Globally, PrEP has been most commonly used among gay and bisexual men - but it's increasingly being used by other groups of people.

In part, this is because some of the early PrEP trials were only conducted in cisgender gay men and bisexual men. In some of the trials that did include other groups, such as the England IMPACT trial, uptake of PrEP was lower.

It’s important for us to ensure that information about PrEP - and PrEP itself - is available to everyone who needs it, regardless of their gender or who they have sex with. PrEP works, and can be used by everyone who is HIV negative.

Despite this, some prescribers of PrEP are reluctant to make PrEP available beyond strict eligibility criteria, or beyond certain groups of people. PrEPster believes that individuals often have a clearer understanding of whether they need PrEP than health workers. International guidance suggests that if someone requests PrEP, it’s an indication they are likely to be at risk of HIV, and PrEP should be considered. UK guidance says that PrEP should be offered on a case-by-case basis that takes into account the personal circumstances of the person.

PrEPster strongly supports the self-determination of individuals in establishing their HIV risk and the benefits that they might get from PrEP – including benefits such as a reduction in stress and fear, and an increase in sexual pleasure.

Decisions about using PrEP should be up to every individual person, free from coercion. Partners, family members, clients, bosses, health workers or others should not decide if any individual uses PrEP. None of us should be pressured into doing so.

And so, the information that follows provides further additional information for different groups of people to help you decide if PrEP is an option. The information should be read alongside the main information on the homepage of this website.

Is PrEP for you (or someone you know)?

  • PrEP and women

    Evidence is clear that PrEP works for all women - cisgender and transgender, and regardless of the kind of genitals you have and the kind of sex you have. 

    There are different ways to use PrEP depending on the kind of sex you have. For people whose HIV risk is through vaginal/frontal sex, PrEP needs to be taken daily. For people whose risk is through anal sex, it is also possible to use on-demand dosing. Click here for more information on different ways to take PrEP.

  • Does PrEP work for trans women?

    Data from the open-label extension of the iPrEx study suggest that PrEP is highly effective for trans women when it is taken as prescribed. Among 151 trans women who have sex with men, nobody with drug levels equivalent to two to three pills a week or more acquired HIV. However, three trans women with drug levels equivalent to less than two pills a week did acquire HIV. There are likely to be reasons why some trans people are concerned about using PrEP, which might explain why these women took fewer doses than recommended. The answers to the questions below should provide reassurance to trans women regarding some common concerns about using PrEP.

    Guidance for trans women about the most effective ways to take PrEP does differ depending on whether someone has a vagina (including neovagina) or penis and whether they have vaginal, receptive anal or insertive anal sex.

  • Does PrEP interact with hormone medication?

    One factor leading to lower adherence of PrEP in trans participants in some of the international studies may be either a fear of, or lack of information about, drug-drug interactions between PrEP and gender-affirming hormone medications. Many trans people will understandably choose to prioritise hormone use over other health concerns, including HIV.

    Guidelines note that there are no known interactions between PrEP and feminising or masculinising hormones, except for ethinylestradiol (a hormone which is no longer recommended as part of gender affirming therapy).

  • Does PrEP interact with any other medication or drug?

    PrEP does not interact with most other medicines. PrEP can be taken when drinking alcohol or using recreational drugs (including injected drugs) or performance or image enhancing drugs (like anabolic steroids). PrEP can be taken by people who are taking hormonal contraceptives and most over-the-counter medications.

    However, tenofovir disoproxil fumarate (one of the drugs in some formulations of oral PrEP) may interact with other medicines which are also associated with kidney problems. These include some non-steroidal anti-inflammatory drugs (NSAIDs), especially diclofenac; aminoglycosides, used to treat certain bacterial infections; and acyclovir and valaciclovir, used to treat herpes.

    When PrEP users are prescribed other medicines, it is strongly advised that they tell the doctor or pharmacist about taking PrEP and ask them to check for drug interactions. A useful website from Liverpool University allows anyone to look up information on interactions between PrEP and other medications: www.hiv-druginteractions.org

  • PrEP and younger people

    UK guidelines support the use of PrEP in people from the age of 15, depending on their HIV risk. The new UK guidance recommends that TAF/FTC (rather than TDF/FTC) should be offered for those under 18, and continued until the age of 20 for those who started on that formulation of oral PrEP. This is because TAF/FTC has less of an impact on bone density.

    UK guidance also says that young people using PrEP should be offered additional support and guidance, including help with using PrEP regularly (See Q16 of our PrEP info for frontline workers).

  • PrEP and people not born in the UK

    If you were not born in the UK and/or if you have recently arrived (including as a student, on a work visa, on a spousal or family visa, or as a refugee or asylum seeker) and want to use PrEP,  you can access HIV PrEP for free from NHS sexual health clinics. Sexual health clinics in the UK provide testing and treatment for free for everyone. You do not have to provide proof of UK residence or immigration status to access these services. This might be different from some other NHS services you’ve accessed, where a payment is required.

  • PrEP and travelling

    HIV PrEP could be for you if you’re travelling to a part of the world where HIV is more common, and you’re planning or thinking about having sex there. You might also consider using PrEP when travelling if you’re having different types of sex than you usually do. For example, you might be having more sex, attending sex parties or events, or being more experimental in your sex.

    If you’re planning on using HIV PrEP on holiday, make sure you have enough PrEP for the time you’re travelling, and that you’ve got the medicine well enough in advance. 

    Some people like to carry a copy of a prescription for PrEP from a medical service when they travel, in case customs at their destination asks what the medicine is. It’s advisable to carry medicines in carry-on luggage, and not checked luggage, in case luggage gets lost.

    Note that in the UK, travel clinics cannot currently prescribe PrEP. See this section to find out more about how to get PrEP.

  • PrEP and pregnancy

    It is safe to use TDF/TFC versions of oral PrEP during pregnancy, whilst breast or chest feeding. Current guidelines do not include recommendations on other formulations of PrEP but studies have not raised safety concerns about their use during pregnancy (See Q43 of our PrEP info for frontline workers). PrEP does not prevent pregnancy nor other sexually transmitted infections. It is safe to use PrEP alongside hormonal contraceptives.

  • PrEP and sex work

    Many people who do sex work decide to use PrEP as an additional HIV prevention tool - and sometimes even when condoms are always used. Some people who do sex work use PrEP because they want to be in greatest control of their sexual health, including if clients try to be coercive about sex without condoms. Some sex workers use PrEP because they might be offered a higher rate for sex without condoms, and have chosen this as an option.

  • PrEP and drug and alcohol use

    There is no evidence that HIV PrEP interacts with the most common recreational drugs, nor alcohol. That means, if you’re attending a chillout, for example, current available formulations of HIV PrEP do not interact with the most commonly used chillout drugs (or chems). More information about safer chillouts can be read here.

    The Liverpool drug interaction tool provides an easy way of seeing if PrEP interacts with any medicines - including recreational drugs. 

    UK guidelines support the use of HIV PrEP to prevent HIV in people whose HIV risk is through sharing drug injection equipment. There is much less research available on PrEP when the HIV risk is only through injection drug use - and many people who inject drugs will benefit from PrEP if they also have risk via sex. (See Q16 of our PrEP info for frontline workers)