Written by Dr.Deyn Natthakhet Yaemim (Founding Director) on 6 June 2016, Last updated 9 March 2021

Pre-PrEP checklist: How can I get PrEP at PULSE Clinic?

1. Do you already have the prescription?
   
   • If you already have a prescription for PrEP, you can show us your prescription and buy the medication.
2. If not, do you have health check-up results from the last 3 months?
   • If you already have one, you can get a 12-month supply at PULSE.
   • If you do not have recent health check-up results, you can get tested at PULSE and receive a 12-month supply of PrEP.
   • You can also get fewer than 12 bottles and have the rest delivered to your door.

PrEP FAQ - Frequently Asked Questions at PULSE Clinic Singapore

WHAT IS PrEP?

PrEP means Pre-Exposure Prophylaxis, and it’s the use of anti-HIV medication that keeps HIV negative people from becoming infected. PrEP has been shown to be safe and effective. A single pill taken once daily, it is highly effective against HIV when taken every day. The medication interferes with HIV’s ability to copy itself in your body if you’ve been exposed. This prevents it from establishing an infection and making you sick.

IS PrEP FOR BOTH TOP AND BOTTOM?

Yes, even though there is more risk bottoming, tops can also acquire HIV. Uncircumcised tops have a slightly greater chance again. It's very true that tops can also experience anxiety about acquiring HIV. Being on PrEP certainly helps with that.

IS PrEP FOR BOTH MALE AND FEMALE?

Yes, PrEP can prevent HIV infection in both male and female.

SHOULD I CONSIDER TAKING PrEP?

You should consider PrEP if you are a man or woman who sometimes has sex without using a condom, especially if you have a sex partner who you know has HIV infection,  if you don’t know whether your partner has HIV infection but you know that your partner is at risk (for example, your partner inject drugs or is having sex with other people in addition to you) or if you have recently been told by a health care provider that you had a sexually transmitted infection. If your partner has HIV infection, PrEP could be an option to help protect you from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.

Truvada for PrEP provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed. If a daily dose is missed, the level of HIV protection may decrease. It only works if you take it. People who use PrEP correctly and consistently have higher levels of protection against HIV.

HOW EFFECTIVE IS PrEP?

According to data analysis from the iPrEx study that found PrEP to be effective:

• PrEP is highly effective for preventing HIV.
• For people who take 7 PrEP pills per week, their estimated level of protection is 99%
• For people who take 4 PrEP pills per week, their estimated level of protection is 96%
• For people who take 2 PrEP pills per week, their estimated level of protection is 76%.
• PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
• Although there is less information about how effective PrEP is among people who inject drugs, we do know that PrEP reduces the risk of getting HIV by at least 74% when taken as prescribed.

WHAT ARE ACTIVE INGREDIENTS OF PrEP?

The world's first approved PrEP, was the one blue pill branded drug Truvada or its generic equivalent made in Thailand such as Teno-Em, made in India such as Ricovir-Em and Tenof-Em. Generics contain the same ingredients as branded drugs and work in the same way. Buy PrEP online here.

Truvada and the generics contain two drugs: Tenofovir Disoproxil Fumarate (TDF), Emtricitabine (FTC) 
Nowaday, a second pill has been approved for use as PrEP SINCE 2019 – the branded drug Descovy or its generic equivalent, they contain: Tenofovir Alafenamide (TAF), Emtricitabine (FTC). You can buy generics Descovy when you have prescription.

ARE THERE LONG TERM SIDE EFFECTS FROM TAKING PrEP?

PrEP was approved in 2004, so it’s been around for more than a decade. Before it was used as PrEP, it was used as treatment for people infected with HIV or exposed to HIV (it contains molecules that are used in HIV drugs). The worst side effects that have been reported are one percent bone mineral density loss and reduced kidney function. Is it safe? Yes. To put it into perspective, they can't tell if it's any worse than just getting older. People in the USA have been taking it for years. Your doctor will check your liver and kidney function as well as a HIV/STI screening every three months to make sure you're ok. It's a normal part of getting your updated script each time. If you are concerned about any effect from taking PrEP then chat with your doctor.

BEFORE GETTING PrEP FOR THE FIRST TIME?

• PrEP is for HIV negative people to take to prevent HIV to keep their status HIV negative. So you have to know for sure you are HIV negative, that's by getting tested.
• Taking PrEP long term may cost side effects on kidney function of 3% of PrEP users, so you have to know that your kidney functions is normal that's by getting tested.
• You also have to get tested for Hepatitis B virus antigen
•  

HOW TO TAKE PrEP?

There are many ways to take PrEP, How to take PrEP?
Once started, you can stop. You can re-start again. You don't have to take it forever.

WHAT IF I MISSED A DOSE?

Current studies are showing that PrEP works well even if you miss a dose.  It was shown that users who took PrEP at least 4 days out of 7 hadn't acquired HIV.  We strongly, and I mean STRONGLY, recommend that you stick to one pill a day though.  That gives maximum protection.  If you're not consistent then that's where you can miscalculate and undo all your good work. So one pill a day keeps everybody happy, secure and safe.

WHO SHOULD TAKE PrEP?

A recommendation from the U.S. Preventive Services Task Force that urges doctors to prescribe a daily pill for all people with known risk factors for HIV could significantly raise awareness about an effective yet little used drug. 

