You may have seen that PHARMAC has changed the criteria for accessing and prescribing PrEP and PEP. This is a really exciting development.
It's going to take some time for us to process these changes and update the advice in all our resources - but here is a quick rundown of some frequently asked questions around these changes and PrEP and PEP in general.
Watch this space for more updates.
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).
