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Like the flu shot or the HPV vaccine, PrEP is a preventative medicine designed to protect your health
Risk assessment is a huge part of living. Every day, we make decisions to protect ourselves from illness and prolong our health. We get the flu shot to reduce your risk for influenza. We take birth control to prevent unplanned pregnancy. And now we can take pre-exposure prophylaxis, or PrEP, to protect ourselves from HIV infection.
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PrEP is a relatively new medicine, though, so there are a ton of questions people have 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.
PrEP is a preventative 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. These three forms of PrEP are:
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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:
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 to 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,” says 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.”
Anyone who doesn’t have HIV can be on PrEP. If you’re curious or interested in using PrEP as a preventative medication, talk to your primary care doctor. They can answer any questions you have about the medication.
They may recommend you go on PrEP if you:
“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,” adds Dr. Hekman. “If you think you may be at risk, please contact your provider for additional discussion.”
Before you can start taking 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 preventative medicine.
You should be on PrEP for one, 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.
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As part of the requirement for taking PrEP, you’ll need to get tested for HIV:
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:
If you have kidney disease or a history of hepatitis B, be sure to tell your healthcare provider. It may impact whether you’re able to take PrEP.
“PrEP does not prevent the spread of other STIs,” Dr. Hekman says. “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, too.
PrEP should not 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.
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 means PrEP is not the right medication to take if you’ve been exposed to HIV and want to reduce your chance of infection.
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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 your healthcare provider. If you’re looking for someone who is 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.
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