I swallow, do you?

Whenever I’m talking to my older gay friends, I hear stories about the 80s and 90s. Stories about better nightlife, more gay bars, more fetish places, and better sex parties. Probably all true, but it doesn’t make me envious. I’m grateful to be living in a time where I don’t see my best friends suffering and dying at a young age. I’m living in a time where I’m not afraid of HIV, and knowing I can be protected. Even if I do get it, my life will continue. 

We have amazing and efficient medication that allows people to have a normal life and have sex without fear of transmitting HIV to another person. However, there is still a big stigma around this topic. It is important to know your HIV status and use proper medication if necessary. People with HIV deserve respect, understanding, and support from all of us. HIV does not define a person. People with HIV are not a threat. Rather, they are an example of the strength and resilience of our community.

In this interview, we sat down with Kenneth Yap (he/him), Medical Supervisor of PrEP Care at the Public Health Service (GGD) of Amsterdam, to talk about the importance of education, the proper use of PrEP, and the latest discoveries in combating HIV.

Kenneth Yap, Medical Supervisor of PrEP Care at the Public Health Service of Amsterdam

To start, what is the difference between PrEP and PEP?

“PrEP stands for pre-exposure prophylaxis, and PEP stands for post-exposure prophylaxis. PrEP is taken before sexual contact as a daily or event-driven oral medication to prevent HIV infection, while PEP is taken after possible exposure to HIV. PEP is a monthly oral medication that includes PrEP, plus an additional preventive medication. If someone has had sex with a possible risk of HIV infection, without using preventive methods, they may be eligible for PEP. This can sometimes happen in case you forget to take your PrEP as advised.”

Can you tell us about the effectiveness of PrEP? And are there any side effects to be aware of?

“The effectiveness of PrEP in research studies is above 95%. The only reason PrEP might not be effective is if someone forgets to take their pill. The side effects of PrEP are temporary and mostly related to taking the pill orally. Side effects, such as nausea, vomiting, stomach ache, and headache typically occur in the first few weeks of taking the medication. However, if someone takes PrEP with a meal, as we recommend, these side effects can be prevented.”

What does U=U mean?

“U=U stands for undetectable equals untransmittable. This is a crucial campaign that has been around for almost a decade. If someone with HIV is taking their medication as prescribed and has undetectable levels of the virus, they cannot transmit it to others. In the western world, everyone with HIV who knows their status receives treatment until they are undetectable and cannot transmit the virus to others, and their levels are frequently monitored to ensure being undetectable.”

What is the process for getting PrEP prescribed?

“To get PrEP, you need to see a doctor for a prescription. This process may vary by country. In the Netherlands, PrEP can be prescribed by a family doctor or at the Public Health Service, where the medication is more affordable. However, the Public Health Service reached full capacity in September 2021 and is no longer accepting new participants.”

Can you share PrEP with your partner(s) or friends?

“This is called informal PrEP use, and it is not recommended. Every person who uses PrEP should be under the care of a professional, such as a doctor, nurse, or doctor’s assistant. In that way, they receive PrEP counselling and education. Sharing PrEP without proper education and counselling can lead to mistakes in usage or misunderstandings, which can still result in HIV infections. Using PrEP after contracting an HIV infection can also be dangerous, as it can lead to resistance to treatment and limited possibilities for treatment. That’s why it is important to be supervised by a health professional, and to be tested regularly.”

Eurosurveillance (European Centre for Disease Prevention and Control)

Is the fight against HIV over?

“The fight against HIV is not over yet. In 2021, the number of new cases of HIV infections in the Netherlands was 427 out of 17.5 million people, which is still too high. The situation is even worse in other parts of the world, and that is why PrEP must be widely available to those who need it.”

What are the latest developments in HIV prevention?

“There are many new medications in development, including a monthly pill and an injection that can be taken every two months to provide protection against HIV infection. The injection is already available in Belgium and the United States. These developments are promising, and I’m looking forward to these new methods of HIV prevention.”

Here are some links to more information about the subject:

European Centre for Disease Prevention and Control

The Elton John AIDS Foundation