PrEP Offers Everyone Protection From HIV

Risk assessment is a huge part of living. Every day, we make decisions to help protect ourselves from illness and prolong our health. We get the flu shot to help reduce our risk of getting influenza. We take birth control to help prevent unplanned pregnancies. And now, we can take pre-exposure prophylaxis, or PrEP, to help protect ourselves from HIV infection.

But PrEP is a relatively new medicine, so there are many questions about who should take it, how it works and how it affects your body. Internal medicine specialist James Hekman, MD, answers those questions and explains why PrEP is really meant for anyone who currently doesn’t have HIV and is at higher risk for infection.

What is PrEP?

PrEP is a preventive medicine that blocks the HIV virus from taking hold within your body. There are currently two forms of daily oral medications for PrEP and one long-acting injectable form of PrEP:

• Truvada® is a daily pill that combines two medications called tenofovir disoproxil and emtricitabine. It’s for anyone who weighs at least 77 pounds and is at risk of contracting HIV. It’s also available in generic form.
• Descovy® is a daily pill that combines two medications called tenofovir alafenamide and emtricitabine. It’s for sexually active cisgender men and people assigned male at birth (AMAB) who weigh at least 77 pounds. It’s not for people assigned female at birth (AFAB) who are at risk of getting HIV through vaginal sex, as there are currently no studies on the effectiveness of Descovy in these populations. The generic form of Descovy is not currently available in the U.S.
• Apretude® is the brand name of medication called cabotegravir, which is a prescribed injection you receive every two months from your doctor. The U.S. Food and Drug Administration (FDA) approved it for use in December 2021, and no generic form is currently available. But this form of PrEP is particularly helpful for adolescents 12 and older and adults who weigh at least 77 pounds and who have difficulties keeping up with daily medications.

Why should you consider PrEP?

The human immunodeficiency virus, or HIV, is a sexually transmitted infection (STI) that attacks your immune system, which can make it difficult for your body to fight off illness. HIV enters your body through broken skin (like a cut or open wound), your anus, penis or vagina. The infection itself is carried by these body fluids:

• Blood
• Semen
• Cervical secretions
• Rectal fluids
• Breast milk

Globally, 44% of all new HIV infections in 2023 were among women and girls of all ages. Men who have sex with men, transgender women and people of color continue to be most affected by HIV. But anyone of any gender or sexual orientation can get an HIV infection at any age.

For these reasons, PrEP can be a useful tool in preventing the spread of HIV before anyone is ever even exposed to it.

“PrEP is presently being offered to many people in many individual circumstances,” shares Dr. Hekman. “Anyone who has a greater than average chance of acquiring HIV due to sexual contact or IV drug use should consider speaking with their doctor about a prescription for PrEP.”

Who is PrEP for?

Anyone who doesn’t have HIV can be on PrEP. If you’re curious or interested in using PrEP as a preventive medication, talk to your primary care doctor or see a healthcare provider. They can answer any questions you have about the medication.

They may recommend you go on PrEP if you:

• Have a sexual partner with HIV
• Have multiple sexual partners
• Have sex without using condoms
• Aren’t participating in safer sex practices
• Have been diagnosed with a sexually transmitted infection (STI) in the last six months
• Have been exposed to HIV in the past
• Use shared needles for injections

“Several new HIV infections have been acquired in relationships that were thought to be monogamous, so being in a relationship does not exclude someone from considering PrEP,” clarifies Dr. Hekman. “If you think you may be at risk, please contact your provider for additional discussion.”

How to take PrEP

Before you can begin PrEP, your healthcare provider will have you take an HIV test. If you test negative, that means you likely don’t have HIV and can begin taking PrEP as a preventive medicine.

You should be on PrEP for one week, in most cases, in order for it to start working. For receptive vaginal sex and injection drug use, PrEP pills reach maximum protection at about 21 days of use. To maximize your protection from HIV, you have to be sure to take every dose. Simply put, Dr. Hekman says, “PrEP is incredibly effective, but only if you take it as prescribed.”

HIV.gov reports that when taken correctly, the pill forms of PrEP reduce the risk of getting HIV from sex by about 99%. And it reduces the risk of getting HIV from injection substance use by at least 74%. But the medication isn’t nearly as effective if it isn’t taken consistently, so be sure to set those daily reminders.

As part of the requirement for taking PrEP, you’ll need to get tested for HIV:

• Every two to three months if you’re taking oral PrEP
• Every eight weeks if you’re taking injectable PrEP

Side effects of taking PrEP

PrEP is considered safe, but you may experience some side effects at first. They should go away on their own, but talk to your healthcare provider if you continue experiencing these symptoms:

• Nausea
• Diarrhea
• Headache
• Fatigue
• Stomach pain

If you have kidney disease or a history of hepatitis B, be sure to tell your provider. It may impact whether you’re able to take PrEP.

Does PrEP prevent STIs?

“PrEP does not prevent the spread of other STIs,” Dr. Hekman states. “It only prevents the spread of HIV.”

You can (and should) pair PrEP with condom use for the best chances of reducing your risk for any STIs. Embracing safer sex practices can also be helpful when preventing STIs.

Will PrEP interfere with hormone therapy?

PrEP shouldn’t affect gender-affirming hormone therapy. In fact, PrEP is effective for transgender women. And because the transgender population is at high risk for HIV, it’s important to work with a doctor who can ensure you remain on hormone therapy and guard yourself against HIV.

Talk to your doctor about PrEP

PrEP is a pre-exposure medication, which means that in order for it to do its job, you need to be taking it before you’re exposed to HIV. That also means PrEP isn’t the right medication to take if you’ve been exposed to HIV and want to reduce your chance of infection.

If you’ve been exposed to HIV and aren’t already on PrEP, see a doctor — whether your primary care physician or at an emergency room or urgent care facility — within 72 hours. They can prescribe post-exposure prophylaxis (PEP), medication to prevent HIV after exposure. Unlike PrEP, PEP is used in emergency exposure situations.

PrEP is only available by prescription, so if you’re interested in starting it, make an appointment to speak with a healthcare provider. If you’re looking for someone who’s trained in health issues specific to the LGBTQIA+ community, there are many nationwide health services and other ways to find an LGBTQIA+ doctor’s office near you.

If you’re concerned about how to pay for PrEP, be sure to ask your doctor about that, too. Most insurance companies and state Medicare plans cover PrEP, and other options are available for those who qualify.