How do I get PrEP?

Many gay, bi and other guys who have sex with guys in BC can now access PrEP at no cost using our BC personal health number (care card), or if you have refugee status. Status First Nations guys can also get PrEP covered.

Those of us here without Canadian Citizenship or Permanent Residency cannot access PrEP through the free public program yet, but can import PrEP for as little as $35 per month’s supply. Learn more about importing PrEP here.

For those of us who are able to get PrEP covered, a doctor or nurse practitioner needs to prescribe PrEP and enrol you in this public program. It also requires some minor (but really important) regular follow up.

Step 1 – Talk to your Doctor

Here is what you can expect when you talk to a doctor:

  1. Talk to your doctor or nurse practitioner about PrEP and why you are interested in it. If you don’t have a doctor or nurse practitioner feel free to come to the HIM health Centres of Davie or Commercial drive to get started.
  2. A doctor or nurse practitioner will check if you are eligible to get PrEP for free in BC using this eligibility and baseline assessment form.Some of us may not meet the ‘HIV risk’ eligibility requirements, but don’t worry, it’s not all about “risk”. Our sex lives could change and it’s a smart idea to be on PrEP before we make those changes. For example, you might want to have more bareback sex, get into sex work, or try bottoming more often.  Feel free to explain to the healthcare provider you are talking to that you may be more likely to pick up HIV in the near future and that you want to be prepared when you are.
  3. The nurse or health practitioner will then give you a laboratory requisition form to take to a lab for blood and urine tests (described in Step 2).
Step 2 – Blood and Urine Tests

After deciding that PrEP is a good fit, there are some really important tests that will need to be completed at least one week before starting PrEP.

After deciding that PrEP is a good fit, there are some really important tests that will need to be completed at least one week before starting PrEP.

Don’t worry, no printed records are needed, because the doctor or nurse practitioner will receive the results of your tests directly using the electronic medical records system that relies on your personal health number.

Tests before starting PrEP…

  1. HIV test:
    You need to get an HIV test before starting PrEP to make sure that you HIV negative.  This is because starting PrEP when we have HIV (but don’t know it) can cause serious complications. The medications used for PrEP are sometimes the same ones used by those of us who have HIV, and so knowing our HIV status is needed to make sure we are taking the medication in the right way.
  2. Hepatitis B:
    You will need to get tested for Hepatitis B. This is because the PrEP medication can cause complications for people who have Hepatitis B or for people who get Hepatitis B after they start PrEP. If your tests show that you are not protected against Hepatitis B you can get a free immunization to protect you.
  3. Kidney function test:
    You need to have your kidney function tested before you start PrEP. This is because a very small number of people will have decreased kidney function as a side effect of PrEP. If PrEP does reduce your kidney function, your kidney function returns to normal when PrEP is stopped.You will also need to have this kidney function test a month after you start PrEP to make sure that PrEP isn’t harming your kidneys.
  4. STI tests:
    You need to get checked for STIs before starting PrEP. This is because PrEP does not prevent any other STIs.

Test while you’re on PrEP (every three months)…

  1. HIV:
    You will need to get tested for HIV every three months. This is because though PrEP is highly effective, no method is 100% effective. For example, missing doses reduces the effectiveness of PrEP – meaning HIV testing is still important. Getting tested regularly for HIV helps make sure we are on the right track.
  2. STI tests:
    You’ll need to get checked for STIs every three months. This is because PrEP doesn’t prevent other STIs. Even if you’re using PrEP and condoms together you can get STIs. Early diagnosis and treatment for STIs means less complications, less time feeling unwell, and less chance of passing them on.
  3. Kidney function test:
    You need to have your kidney function tested every three months. This is because PrEP may impact kidney function for a very small number of PrEP users. If PrEP does reduce your kidney function, your kidney function returns to normal when PrEP is stopped.

