Can I get PrEP for free?

British Columbia is providing free PrEP to those of us who live in BC who are coming into contact with HIV on a regular basis. The BC Centre for Excellence in HIV/AIDS has developed guidelines on the use of HIV PrEP based on existing research about who may benefit from PrEP. We know that the existing research doesn't represent all of our bodies or experiences, and that these guidelines use binary language to talk about gender and who we may have sex with. 

For example, there has not been enough research on how PrEP works for trans men for the guidelines to include specific recommendations. But, we know that some trans men in our community are choosing to use PrEP. There also has not been research about PrEP for those of us under 18 years old, and PrEP is not recommended for folks under 18 at this time.

Here are the recommendations for PrEP use based on the research evidence that we have so far:

  • men who have sex with men* who have anal sex without condoms some or all of the time and any of the following:
    • have had a diagnosis of syphilis, rectal gonorrhea, or rectal chlamydia in the past six months
    • have used PEP (post-exposure prophylaxis) more than once
    • have an ongoing sexual relationship with someone living with HIV who is not taking medication and/or does not have a low viral load
    • score at least 10 on a scale called the HIV Incidence Risk Index (HIRI). HIRI takes into account our age, and the types and amount of sex we've had in the past six months. For more information see Table 1 in the guidelines available here.

  • transgender women who are having anal sex without condoms some or all of the time and any of the following:

    • have had a diagnosis of syphilis, rectal gonorrhea, or rectal chlamydia 
    • have used PEP (post-exposure prophylaxis) more than once
    • have an ongoing sexual relationship with someone living with HIV who is not taking medication and/or does not have a low viral load
    • score at least 10 on a risk indicator called the HIV Incidence Risk Index (HIRI). HIRI takes into account our age, and the types and amount of sex we've had in the past six months. For more information see Table 1 in the guidelines available here.

  • people who share injection equipment with someone living with HIV who is not taking medication and/or does not have a low viral load

  • heterosexual men and women who are having condomless anal or vaginal sex with a partner living with HIV who is not taking medication and/or does not have a low viral load

We know that not all of us are included here; for example, the guidelines don't specifically say whether "men who have sex with men" includes transgender and cisgender men, intersex people, nonbinary folks, masc of centre folks, or Two-Spirit people. However, we know that trans men are accessing PrEP, and may be able to help connect trans men to doctors who will prescribe PrEP. We know less about how PrEP works for trans men, but we do know that some trans men are choosing to use PrEP and can do so safely.

*The guidelines don't specifically state whether "men who have sex with men" includes transgender and cisgender men, intersex people, nonbinary folks, masc of centre folks, or Two-Spirit people. What we are hearing from those involved in making this policy and prescribing PrEP is that people who meet the criteria described above (e.g. recent STI diagnosis, previous use of PEP, ongoing sexual relationship with people living with HIV who have viral loads above a certain level, score over 10 on the HIRI) will be offered PrEP. We know that people of all genders are accessing PrEP, and may be able to help connect folks to doctors who will prescribe PrEP.