PrEP may be right for you if you test negative for HIV, and any of the following apply to you:
You have had anal or vaginal sex in the past 6 months and you

• have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load),
• have not consistently used a condom, or
• have been diagnosed with an STD in the past 6 months.

You inject drugs and you

• have an injection partner with HIV, or
• share needles, syringes, or other equipment to inject drugs (for example, cookers).

You have been prescribed PEP (post-exposure prophylaxis) and you

• report continued risk behaviour, or
• have used multiple courses of PEP

PrEP AND CONDOM USE?

If condoms work for you, absolutely continue to use them! But because it is a fact that condoms do fail, you can still take PrEP for double protection.

If someone who doesn‘t use condoms, but takes PrEP to protect themselves from HIV, that‘s already quite something! And also, for a new PrEP prescription you have to go to see your doctor every three months, where they will test not just for HIV but other STIs as well. With PrEP, people engaging in high-risk behavior would go to see a doctor regularly and other STIs would be detected and treated early. This might even reduce the spread of other STIs.

IS PrEP SAFER THAN CONDOMS?

Even when condoms are used consistently, they can fail. With the low number of HIV cases among people actively taking PrEP we are now talking about greater than 99 percent effectiveness, in other words, the pill is more effective at preventing HIV than condoms.

CAN I GET PrEP AS AN EXTRA PROTECTION EVEN THOUGH I USE CONDOMS REGULARLY?

Yes. If you are anxious about situations like condoms breaking, slipping off, not being applied correctly or doing head jobs without a condom then PrEP is still good for reducing your fear and anxiety.  Some people just want an extra layer of protection and that's fine.  Some medical professionals also use PrEP to stop HIV infection if they get a needle stick injury.  PrEP is incredibly effective and reliable. PrEP users report that they are letting go of fear they didn't even know they carried.

PrEP & STI

PrEP only protects you against HIV.
You need to take other precautions to reduce your risk of contracting other sexually transmitted infections (STIs) such as gonorrhoea, chlamydia, syphilis and hepatitis C.
We recommend regular STI testing, the best STI/STD test nowaday is DNA test for 12 infections. You also need to do an HIV test every three months.

CAN I GET STI VACCINATIONS?

Yes, you can.
Ask our doctor about vaccinations for hepatitis A, hepatitis B and the HPV vaccine.
HPV is the virus that can cause some cancers in the throat and your lower parts (penile cancer and anal cancer) but it can be prevented by three shots of painless HPV vaccine available at our clinics. Book an appointment now!

SHOULD I TELL PEOPLE I'M TAKING PrEP?

It’s totally your decision to disclose if you’re taking PrEP. Some people are proud to say they are taking PrEP and in doing so they are helping beak down stereotypes and showing that taking PrEP is a choice to look after their own health. Telling people that you are on PrEP also lets them know that protecting yourself against HIV is important to you. You're not legally or morally required to tell anyone. It's important to respect where other people are at on their safe sex journey so if your partners prefer to use a condom then that's their right. They don't have to take your word for it that you are safe. Of course they could take PrEP themselves and then their safety is completely in their hands.

SOMEONE TOLD ME PrEP COULD CAUSE HIV TO MUTATE?

That's not true. PrEP works by stopping the virus penetrating the cell.  If it can't get into the cell then it can't multiply.  Mutations occur when the virus reproduces. So essentially no infection means no mutation.  It's important that you are not already HIV positive when you start PrEP. If the virus is already reproducing in your body then taking PrEP may cause some inconvenient problems with resistance and your doctor may have to try other medications.  Your doctor will test to make sure you're not HIV positive before you start.

WHY GET PrEP AT PULSE CLINIC?

PULSE is the first licensed private medical practice in Asia to prescribe and provide ORIGINAL AND GENERICS PrEP since 2015. PULSE clinic is working with iWantPrEPnow (UK) and other NGOs worldwide to provide PrEP ONLINE to countries allowed by law. For people who have prescription and re-visitor of PULSE clinic, now you can submit your prescription/blood test result from your doctor and order PrEP online HERE. by prescription only.

WITHOUT BLOOD TESTS SHOULD I GET PrEP?

That is a black market, we DO NOT SUPPORT BLACK MARKET. If you take PrEP without knowing that you are HIV positive, it can lead to drug resistant HIV infection. What we are trying to provide for our community is smart and proper way to be protected by PrEP. 

IS IT A GOOD IDEA TO BUY PrEP FROM PHARMACY WITHOUT GETTING TESTED OR PRESCRIPTION?

Buying medication over the internet or from the pharmacy is bad idea unless you can be sure that the supplier is legitimate or unless you buy from our online pharmacy. Otherwise, there is a risk that you may be given pills that do not work or which cause you harm. And if side effects or complications happen, those supplier will not be able to and will not take care of you. It is also important that anyone being prescribed PrEP has medical supervision for this to happen. Because continuous care is important as long as you're taking PrEP.m

WORRIED THAT THE DRUGS YOU'VE BOUGHT AREN'T REAL?

PULSE CLINICS provide a blood test to check the correct drugs are present in your body, this is called Therapeutic Drug Monitoring (TDM). You need to have taken a pill in the 24 hours before the test. 

For more information about the medication and ordering process,

please email pulseliving@pulse-clinic.com or chat on your preferred platform. 

 +66-84-226-2569    @pulserx         PulseClinic