Get PrEP at the RFSU clinic

What is PrEP?

PrEP is a medication that reduces the risk of contracting HIV during sex. You can only take PrEP if you do not have HIV. PrEP does not protect against other sexually transmitted infections or pregnancy. It cannot cure HIV.

PrEP means that you take two different HIV medicines in one tablet (emtricitabine/tenofovir disoproxil). This is the same type of medicine used to treat HIV, but in combination with other HIV medicines.

PrEP was approved for use in Sweden in 2016. It is given to people who are at high risk of contracting HIV and is included in the capped annual cost of healthcare (“high cost protection”). In some other countries, other types of HIV drugs are used as PrEP treatment, but in Sweden emtricitabine/tenofovir disoproxil is the only drug that has been approved.

How does PrEP work?

PrEP prevents the HIV virus from infecting the body by blocking an enzyme. However, it cannot remove the virus from the body of someone already carrying HIV.

How to take PrEP

The PrEP tablets are taken orally, preferably with food. It is important to take the tablet at approximately the same time each day. This also makes it easier to remember to take your medicine. Missing doses reduces the effectiveness of PrEP.

PrEP cannot be used as a morning-after pill, nor should PrEP replace HIV testing. Once you are taking PrEP, it is important that you continue to get tested for HIV regularly.

There is no time limit on how long you can take PrEP, as long as you can tolerate the drug and provide regular blood and urine samples to us.

Before you start taking PrEP, it is very important that you are first tested for HIV. This is to ensure that you are not already carrying the virus.

Taking PrEP while you are unknowingly carrying HIV increases the risk of resistance, which means that the medicine stops working properly. The same effects apply if you have Hepatitis B as PrEP is also active against the hepatitis B virus.

You can only take a reliable HIV test (blood test) six weeks after possible infection. A so-called rapid response test can be taken eight weeks after infection, but this is not available at all clinics.

To start PrEP when you live in Sweden, you need to visit a clinic to get a prescription. The wait time depends on which region you live in. You will be given a prescription for three months' use at a time. To continue, you need to come for regular testing. You must not share the tablets with anyone else – all treatment requires contact with your healthcare provider and sampling.

We strongly discourage you from buying PrEP without a prescription. It is difficult to know for sure that these tablets contain the right medicine. If you take the wrong one, you may experience side effects or the medicine may not work properly.

There are two different ways to take PrEP. Whether you take the medicine daily or as needed, you will need to come to a clinic and provide samples every three months.

Daily PrEP treatment

Daily PrEP treatment means taking one tablet a day, at approximately the same time. It is suitable for all types of sex (oral, vaginal, anal) and is the proven most effective way to take the medicine. If you have a vagina you should use daily PrEP treatment.

If you have chronic hepatitis B, daily PrEP works well, but it is important that you also get specific information from your doctor about what applies to you.

On demand PrEP treatment

On demand PrEP means that you take PrEP pills before and after having sex. You take two tablets at least two hours before you have sex, and then continue to take one tablet daily until two days have passed since your last sexual activity.

There is less research on on demand use than on daily use. Therefore, we do not know if the protection against HIV will be as effective as with daily PrEP treatment. For those who have vaginal sex it provides less protection, so if you have a vagina you should use daily PrEP treatment.

If you are going to take PrEP on demand, you need to be vaccinated or immune to hepatitis B.
If you have chronic hepatitis B, you should not take PrEP on demand as it may cause resistance.

If you plan to take PrEP on demand, we recommend that you start with daily PrEP for the first month. This will allow you to evaluate how the treatment has worked as well as evaluate the results of your tests before deciding how to continue your treatment.

Side effects

You may experience mild nausea or headaches in the first few weeks of using PrEP. In most cases, this will pass after a couple of weeks or when you stop taking the PrEP medication.

More serious side effects are rare, but there may be side effects affecting the kidneys and bones. You will therefore need to provide urine and blood samples so that we can measure your creatinine level, a measure of how your kidneys are working. A slight increase in your creatinine level does not necessarily mean that you have to stop your treatment.

If you have chronic hepatitis or other liver disease, PrEP may affect your liver. If you have hepatitis, you will be referred to an infectious disease clinic.

PrEP is not affected by alcohol and has no sexual side effects.

Keep in mind that other medicines can affect PrEP treatment, for example, reducing the effect of your treatment giving you worse side effects. Therefore, it is important that you inform all healthcare professionals that you are taking PrEP pills.

Should I still use a condom?

Condoms are the only contraceptive that protects against both HIV and other sexually transmitted infections (STIs). Contracting an STI can be an unpleasant and painful experience. We recommend that you continue to use condoms along with PrEP during penetrative sex (oral, vaginal, anal). When you meet us at the RFSU clinic, we can give you more tips on how to reduce your risk of contracting an STI.

About your PrEP treatment at the RFSU clinic

If you live in Stockholm and want to get PrEP treatment, you need to sign up for the waiting list at Venhälsan, Södersjukhuset. When it is your turn, you will receive an invitation to the RFSU clinic or one of the other clinics offering the treatment in Region Stockholm.

At the clinic, you will complete a written questionnaire about your sex life and sexual practices. We will talk about the advantages and disadvantages of PrEP treatment. We will also discuss the risk of side effects and how other medications may affect the treatment.

You will get an HIV test and also be tested for other sexually transmitted diseases, including hepatitis B and C. If you are not already vaccinated against hepatitis A and B, we recommend that you get vaccinated. We also test your kidney function through blood tests and urine tests.

Visit the clinic every three months

Once you have been prescribed PrEP, we will schedule several visits to the clinic. It is important that you come to these appointments.

The first visit will take place after one month and then you will visit us every three months. We will talk about how your medication is working and about safer sex. You will be tested for hiv and other sexually transmitted diseases.

After a year of prep, you will also be tested for hepatitis C. You will also be asked to complete another written questionnaire about your sex life and sexual practices. We will also take samples to examine your kidney function. 

Prescription renewal

Your first prescription for PrEP will be given to you by your doctor a few days after your visit, when the samples are expected to be analyzed. This prescription can be collected from any pharmacy in Sweden. If you do not have a Swedish personal number the prescription will be sent to a specific pharmacy.

Every three months you will visit the clinic and a few days after the visit you will be informed when a new prescription is available at the pharmacy.

Emtricitabine/tenofovir disoproxil is included in the capped annual cost of healthcare (“high cost protection”). The pharmacy will offer you the cheapest option. Prices vary continuously and you may receive a different brand each time. All brands contain the same active substance.

Ending PrEP treatment

PrEP is not suitable for everyone. If you have side effects or find it difficult to take the tablets as instructed, we recommend that you choose other ways to protect yourself against HIV. It is important to continue regular testing for HIV, hepatitis and other sexually transmitted diseases.

If you have any questions, please contact Venhälsan or the RFSU clinic.

The text in this brochure is based on information from Venhälsan, Södersjukhuset.