Step 3 – Enrolment, getting a prescription, and picking up your PrEP

These are the next step after you have completed your tests:

  1. Your doctor or nurse practitioner receives your test results. They will then likely ask you to come in person for a PrEP appointment where they will review the test results, answer your questions, sign you up to the PrEP program, and do your first prescription using these enrolment forms.
  2. The doctor or nurse practitioner will fax these forms to the BC Centre for Excellence at St. Paul’s Hospital at the fax number listed on the documents. New enrollments are processed in approximately three working days. You will then need to pick up your prescription at St. Paul’s Hospital ambulatory pharmacy 3-5 business days after your forms are sent in.If you live outside of Greater Vancouver, the pharmacy can mail you your prescription to your prescriber’s office, local pharmacies, or certain sexual health centres and clinics. You can ask your doctor or nurse practitioner to help you set this up. If you want to pick up your PrEP at your local pharmacy, you may also need to ask if they are able to accept and dispense the PrEP medication for you.

Your first prescription will supply you with 30 days’ worth of PrEP. After that, prescriptions will be for three months’ worth of medication.

Step 4 – PrEP Refill

This is what you need to do to refill your prescription:

  1. When it’s time to refill your prescription, you will need to do another round of tests.These tests will make sure that PrEP is working, is not causing problems with your kidneys and is not causing other problematic side effects.
  2. To get these tests, you will need a requisition from your doctor or nurse practitioner.You will probably get a requisition for your next round of blood tests at the appointment where the doctor or nurse practitioner filled your first prescription.
  3. Your health care provider will fax a PrEP refill prescription to the BC Centre for Excellence at St. Paul’s Hospital.
  4. If you know when you will pick it up this can be written on the prescription. Otherwise, you will then need to call the St. Paul’s Hospital ambulatory pharmacy to confirm your PrEP order is filled for you.
  5. Paul’s Hospital ambulatory pharmacy will prepare your three-month supply of PrEP. Your PrEP will be ready for pick up in 3-5 business days.

Stopping PrEP

There’s lots of reasons for wanting to stop PrEP. Maybe you’re not having condomless sex, or have a  new monogamous relationship with a partner who is also HIV negative or undetectable.

Here are some things to keep in mind when stopping PrEP if you were taking it daily:

  • Consult with your PrEP doctor or nurse to make sure you’re stopping PrEP in a way that’s right for you.
  • Provincial guidelines recommend we take PrEP for 28 days after situations where we might have come into contact with HIV (e.g., condomless anal sex).
    • That said, health care providers may advise us differently depending on our situation, body, and the newest data available.
    • The BC Centre For Excellence, for example, advises cis men to continue taking PrEP for at least 48 hours after situations where we might have been in touch with HIV. For some of us, it might be recommended that we continue taking PrEP for a little longer. That’s why it’s important to talk to your prescriber before stopping.
  • Don’t forget to get an HIV test 4-6 weeks after stopping PrEP to confirm your HIV status.
  • Communicate with your partners, and let them know that you’ve decided to stop PrEP and let them know if this is going to change the kinds of sex you want to have.
Need Support with These Steps?
I need help walking my doctor through the steps…

Because PrEP is relatively new and the province only started its public program in 2018, some doctors may not have heard of it. You may have to introduce your doctor to PrEP and walk them through the process.

Show your doctor GetPrEPed, or bring these documents with you to your appointment:

Feel like you need or want more info? Check out Accessing PrEP Step by Step!

I don’t have a queer-friendly doctor or nurse practitioner…

Getting a prescription for PrEP is hard if you don’t have a doctor or nurse practitioner, or if they aren’t queer-friendly.

If you don’t have a primary care provider or you’re not comfortable sharing details about your sex life with them, you can find other prescribers using checkyourself.today.

You can also contact HIM and we can try to help connect you with a queer-friendly PrEP prescriber.

Remember that what is most important is that you have to have a prescription for PrEP, and that it does require some follow up, so having a regular provider is essential.