Reader queries

Hello, I’m a 35 years old pansexual man living in West Bengal. I’m sexually active with multiple partners. I’ve heard a lot about PrEP as a substitute for condoms. Is it correct to say that it’s a substitute? I want to know how it works and if it’ll be good for me – how do I find this out? Will I have to take it lifelong? Most importantly, where do I access it?
Anonymous, West Bengal

Dear Anonymous

First, I’d like to commend you on your readiness to reach out for professional advice. Let me state a few facts about pre-exposure prophylaxis or PrEP and how it works.

PrEP is an antiretroviral drug combination that acts against the retrovirus family of viruses, which includes HIV. This drug is taken pre-exposure, that is, before an exposure to HIV can take place, say, through penetrative sex (anal, vaginal or oral) without a condom. Because it prevents an anticipated infection, it’s called a prophylaxis. Hence the full name – pre-exposure prophylaxis.

Now, in your case, yes, you can start taking PrEP, but only after consulting an HIV counsellor and taking a blood test to make sure you don’t have HIV. Once you know that you are HIV negative, you’ll need to consult a doctor who can prescribe the PrEP medicine. On the other hand, if you test positive for HIV, you’ll need to start a different line of HIV treatment. PrEP won’t be effective if you’re already HIV positive. Please click here to access queer-friendly healthcare providers for HIV counselling and testing information.

About how long to take PrEP, no, you don’t have to take it lifelong. You can take it when you feel you’re at a high risk of acquiring the HIV infection, and stop taking it when you don’t have any risk at all. However, let me repeat, starting, stopping and even re-starting PrEP must be done only in consultation with an HIV counsellor and qualified doctor.

If taken strictly as advised by the doctor, PrEP can help reduce the risk of HIV transmission from one person to another by more than 95%.

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On whether PrEP is a substitute for condoms, let’s take a look at the rationale behind using condoms. A condom is used as a physical barrier to prevent the mixing of body fluids like semen, vaginal fluids and blood between sexual partners when they engage in sexual activities like anal sex, vaginal sex, oral sex, or sharing of sex toys.

Using a condom prevents the transmission of several bacterial, viral and fungal infections between sexual partners. These infections are collectively called sexually transmitted infections (STIs) and HIV is also one of them.

Though PrEP gives maximum protection against HIV infection, it cannot prevent other STIs like syphilis, gonorrhea, chlamydia and hepatitis B and C. So, whether one is on or off PrEP, condoms are non-negotiable. PrEP, therefore, is not a substitute for condoms if you want to protect yourself against a wide variety of STIs. Rather, PrEP and condoms together can be the best protection against HIV and other STIs for people who have multiple sexual partners.

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Finally, for information on where and how to access PrEP facilities in India, please contact non-government organization SAATHII here. SAATHII works on the issues of universal access to public health and social justice.

About the main graphic: Representative image of a PrEP tablet. Image courtesy iStock