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:
These methods can be used together according to individual needs and circumstances, to provide a combination approach to preventing HIV infection.
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.
What to discuss: |
How to discuss it: |
Assess the client’s risk profile |
Develop a clear picture of the client’s risk profile and lifestyle; make sure they understand how their lifestyle impacts their risk profile. IMPORTANT: use your organisation’s risk assessment tools. |
Combination prevention |
Taken daily, PrEP is an additional prevention option. It should be used in combination with other prevention tools, like condoms, PEP, healthy lifestyles, treatment for STIs, male medical circumcision, and ART for partners living with HIV. REMEMBER: counselling should highlight that ideally PrEP should be used with condoms. |
Condom negotiation |
Some clients, may not be able to enforce condom use. Provide guidance on how to safely advocate for condom use by the partner. IMPORTANT: does your organisation have a tool that can help you? |
STIs |
PrEP does not protect against STIs. Regular testing for STIs is encouraged, regardless of PrEP use. REMEMBER: STIs may increase the risk of HIV acquisition. |
Contraception / Fertility goals |
PrEP is not a contraceptive. PrEP is safe to use with all contraceptive methods. Consult with a physician to provide guidance on how to proceed if the client becomes pregnant. |
Adherence (daily)* |
For PrEP to be effective, the pill must be taken every day. Adherence counselling is critical for full HIV protection. *More detail is provided in the Adherence section that follows. |
Side effects |
Some people get mild side effects when they start PrEP, but they generally go away after a few weeks. The most common side effects include: nausea, headache, tiredness, diarrhea, depression, abnormal dreams, vomiting, rash, problems sleeping, and changes in appetite. |
Intimate partner violence (IPV) |
People who have abusive or controlling partners may find it more difficult to take care of their sexual health and to adhere to PrEP. Ask about the client’s relationships, and for clients experiencing abuse, provide counselling and referrals, when possible. |
Talking to your partner, family, friends, etc. |
Deciding whether to tell anyone about your PrEP use is a completely personal decision. Some people find it helpful to tell friends or family for support and to provide reminders to take the pill daily. Discuss with the client whether and how they would like to discuss PrEP with loved ones and how to overcome any potential barriers to gaining their support. |
Visit schedule |
Explain the visit schedule for PrEP use. The client must return for follow-up visits at the first month, and then every three months. They must also return to the clinic monthly to pick up their pills. |
Adherence means taking the PrEP pill every day.
Suggest methods to remind the client to take the pill every day.
For example:
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:
“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:
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.
Re-assess the client’s risk profile |
Discuss any lifestyle changes that may affect the suitability of PrEP use. |
Combination prevention |
Touch base with the client’s sexual health plan and make sure they have access to other prevention resources, as appropriate. |
STIs |
PrEP does not protect against STIs. Regular testing for STIs is encouraged, regardless of PrEP use. IMPORTANT: If your client presents with an STI, they will need additional counselling. |
Contraception / Fertility goals |
PrEP is not a contraceptive. PrEP is safe to use with all contraceptive methods. Consult with a physician to provide guidance on how to proceed if the client becomes pregnant. |
Adherence (daily)* |
For PrEP to be effective, the pill must be taken every day. Adherence counselling is critical for full HIV protection. *More detail is provided in the Adherence section that follows. |
Side effects |
Touch base about the client’s experience with side effects. REMEMBER: If side effects are serious, please involve a doctor with your client’s care. |
Intimate partner violence (IPV) |
People who have abusive or controlling partners may find it more difficult to take care of their sexual health and to adhere to PrEP. Ask about the client’s relationships, and for clients experiencing abuse, provide counselling and referrals, when possible. |
Talking to your partner, family, friends, etc. |
Deciding whether to tell anyone about your PrEP use is a completely personal decision. Some people find it helpful to tell friends or family for support and to provide reminders to take the pill daily. Discuss with the client whether and how they would like to discuss PrEP with loved ones and how to overcome any potential barriers to gaining their support. |
Visit schedule |
Explain the visit schedule for PrEP use. The client must return for follow-up visits at the first month, and then every three months. They must also return to the clinic monthly to pick up their pills. |
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