The medical system is the main point of access for PrEP.

To get it, you need to:

1. Go to a PrEP provider (face to face or online), a doctor, a nurse practitioner, or a clinic that can issue a prescription, where you feel comfortable talking about your sexual activities.

PrEP providers have recently emerged as clinics that are specialized around PrEP, and who are sex positive and extremely accessible to the queer community. These providers (physical and online clinics) can usually assess your need for PrEP, arrange for adequate testing, write and fill prescriptions, counsel you on taking PrEP and assist you with figuring out how to take advantage of any programs and services that can cover PrEP costs.

Many face-to-face and online PrEP services have their own team of doctors, nurses and pharmacists and have streamlined their online and in-person systems to do all that is needed very quickly, safely, confidentially and be flexible enough to utilize technologies such as WhatsApp, Zoom, texting or a phone call throughout the process. Some can do this in more than one language as well. Some can even set you up with PrEP in one visit.

2. Be prepared to be specific about your sexual activity (what you do and how often)— this is to assess for your HIV risk. That’s why it’s important to find someone you feel comfortable talking about your sex life with.

3. Be ready to get tested for HIV, other sexually transmitted infections (STIs), and checked for pre-existing conditions (see point #4 below). The doctor or clinic likely wants to keep the HIV test on your medical record to document that you are not HIV-positive before starting PrEP, so an anonymous HIV test will not be useful in this context. Note: If you test reactive (positive) or indeterminate for HIV a second test for HIV will be done to confirm a diagnosis of HIV and you should be connected with counselling and care options for HIV.

4. Your provider will consider your bone density and kidney functions as well as look for hepatitis infections.

5. They will need to issue you a prescription.

6. In order to fill the prescription a pharmacist will talk to you further about taking the medication and coverage to pay for the PrEP. It is helpful to have a pharmacist who you feel comfortable with as they can answer questions about what to do if you miss a dose of PrEP when you are sexually active or have shared a syringe.

7. Be prepared to get regular (every 3-months) STI screening, and monitoring for side effects of PrEP while you take the medications.

Tips on Finding A Good PrEP Provider for You

• Research the clinic, pharmacy or doctor’s reputation: Look for reviews or testimonials from other patients who have visited the clinic or used the service. This can give you an idea of the quality of care and services provided.
• Talk with your primary care physician: Your own healthcare provider may be able to provide recommendations or insights about the online service, clinic or pharmacy you are considering.
• Ask about their experience: if the service is affiliated with an HIV treatment clinic or has personnel who have a background in HIV treatment that’s a good thing. HIV treatment medications are basically the same as HIV prevention medications, but HIV treatment has been available for a lot longer in Ontario. If the PrEP provider you are considering has a history of HIV treatment, they are likely particularly experienced medical professionals who know their HIV meds well. Expertise in sexually transmitted infections is also a good thing to ask about from the people who will be assessing you and monitoring your health while you take PrEP.

Verify credentials:

• Medical Clinics (including online clinics) are licensed by the College of Physicians and Surgeons of Ontario (CPSO). (The CPSO is responsible for regulating medical clinics and ensuring that medical professionals in Ontario are practicing with professional standards.)
• Online pharmacies are verified and accredited by recognized organizations, such as the Ontario College of Pharmacists.
• A lot of Online Clinics use Nurse Practitioners to prescribe PrEP – they are certified by the Ontario College of Nurses.

All of these sites offer ways to search and verify who are their accredited members.

Buying PrEP Online

When it comes to purchasing PrEP online in Ontario there are a few things to consider:

1. You still need to talk with a medical professional first who can issue a prescription. An online PrEP provider will likely tell you that you need to be screened by a healthcare professional first. Many online PrEP providers work with medical professionals to do this and have assembled their own team to make the process as efficient as possible. To be prepared for this, you should know your medical history and tell about what other medications you are taking, including hormones.

2. You need a prescription, even if you are buying online. PrEP is a prescription medication, so it’s important to only purchase it from sources that require a valid prescription from a healthcare professional. If they do not have a team of their own as part of their PrEP service, they should be asking you for a prescription from a doctor or nurse practitioner who has looked into your health.

3. PrEP is part of your overall sexual health so be clear on how this will be monitored when getting PrEP through the internet and are not using your local medical professional.

Find out what the plan is to diagnosis and treat sexual transmitted infections while you are taking PrEP. This will include HIV testing. If they are mailing you an STI diagnosis kit as part of their process for monitoring your health, ask for swabs and be clear on how to use them with the various parts of your body. The GMSH has developed an online resource on how to swab properly.

If part of the testing routine is to use a private lab where you live, be aware some tests can be forgotten, especially when a series of lab tests are being ordered on a one page lab requisition form. Don’t be afraid to keep a copy of your lab requisition form to see what is being ordered – you can, if you wish, verify this the next time you are with your PrEP provider. It is likely a specialized PrEP provider will notice anything that is missing.

Note: There should also be testing for bone density and kidney functions as well as Hepatitis infections.

4. Ensure that the medication you purchase is authentic. The medications you receive should be from licensed manufacturers and distributors. You can verify the authenticity of the medication by checking for a DIN (Drug Identification Number) on the packaging. (This means the medication is approved by Health Canada.) Be cautious of websites that offer medications at significantly lower prices than other legitimate sources.

The DIN numbers for PrEP medications are:

• Teva-Emtricitabine/Tenofovir: 02399059
• APO-Emtricitabine/Tenofovir: 02452006
• Mylan-Emtricitabine/Tenofovir: 02443902
• Truvada (name-brand): 02274906
• PMS-Emtricitabine/Tenofovir 02461110
• Mint-Emtricitabine/Tenofovir 02521547
• Jamp-Emtricitabine/Tenofovir Disoproxil 02487012
• Auro-Emtricitabine/Tenofovir 02490684
• AG-Emtricitabine & Tenofovir Disoproxil 02496356
• Descovy (tenofovir alafenamide/emtricitabine) DIN: 02454424

5. Ensure your privacy and security. Check that the online pharmacy has appropriate measures in place to protect your personal and financial information:

• Look for privacy statements on their page.
• Look for terms of sale as well as shipping, complaints, return and exchange policies that are easy to understand.
• Ask if anything will appear on your credit card bill and consider who has access to your bill.
• Ask what your package will look like when it arrives, and if you will get a notification of when it is delivered.