Dr. Tan and Partners is one of the few approved Anonymous HIV Testing Centres in Singapore. A detailed write up on our service is available here.

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HIV Prevention: To HIV PrEP or not to HIV PrEP?

If you’re reading this, most probably you would have an awareness about HIV and are worried about getting infected. Rightfully so, as there is still no cure for HIV and it can lead to a severe disease called AIDS and eventually death.

 

Every year more than 400 new cases of HIV are reported in Singapore majority of which are still in the prime of their lives between the ages of 20-49. So if you are HIV negative and sexually active, you have a right to be afraid of HIV infection. So what do we have to protect ourselves from this deadly virus? Well the condom helps to reduce HIV transmission, STDs and pregnancy very well.

 

What if you are not able to use the condom? Or not keen to use the condom? Or worried about condom mishaps? This is where PrEP comes in.

Learn more: “A Quick Breakdown on How HIV Can be Transmitted

 

 

How effective are Condoms, Diaphragms and Circumcision in preventing HIV transmission?

What is PrEP?

PrEP stands for Pre- Exposure Prohylaxis. Prophylaxis means prevention. HIV PrEP involves taking one pill a day to prevent HIV infection.

 

How effective is PrEP?

It is effective in preventing HIV transmission up to 99%

 

How does it work?

PrEP prevents HIV from infecting your cells and multiplying. So if you do get exposed to the HIV virus, you will not get infected.

 

Do I need to take it daily?

For the PrEP to be effective, it needs to be taken daily. For men it will be take 7 days before its effective. For women it will take 3 weeks for it to be effective.

 

What is the difference between PrEP and PEP?

PrEP is pre exposure. HIV Post Exposure Prophylaxis is post exposure. PrEP is to be taken before you are exposed. PEP is taken only after you are exposed to a potentially high risk sexual encounter. PrEP is one pill to be taken daily. PEP is made up of 2 pills taken for a month. PEP has lower protection rate than PrEP.

 

HIV PEP treatment at our clinic

 

Condom Broke

Am I suitable for PrEP?

 

You are a suitable for PrEP if you are any of the following:

 

You are a gay/bisexual man and

  • have an HIV-positive partner.
  • have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown –and– you also
  • have anal sex without a condom, or
  • recently had a sexually transmitted disease (STD).

 

You are a heterosexual and

  • have an HIV-positive partner.
  • have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown –and–you also don’t always use a condom for sex with people who inject drugs, or don’t always use a condom for sex with bisexual men.

 

You inject drugs and

  • share needles or equipment to inject drugs.
  • recently went to a drug treatment program.
  • are at risk for getting HIV from sex.

 

Are there any side effects?

Like any drugs, PrEP does have side effects.  In a small number of people there is some gastrointestinal discomfort (e.g. gas, bloating nausea) or dizziness when starting PrEP.  For those who do experience discomfort it nearly always goes away after about a month. There is also concern that PrEP may affect your kidney or bone function. You doctor will monitor your bloods regulrly to check for this.

 

Do I still need to use condoms?

Taking PrEP and using condoms will further increase your protection rate from HIV. Taking PrEP is protective enough against HIV. However, you are still at risk for other STDs. For women, you still can get pregnant. Also a periodic STD and HIV Testing is needed to to check on your STD and HIV stats.

 

What if still have questions?

Call or email us to make an appointment with any of our clinics. Speak to the doctor to discuss if PrEP is really suitable for you.

 

 

If you are interested in getting HIV Pre-exposure prophylaxis (or HIV PrEP) or learning more, please visit Our Clinics.

All Our Doctors are Fully Certified and Trained to conduct specialised STD and HIV Testing.

 

advise


Need more advice?

Come down to Our Clinics for a discussion with Our Doctors, or call our clinics for more information:

1.) Robertson Walk (Anonymous HIV Clinic)  (+65 6238 7810)

2.) Bencoolen Street (+65 6884 4119)

3.) Novena Medical Centre (+65 6397 2095)

4.) Scotts Medical Centre (+65 6694 2348)

5.) Somerset – Orchard Building (+65 6262 0762)

6.) Katong – (Opening soon)

 

Where to find us – here

Selected clinics are open on Saturday and Sunday.

Email: hello@dtapclinic.com

All Our Doctors are Fully Certified and Trained to conduct specialised HIV Testing.

For lady patients who prefer female doctors, we have professional certified female Doctors to attend to your medical needs.

