrepresented in the number of mpox cases, but the reasons for this are not certain. It appears that people living with HIV who are on effective treatment are typically experiencing infection in a very similar way to their HIV-negative counterparts, which means it is most often mild and self-limiting. However, those who are not on treatment or have low CD4 cell counts may be more vulnerable to more severe mpox disease.
The JYNNEOS vaccine is safe for people living with HIV. It has been tested among people living with HIV with CD4 counts >100. It can be used in people with lower CD4 counts, but we are not yet sure if it will be as effective.
What can I do to protect myself?
Right now, the best thing you can do is arrange an mpox consultation with your GP or local sexual health clinic, who will work with you to determine if a vaccine is appropriate.
Otherwise, keep an eye out for symptoms. Look out for any skin changes, new lesions/spots/scabs or any new pain and discomfort in the genital, anal or rectal areas (around your butt and butthole).
Other symptoms include fever, swollen lymph nodes, fatigue, muscle ache, headache and flu like symptoms (keep in mind that these do not appear in all mpox cases and can often be symptoms of other illnesses).
If you are concerned, stay home and get in touch with your local sexual health clinic or GP and follow their instructions.
Being alert and getting tested if you experience symptoms will be the easiest way to know what you might be dealing with.
What makes gay, bisexual, and other men who have sex with men more at risk?
Mpox is primarily transmitted through skin-to-skin contact and direct contact with skin rashes, lesions or scabs, and may be transmitted through bodily fluids. In this global outbreak, the most common and efficient way mpox is spreading is through sexual contact.
Gay, bisexual, and other men who have sex with men make up a small portion of the population. So, when we’re meeting another person for sex, the pool of people we are choosing from is much smaller. That makes us quite closely connected sexually, which can allow mpox to spread more quickly among us.
Will it be obvious if I get mpox?
Not necessarily. Symptoms can start with just some spots/lesions (usually around the face, arms or legs). In this global outbreak, we are seeing more rashes/lesions on the mouth, genitals and anus where they may not be easily spotted by the individual. Because of this, it’s important that if you are at risk and you notice any new symptoms, that you get them checked out early. For example, there have been reports of people experiencing proctitis, rectal pain discharge, or constipation) as the only symptom of mpox, so make sure to see your doctor if you have pain in or around your anus (butt) and genitals.
Is mpox contagious?
Yes, mpox is contagious if you have close or skin to skin contact with an infected person. But by following public health advice, you can avoid passing it on to other people. In the current outbreak, most infections are thought to have occurred through sexual contact. Mpox is not spread the same as illnesses like COVID-19. Mpox can be passed on through breathing in droplets exhaled by someone who has the virus, but this is very rare.
What might the risk be to my whānau if I get mpox?
Mpox can spread to those you live with as direct contact is also a mode of mpox transmission, but in general the risk of this happening is low.
If you want to reduce the risk to your friends and whānau make sure to do the following:
If any of your whānau are identified as close contacts, they should also follow instructions from Public Health officials. They will not be required to isolate unless they start showing symptoms.
You will also be provided with specific guidance and advice from Public Health about how to keep others safe.
Are we fear-mongering?
Our communities have a right to know about issues that could affect our health and wellbeing.
Talking about a global public health issue that has had cases within New Zealand is not what we would call fear mongering. We are raising awareness, encouraging government to protect those most at risk, and giving people information they need to be safe and make informed choices about their own health. Prevention is the best medicine – the more people who know what to look out for, what to do and where to get help, the less likely it is we’ll see a larger outbreak disrupting people’s lives and the health system here.
Is mpox an STI?
This is complicated. It is not classified as a sexually transmitted infection (STI), BUT, in this global outbreak it is primarily spreading through sexual contact (the majority of cases have been associated with sexual contacts!). This is because of the role that close skin to skin contact has in transmission.
Why should I use a condom if it won’t stop me getting mpox?
Using condoms is important as we are seeing that the first mpox lesions may often appear where the person has had contact with infected lesions or skin to skin contact. If this is while having oral sex, you could get lesions in your mouth. If this is after anal sex, you can develop lesions on the penis, scrotum or in the anus and rectum (inside your butt or around your butthole – ouch!), which are more sensitive than other areas. This can be very painful or can cause complications.
Essentially, while unlikely to eliminate the risk of mpox transmission, using condoms can prevent you getting mpox where it might be more painful or sensitive.
Plus, (and this applies to everyone, even if you are using PrEP or relying on U=U as HIV prevention), condoms are effective at reducing the risk of other sexually transmitted infections which can appear similar to monkeypox and can also be associated with unpleasant symptoms.
Do I have to tell anyone if I get monkeypox?
Some people will need to know so that they can protect themselves or support you, but you won’t have to tell anyone who doesn’t need to know:
Close Contacts (including sexual partners)
Yes, people who have had close contact with you while you have been infectious do need to know. Public Health will work with you to inform your contacts. Unless you tell them yourself, public health will not tell your contacts that you have mpox, just that they have been in contact with someone who has mpox.
The people you live with may need to know so that you can protect each other. You don’t need to tell anyone else in your whānau or anyone else you don’t want to know. Having mpox is nothing to be ashamed of, so if you need any help, consider reaching out to those around you for support.
Public Health will work with you to do this. Your healthcare provider can provide you with a medical certificate to give to your employer as evidence that you are required to isolate and cannot attend your place of work. This certificate will not include clarification of an mpox diagnosis unless you have asked for it to. Instead, it will just give a general explanation that you cannot attend work due to medical reasons. Your employer would only be told of your mpox diagnosis if Public Health needed to manage potential exposure to mpox in your workplace, but this is unlikely.
Do I have to isolate if I get mpox?
Yes. You must isolate at minimum for 7 days from when the lesions first appeared. After this, your isolation requirements will be reviewed by Public Health. Your time to isolate depends on the stage of healing for your lesions, where they’re located, and how you’re feeling. This is likely to be a two-to-four-week timeframe depending on when you tested positive. Public Health will assist with ensuring you are safe to leave isolation as soon as possible.
How can I avoid getting mpox?
Is there a vaccine for mpox?
Globally, there are vaccines that can be used to prevent mpox. The JYNNEOS vaccine has been used internationally and shows good safety and efficacy. Mpox vaccines can be used to prevent mpox before you have been exposed or after you have been exposed to prevent mpox from developing.
The supply of the mpox vaccine has touched down in Aotearoa, and is available via select GPs and sexual health clinics to:
The vaccine itself is free, however consultation fees may apply.
Once you have received a vaccine, you will be eligible for a second dose after 4 weeks.
Will I have to give ID if I get vaccinated?
We expect you should be able to access the vaccine in a way that offers you as much privacy as possible. Our understanding is that this vaccine does get documented on your medical record. As it is a two-dose schedule that's spaced apart, documentation in this way will help you and your provider make sure this is done correctly.
Are there any mpox cases currently in Aotearoa New Zealand?