PrEP, PEP & Safe Sex: Your Complete Guide

When it comes to sexual health, knowledge isn’t just power—it’s protection. Whether you’re newly navigating the world of queer sex, in a committed relationship, or living your best single life, knowing your options for PrEP and STI prevention is essential.

In this guide, we’ll explore every angle of PrEP, including PEP, DoxyPrEP, access in South Africa, and how to protect yourself not just from HIV, but from other sexually transmitted infections (STIs) too. It’s not about fear—it’s about being informed, empowered, and ready for whatever (or whoever) comes your way.

What Is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, a daily or event-based medication regimen that dramatically reduces your chances of contracting HIV. When taken correctly, PrEP can reduce HIV risk by over 99%.

PrEP is not a vaccine—it’s a pill (or in some cases, an injection) that you take before potential exposure to HIV. Think of it as a protective layer for your immune system, especially helpful if condoms aren’t always on the cards.

Who Should Consider PrEP?

You might consider PrEP if:

• You’re HIV-negative and sexually active
• You’re in a relationship with an HIV-positive partner
• You have multiple partners or engage in casual sex
• You don’t consistently use condoms
• You’re a sex worker
• You’ve recently been diagnosed with an STI

No matter your age, gender, or sexual orientation—if you’re at risk, PrEP is for you.

Types of PrEP Available

PrEP isn’t one-size-fits-all. There are a few different versions to suit different people and needs.

1. Daily Oral PrEP (Truvada or generics)

• Taken once a day, every day.
• Best for people who are regularly sexually active.
• Available in South Africa’s public health system for free.

2. On-Demand PrEP (Event-Based Dosing)

• Also known as the “2-1-1 method.”
• You take 2 pills 2–24 hours before sex, 1 pill 24 hours after, and another 48 hours later.
• Not yet officially endorsed in all national guidelines, but widely used and supported by research.

3. Long-Acting Injectable PrEP (Cabotegravir)

• An injection every 2 months.
• Ideal for those who struggle with daily pills.
• Approved by the World Health Organization and being rolled out in some countries.
• South Africa is currently conducting trials and pilot programmes—watch this space.

How to Access PrEP in South Africa

In South Africa, PrEP is available for free through government clinics and selected non-profit organisations. You can also access it through private healthcare providers, though this may incur a cost.

Places to start:

• MyPrEP.co.za
• Public sector clinics under the National Department of Health

When starting PrEP, expect to undergo:

1. An HIV test (you must be HIV-negative to begin)
2. Kidney function tests
3. Follow-up appointments every 3 months

PEP: The Emergency Backup Plan

While PrEP is taken before exposure, PEP—Post-Exposure Prophylaxis—is your emergency option after a potential HIV exposure.

When to Use PEP:

• After a broken condom during sex with an HIV-positive or status-unknown partner
• Following sexual assault
• If you’ve shared needles or injection equipment
• If you’ve had unprotected sex and are unsure of your partner’s status

How PEP Works:

• Must be started within 72 hours (the sooner, the better)
• Taken daily for 28 days
• Available at most hospitals and emergency clinics in SA, often free in public facilities

PEP is not a substitute for PrEP—it’s a last-minute safety net. If you find yourself needing PEP more than once, it might be time to consider starting PrEP.

What About Other STIs?

Here’s the kicker: PrEP only protects you from HIV. It does not prevent other STIs like:

• Chlamydia
• Gonorrhoea
• Syphilis
• Herpes
• HPV (Human Papillomavirus)

This means you still need to think about condoms, regular STI screening, and now—possibly—DoxyPrEP.

DoxyPrEP: The New STI Fighter on the Block

DoxyPrEP (or DoxyPEP) involves taking 200mg of doxycycline, an antibiotic, within 72 hours of condomless sex to reduce the risk of bacterial STIs. It has shown promising results in reducing:

• Chlamydia by up to 90%
• Syphilis by around 70%
• Gonorrhoea to a lesser extent (due to growing antibiotic resistance)

Is DoxyPrEP Available in South Africa?

At the moment, DoxyPrEP is not part of official national guidelines, but it is being studied in clinical trials in South Africa and globally. Some individuals are already using it informally, often through private healthcare providers.

Before hopping on DoxyPrEP, speak to a doctor. Overusing antibiotics can lead to drug resistance and gut issues—not ideal.

Combining PrEP, DoxyPrEP and Condoms: A Triple Barrier

For the most comprehensive protection:

• PrEP: blocks HIV
• DoxyPrEP: helps prevent bacterial STIs
• Condoms: reduce risk of all STIs, including viral ones like herpes and HPV

You don’t have to use all three all the time, but knowing your tools means you get to decide what works for your lifestyle.

PrEP and Relationships

If you’re in a monogamous relationship with an HIV-positive partner who is undetectable (thanks to ART), you’re already very low risk. Still, some choose to use PrEP for peace of mind or in open relationships.

U=U (Undetectable = Untransmittable) means that someone with an undetectable viral load cannot transmit HIV through sex. But PrEP can still offer an added layer of security, especially in new relationships or when trust and communication are still growing.

Side Effects and Safety

Most people tolerate PrEP well, but some may experience:

• Nausea
• Headaches
• Mild kidney strain (rare, and reversible)

These side effects often go away after a few weeks. Regular check-ups ensure everything’s working as it should.

If you’re starting injectable PrEP, you might have some injection site soreness or mild reactions. Again—nothing most can’t handle.

Myths That Need Busting

Let’s kill a few myths while we’re here:

• “PrEP is only for promiscuous people.” Nope. It’s for anyone who wants control over their sexual health.
• “If I’m on PrEP, I don’t need condoms.” Maybe for HIV, yes—but not other STIs. Use your judgment.
• “PrEP is hard to get.” Not true in South Africa—it’s available and free in many places.
• “I don’t need PrEP if I only top.” Wrong again. HIV can be transmitted to both tops and bottoms.

Quick Tips for Smart, Safe Sex

• Test regularly: every 3 to 6 months
• Communicate with partners: honesty builds safety
• Use what works for you: PrEP, PEP, condoms, DoxyPrEP—your mix depends on your risk
• Don’t wait: If you think you’ve been exposed, get PEP within 72 hours

Final Thoughts

Sex should feel good—and safe. With PrEP, PEP, DoxyPrEP, and regular testing, we’ve got more tools than ever to protect ourselves and each other. Whether you’re in Cape Town, Joburg, Durban, or beyond, access is improving, and knowledge is growing.

So, arm yourself with information, stay curious, and don’t be afraid to take control of your sexual health. You deserve it.