20 Comments

  1. Hi. What is the window period for testing if you’re on PrEP? I know that Dr. Tan suggests that a test at 3-4 weeks is conclusive if you’re NOT on PrEP but I was wondering if there’s a difference in the window period if you are on PrEP. If I had a risk when PrEP wasn’t fully effective yet because I just started taking it, is a test at 26 days (2 days shy of the 28-day window period which according to Dr. Tan and most other experts is conclusive) good enough? Please. Your help will be greatly appreciated. Thank you!

  2. Hello doctors. First, I would like to apologize for a very lengthy post. I really hope you answer my questions please.

    I tested non-reactive on an Ag/Ab test 27 days after a sexual encounter. This was considered good as conclusive so I asked my doctor if I can be put on PrEP as an additional protection for future possible encounters. I started PrEP on the same day. However, just to be completely sure and to ease any uncertainty (since I felt feverish and under the weather when I woke up on Day 29) I took two more Ag/Ab tests – one on Day 29, another on Day 36 (both days were counted from the day of the original encounter). These tests were done while I was already on PrEP. Both were non-reactive.

    My worry is this though, 11 days after the Day 29-test (more than 5 weeks after the original exposure), I developed several flat, red, non itchy spots on my arms. I have about 10 on the left arm, 3 on the right, and 2 on my legs. This got me worried because I know that rashes are symptoms of ARS. Now this got me thinking, was my 27-Day test really conclusive? Or could I have been infected by a used needle from my Day 29 or Day 36 test? I didn’t see the lab personnel open the needle/syringe in front of me and I’m not sure whether a used needle may have been used by accident.

    With my scenario, I hope you can help me with my questions:

    1. Was my 27-day test really conclusive? If the result wasn’t conclusive at Day 27, then the tests on Day 29 and Day 36 should be, correct? Or will there be a delay in the detection since I started PrEP on Day 27?
    2. What’s the risk of transmission from a used needle (if, for example, a used needle/syringe was used by accident for the blood draw)? Will the PrEP already have some effect on the prevention given that I have only been taking it for 2 days and 9 days during the day 29 and day 36 tests?
    3. Will PrEP affect the window period for detection? I know that 28 days is conclusive but Dr. Tan’s website also suggests that he’s very confident when someone tests negative at 2 weeks and a 3 week test is already a very strong indication that an infection has not occured. I want to get tested again (3 weeks after the day 29 test and 2 weeks after the day 36 test) but I don’t know whether I can trust that result since I don’t know whether my daily adherence to PrEP may have an effect on the window period for detection.

    Please respond to my questions doctor. I would really really appreciate it and it will help clear all these questions in my head.

    • Dr. Taufiq

      Dear PrEP,

      thanks for your question. Please see my reply below.

      1. Was my 27-day test really conclusive? If the result wasn’t conclusive at Day 27, then the tests on Day 29 and Day 36 should be, correct? Or will there be a delay in the detection since I started PrEP on Day 27? Results are conclusive. PrEP does not affect the results.
      2. What’s the risk of transmission from a used needle (if, for example, a used needle/syringe was used by accident for the blood draw)? Will the PrEP already have some effect on the prevention given that I have only been taking it for 2 days and 9 days during the day 29 and day 36 tests? Labs are audited by strict protocols. Used needles are unheard of in Singapore. So don’t need to worry about this at all.
      3. Will PrEP affect the window period for detection? I know that 28 days is conclusive but Dr. Tan’s website also suggests that he’s very confident when someone tests negative at 2 weeks and a 3 week test is already a very strong indication that an infection has not occured. I want to get tested again (3 weeks after the day 29 test and 2 weeks after the day 36 test) but I don’t know whether I can trust that result since I don’t know whether my daily adherence to PrEP may have an effect on the window period for detection. PrEP does not affect the window period.

      If ever in doubt, best to consult a physician who is familiar with HIV testing and PrEP.

      Regards,
      Dr Taufiq

  3. Hi dr.julian Ng..

    Please replay me..
    Iam sitting on worried bomb pls replay m….

    Thank you…

  4. Thank you julian ng…

    My question:-
    This year june iam get married make childrens happy family…. this reason iam full worrying…

    Pls understand my switchivation iam hope your help…..

    This is last question dr.Ng..

    Pls tell me iam free from hiv..
    Answer my question
    Thank you…

  5. badthink

    Hi dr.julian Ng..
    Iam hope
    Iam just change my name badthink..
    Pls answer me

    Thank you..

  6. badthink

    Thank you julian ng…

    My question:-

    This year june iam get married make childrens happy family…. this reason iam full worrying…

    Pls understand my switchivation iam hope your help…..

    This is last question dr.Ng
    Pls tell me iam free from hiv..

    Answer my question
    Thank you…

  7. My test result is conclusive..but my brain not accepted my result..
    Iam think avery time iam sex with a hiv positive girl..
    How to i realize my anxiety pls give me suggestions..

