Question about PrEP on Demand for heterosexual contact

[ginseng]

For those not familiar, PrEP is preexposure prophylaxis which is a combination of preventative HIV drugs you can take before sex to nearly eliminate HIV risk.

Usually, people take it daily, but it can also be taken "On Demand" which is 2 pills 2-24 hours before sex than a pill a day for the next 2 days 24 hours apart after sex has stopped.

 

I've read about people utilizing On Demand PrEP on this site. Those posts seem to involve vaginal sex with men and women. All the information I can find about On Demand Prep indicates it's only been tested for anal sex both insertive and receptive with men. If it works for that logically I'd think it'd work fine for insertive vaginal sex too but for whatever reason, I can't find any studies conclusively affirming that. Does anyone know if anyone ever did studies proving on Demand PrEP works for insertive vaginal sex? (Men and woman)?

On-Demand PrEP | PrEP | HIV Basics | HIV/AIDS | CDC

 

Edited December 30, 2022 by ginseng

[shadscat]

I think your logic is correct, however for me the risk from vaginal is soo low I'd rather not use  Prep and have to worry about the sides it may cause.

[ginseng]

2 hours ago, shadscat said:

I think your logic is correct, however for me the risk from vaginal is soo low I'd rather not use  Prep and have to worry about the sides it may cause.

It's true vaginal sex has lower risk, however one of the benefits of taking PrEP on demand is less side effects. 

[Annex191]

I asked the doctor in Germany who prescribed me my PrEP the same question.

He looked at me like I'm an idiot and said it doesn't make a difference whether you have sex with a man or a woman, the only thing that makes a difference is whether you're the one inserting or the recipient, didn't cite any studies though.

He also strongly recommended to stay with the dayly schedule and to take the pills for at least 2 weeks before and one week after any risky encounter. I'm sticking to the doctors recommendation, since i don't get any immidiate side effects and would encourage anyone who thinks about PrEP to just go and consult a specialist for all their questions.

[fun125]

You need to take prep on demand slightly differently for sex with a woman . you need to take one a day for one week prior to having sex with a woman then one tablet per day for 2 days following sex , this is due to you needing more antiviral protection for vaginal sex . i hope this helps

[momo5]

Dosing requirements are based on tissue uptake of the drug.  Takes about 7 days for rectal tissue to be saturated enough for protection with receptive anal sex; 21 days for sufficient uptake of vaginal tissue for protection with receptive vaginal sex.  
 

The ‘on demand’ strategies are based on insertion vs reception and while the data seems to be positive, there is not enough data yet to obtain approval; this intermittent dosing would be off-label use.  
 

I’ve just made PreP part of my daily routine, been using for nearly a year now and have had no side effects.  Have liver and kidney function tested regularly and both have been absolutely fine. 

[WizardOfPattaya]

How available is prep withing Thailand? Is there any hurdles or high price associated with it?

[Korumon]

On 07/05/2023 at 17:53, WizardOfPattaya said:

How available is prep withing Thailand? Is there any hurdles or high price associated with it?

It is pretty available. You can buy it from pulse clinic in Pattaya with prescription.
Pulse clinic also provides a prescription after a consultation with a doctor and some lab tests.
Price is about 4200 baht for a bottle of truvada
 https://www.pulse-clinic.com/prep

edit:
Apparently you can order online provided you give prescription or recent hiv, hep b and kidney function test 
https://www.pulse-clinic.com/buypreponline

Edited May 31 by Korumon

[Scuba+]

8 hours ago, Korumon said:

It is pretty available. You can buy it from pulse clinic in Pattaya with prescription.
Pulse clinic also provides a prescription after a consultation with a doctor and some lab tests.
Price is about 4200 baht for a bottle of truvada
 https://www.pulse-clinic.com/prep

edit:
Apparently you can order online provided you give prescription or recent hiv, hep b and kidney function test 
https://www.pulse-clinic.com/buypreponline

Just throwing money away with Truvada, generic is the same for a fraction, at Bangkok red cross it's under 500 baht a month 

[Korumon]

38 minutes ago, Scuba+ said:

Just throwing money away with Truvada, generic is the same for a fraction, at Bangkok red cross it's under 500 baht a month 

500 baht !?!?!?!?!!?!? Jesus I might grab a bottle then