HIV-negative people interested in PrEP should receive counselling prior to PrEP initiation and at follow-up visits while they are actively taking PrEP.

The information you will find here, is a quick reference guide to support consistent counselling efforts and provide helpful reminders for important topics to cover. It is a supplement for existing counselling practice and guidelines, not a comprehensive replacement.

PrEP = NEW + SAFE + HIV Prevention Method

PrEP is a new and safe method for HIV-negative people to reduce their risk of becoming infected. It is a pill that has 2 anti-HIV medicines: 200 mg of emtricitabine and 300 mg of tenofovir.

HIV-negative people who take PrEP every day can lower their risk of HIV by more than 90 percent.

PrEP is the use of an ART medication for HIV negative people for HIV Prevention.

After taking oral PrEP for 7 days people are fully protected, but they must continue to take it daily to remain protected.

PrEP is an extra HIV prevention option and where possible, should be used in combination with other prevention methods which include:

• Condoms
• Counselling
• Medical male circumcision
• Healthy lifestyles
• PrEP
• PEP
• ART for partners living with HIV
• Treatment for STIs

These methods can be used together according to individual needs and circumstances, to provide a combination approach to preventing HIV infection.

• PrEP does not provide immediate protection—it must be taken daily for 7 days before it offers full protection. It should continue to be taken daily.
• PrEP does not prevent any other sexually transmitted infections or pregnancy.
• PrEP does not protect someone from HIV after exposure.

One PrEP pill should be taken once a day with or without food. It helps to take the pill at the same time each day so that they do not forget.

This is a list of important topics to discuss with the client when explaining PrEP for the first time and deciding whether it might be right for him or her. It is not comprehensive. Please ensure you use your organisation’s available counselling tools for each of these topics.

Adherence means taking the PrEP pill every day.

Suggest methods to remind the client to take the pill every day.

For example:

• Take the pill at the same time every day
• Incorporate it into your daily activities, like part of your morning routine or when a favourite TV show comes on
• Set a phone alarm
• Use daily pillboxes

Daily PrEP can be taken with alcohol, drugs or contraception. It does not react negatively with any normal day to day activity.

Discuss what to do if a pill is missed – take it as soon as client remembers.

Supporting pill-taking should be honest, direct and non-confrontational.

Steps to follow:

1. Assess how pill taking is going for PrEP client
2. Positively affirm client to support provider/client relationship
3. Identify a motivator to support effective pill taking
4. Provide PrEP education regarding effective use and effectiveness of PrEP
5. Identify barriers to effective use
6. Provide realistic strategies to address barriers
7. Discuss use of other HIV prevention measures that are relevant to situation
8. Ensure client leaves with realistic and achievable plan to increase or sustain use

“Let’s look at your risk and options to prevent HIV.”

“Let’s talk about how PrEP fits into your risk reduction efforts.”

“PrEP is a great way to prevent HIV, but it isn’t for everyone.”

“Taking a pill every day for ongoing protection from HIV might not be for everybody, but PrEP is an excellent and much-needed extra prevention method for people at high risk of getting HIV.”

“The use of PrEP is supported by South African medical experts, the South African government, and many international experts.” 

“You’ve decided to use PrEP as a way to protect yourself and that’s great.”

“If you start PrEP, you do not have to take it for the rest of your life.”

“PrEP is a great way to prevent HIV, but it doesn’t protect against other STIs or prevent pregnancy.”

“Using condoms and PrEP together will give you the best level of protection from both HIV and other STIs.”

“Pill taking isn’t easy and takes some practice, especially if you aren’t used to taking pills.”

“It’s okay to not be perfect at taking your pills; it takes time. But remember in order for PrEP to work, you have to take your pills regularly.”

“I’m here to help by working with you to figure out a way to make taking your pills easier, so that you get the most protection you can.”

PrEP is a new and safe HIV prevention method for HIV-negative people to reduce the risk of becoming infected.

PrEP is the use of anti-HIV medication that keeps HIV-negative people from getting HIV

Pre – before
Exposure – coming into contact with HIV
Prophylaxis – a medicine to prevent infection

No. It only protects against HIV infection.

PrEP does not protect against pregnancy or other sexually transmitted infections (STIs).