    My question:-
    This year june iam get married this reason iam full worrying…
    tell me So iam take PrEP your suggestion…
    realy i needs PrEP or not?

    Pls answer my question pls…

    Thank you again and again
    Your the best #DR.JULIAN NG#

    • Dr. Julian Ng

      Hi,

      PrEp is not taken for your scenario. Also your result is conclusive. Move on with your life. If you need help with your anxiety, please seek help with a psychiatrist.

  8. Thank you your replay julian Ng…

    Iam not on PrEP..
    Iam not take any medication….

    17 months post exposure iam no further exposure… still..

    iam involve singel exposure. iam not sexually active but iam start PrEP your suggestion…

    My question:-
    This year june iam get married this reason iam full worrying…
    tell me So iam take PrEP your suggestion… realy i needs PrEP or not?

    17 months hiv result all are negative I am 100% negative
    Any further test needed.

    Answer my question…
    Tq again..

    • Dr. Julian Ng

      Hi,

      You results is conclusive. There is no need for retest.

  9. Hi doctor tan.
    I am 26 years male. I am circumcised male. I am unprotected vaginal sex single exposer with a girl. Later 9 months found she is hiv positive.

    Followup test:
    9 months post exposure hiv western blot result: negative
    11 months post exposure elisa for hiv, hcv,hbsag, vdrl all negative
    1 year post exposure hiv rna pcr qualitative result: not detected
    13 months post exposure hiv 4th generation alere combo result: negative
    14 months post exposure hiv elisa hiv std panel all are negative
    15 months post exposure hiv rna pcr qualitative test result: notdetected
    17 months post exposure hiv 4th generation alere combo result: negative
    Iam not take any mediation….

    My question:

    1) some doctors say hiv lay dormant up to many years can’t detect hiv any test it is true.

    2) this year june I am get married make childrens happy family. Any further test needed.

    3) some doctors say take hiv test every 3 months hiv windowperiod 3 months to 10 years.

    4)iam involve singel exposure. iam not sexually active but iam start PrEP your suggestion… i will see your site PrEP is effective..

    17 months hiv result all are negative I am 100% negative
    Any further test needed.

    Sory long post pls give me pice of mind pls….

    Pls answer my 4th question….

    • Dr. Julian Ng

      Hi,

      Can I clarify why you are on PrEP? Based on your results they are conclusive and there is no need to retest unless you have further risky exposure.

  10. Hello Doctor,
    I am on PREP for the past 2 months. I have not missed my doses.
    On one day I have missed Prep completely. On 5th march I missed Prep. On the next day 6th March I had Unprotected sex. Also on that day I have started as usual taking of Prep.

    My questions:

    1. Does prep is Effective irrespective of One missed tablet where verh next day Unprotected sex has happend.

    2. I am planning to stop Prep and to get into long term relatoonship.
    After the last exposure how many days I have to take Prep to be effectively prevent from Hiv.

    3. When can I test for HIV from my last exposure.

    Thanks Doctor.

    • PrEP is most effective when taken consistently (daily). Missing a dose will increase the risk of PrEP failure, although to what degree we cannot tell you. I would suggest completing another 28 days of PrEP post-exposure and then testing then. If you are more concerned, you may even consider adding Isentress for the 28 days if you are able to start it within 72 hours of exposure (essentially take PEP or post-exposure prophylaxis instead). If you are within that 72 hours and are keen for PEP, please visit us for a proper consult and evaluation.

  11. I just realized I asked Dr. Tan a question about a blogpost on PrEP by Dr. Taufiq. Please consider my question on the benefits of daily vs nondaily use of PrEP to be directed at you both 🙂 Thank you very much!
    Respectfully yours,
    Fred (I work for a medical company that distributes PrEP)

  12. Dear Dr. Tan,

    Doing some research on nondaily use of PrEP, i found your blogpost of March 2015 at the MyPrepexperience blog. In it, you describe how some of your patients are on a nondaily regime. The post strongly suggests you see nondaily PrEP use as effective.
    In this post of 2017 however, you clearly stress daily use. Is there a reason for this apparent change of mind, or should the above be read as an endorsement of a daily regime over a nondaily one? If so, in your opinion based on your experience with nondaily use patients, are there any obvious benefits of daily PrEP use over nondaily use? Thank you!
    Respectfully yours,
    Fred

    • Daily PrEP offers greater protection (92-98% risk reduction), but for people who do not have frequent exposures, this can be a little costly. The non-daily regimen is called EBD, or event based dosing – this option offers about 80-85% risk reduction so it is still very effective.

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