All three contain antiretroviral medicines in different combination for different purposes:

PrEP is a pill that has 2 anti-HIV medicines taken daily to prevent HIV for HIV-negative people. PrEP is taken before you think you might be exposed to HIV.

PrEP is taken within 72 hours after exposure to HIV (e.g. after rape) for 28 days to prevent HIV. PEP is taken after you think you have been exposed to HIV.

ART is a 3-medicine treatment for HIV-positive people that reduces the levels of HIV in a person’s body. ART helps the body stay strong and helps it fight off infections and other illnesses.

HIV-negative people who take PrEP every day can lower their risk of HIV by more than 90%.

After taking oral PrEP for 7 days people are fully protected from HIV. But they must continue to take it daily to remain protected.

People need to take it once a day at more or less the same time. They can take it within a few hours of their normal time - as long as they only take one pill a day.

PrEP has been shown to be very safe.

PrEP is also safe with alcohol and drugs, as well as contraceptives and other medicine.

PrEP should not be used as HIV treatment. HIV-positive people need a combination of three ARVs for treatment, given by the healthcare provider, according to their needs.

Some people may experience mild side effects when they start PrEP.

The most common side effects include:

• Nausea
• Headache
• Tiredness
• Diarrhoea
• Depression
• Abnormal dreams
• Vomiting
• Rash
• Problems sleeping
• Changes in appetite

In most people, these side effects go away after a few weeks.

No, a oerson cannot get HIV from PrEP. The medications in PrEP work to prevent HIV.

PrEP is an extra HIV prevention option and where possible, should be used in combination with condoms.

Using condoms is still the best way to prevent HIV infection. Condoms protect against STIs and pregnancy when used correctly and consistently.

No. It is important that they take PrEP daily while at risk of getting HIV.

When they feel that they are no longer at risk they can talk to their healthcare provider about stopping PrEP.

If your client misses a pill, they should take it as soon as they remember, and continue to take it daily as before.

PrEP requires strict adherence to daily medication and regular HIV testing. Where possible, it should be used together with other HIV prevention methods.

If it is used properly, PrEP will play a role in helping to reduce the number of new HIV infections in South Africa.

If your client decides that they no longer wish to take PrEP, they should discuss stopping with a healthcare provider. They will get information for how long after they should continue to make sure they are properly protected.

No. Your client needs to take the PrEP once a day for at least 7 days before you are fully protected.

Yes, PrEP can be taken with any kind of contraception.

She must inform her clinician and together they will discuss how to proceed.

No. PrEP does not prevent STIs or pregnancy.

PrEP works when used together with other effective HIV prevention methods.

First visit: HIV and blood test screening and get a month's supply of PrEP

One month visit: HIV and blood test screening Get your 3-month prescription and collect your pills every month

Monthly visit: Use the prescription to collect pills every month at your clinic

Every three months: Every 3 months, return for an HIV test and a new 3-month prescription for PrEP

PrEP means taking a pill every day and going for regular HIV testing, NO EXCUSES!

PrEP should be used with other HIV prevention methods.

If your client is on PrEP and they still get HIV their health care provider will do some tests to determine why they seroconverted. It does not necessarily mean that they will be resistant to ARVs (ex: window period, low adherence, infected with TDF resistant virus, etc).

Currently in South Africa, PrEP is being provided through a limited number of service delivery sites. Use the PrEP finder search for the nearest PrEP clinic.

Follow-up sessions will most likely be brief. It is critical to review adherence during these discussions and re-evaluate the client’s risk profile if he or she has experienced lifestyle changes. Please ensure you use your organisation’s available counselling tools for each of these topics.

• Sensitive, inclusive, and non-judgmental
  Recognize that behaviour change is difficult and human beings are not perfect
• Presented as a personal choice
  Counselling should support the client in making a personal choice based on their needs and desires.
• Problem solve and foster motivation
  Offer choices and tangible solutions; identify small wins and achievable next steps in reducing risk.
• Client-driven and based on their needs, resources, and preferences
  Counselling should be interactive and tailored to the client’s specific needs and lifestyle.
• Brief
  10-15 minute check-ins about experience with PrEP and sexual health protection plans are most effective; longer (~30 minute) sessions may be necessary at the first PrEP consultation or if specific issues arise.