As recently as the 1990s, it was unthinkable that drugs could ever prevent the spread of HIV. But in 2012, the United States Food and Drug Administration (FDA) approved the first drug known as pre-exposure prophylaxis, or PrEP, which can prevent HIV from taking hold in your body.
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Today, PrEP has become an important tool in the fight against the spread of HIV. Internal medicine specialist James Hekman, MDexplains what PrEP is, how it works and if it’s right for you.
What is PrEP?
The human immunodeficiency virus, or HIV, is a sexually transmitted disease that attacks your immune system, which can prevent your body from fighting the disease. Vaginal, oral or anal sex is the most common way to get HIV, but you can also get it from sharing needles for taking medicine.
But taking PrEP can prevent you from getting HIV by preventing the virus from taking up residence in your body.
The name says it all: ‘pre-exposure’ means ‘before you’re exposed’ and ‘prophylaxis’ is a common medical word that refers to the steps you take to prevent a disease from developing or spreading. So PrEP is a drug you take to protect yourself from HIV — before you have already been exposed to it.
Should I take PrEP?
“PrEP is for people who don’t have HIV, but are at increased risk of getting it through sex or injection drug use,” says Dr. Hekman.
Your doctor may recommend that you take PrEP if you:
- Having an HIV-positive sexual partner.
- Having sex without using a condom.
- Have been diagnosed with a sexually transmitted disease over the past six months.
- Inject drugs into someone who has HIV.
- Inject drugs by sharing needles or syringes.
- Have been exposed to HIV in the past and continue to engage in high-risk behaviors.
How to take PrEP
PrEP is not a particular brand; it is rather a category. Currently, there are three types of PrEP:
- Truvada® is a daily pill that combines two drugs called tenofovir disoproxil and emtricitabine. It is for anyone at risk of contracting HIV through sex or injection drug use, and it is also available in generic form.
- Descovy® is a daily pill that combines two drugs called tenofovir alafenamide and emtricitabine. It is for cisgender men and sexually active transgender women who are at risk of contracting HIV; it is not for people who have vaginal sex. The generic form is currently not available in the United States
- Apretude® is the brand name of a medicine called cabotegravir, which is an injection you get every two months from your doctor. The FDA has approved its use in December 2021, and no generic form is currently available.
How long does it take for PrEP to work?
You would need to be on PrEP for one to three weeks for it to start working. But to maximize your protection against HIV, you need to make sure you 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, PrEP pills reduce the risk of contracting HIV through sex by approximately 99%, and that they reduce the risk of contracting HIV through drug use at least 74%. But the drug is not as effective if not taken regularly, so be sure to set those daily reminders.
Side effects of PrEP
PrEP is considered safe, but you may experience some side effects at first. They should go away on their own, but tell your doctor if you continue to feel them:
- Stomach pain.
Does PrEP prevent STDs?
Condoms are just as important as they always have been. “PrEP does not prevent the spread of STDs,” says Dr. Hekman. You can (and should) combine PrEP with condom use for the best chance of reducing your risk.
Will PrEP interfere with hormone therapy?
If you are on gender-affirming hormone therapyyou may be wondering if and how PrEP will interfere.
According to Dr. Hekman, trans women have lower blood levels of PrEP than other people, but there isn’t enough research yet to say why. And because the transgender population is at high risk of contracting HIV, it’s important to work with a doctor who can make sure you can continue on hormone therapy. and guard against HIV.
“We know that when trans women are under medical care, doctors can monitor their HIV control and hormone levels,” says Dr. Hekman. “We can adjust the doses to make sure they’re achieving appropriate levels of gender-affirming hormone therapy while still being protected against HIV.”
Can you take PrEP after exposure to HIV?
PrEP is a pre-exposure medicine, which means that for it to do its job, you have to take it before you are exposed to HIV. This means that PrEP is not the right drug to take if you have been exposed to HIV and want to reduce your risk of infection.
If you have been exposed to HIV and are not already on PrEP, see a doctor – either your primary care doctor or in an emergency room or urgent care facility – within 72 hours . They may prescribe post-exposure prophylaxis (PEP), a drug to prevent HIV after exposure. Unlike PrEP, PEP is used in emergency exposure situations.
Talk to your doctor about PrEP
PrEP is only available by prescription, so if you’re interested in starting it, make an appointment to speak with your doctor. “They will give you a HIV test and talk to you about any concerns you have about PrEP,” says Dr. Hekman.
Are you looking for a healthcare professional trained in health issues specific to the LGBTQIA+ community? Many nationwide health services and public clinics are open and welcoming, and there are other ways to find an LGBTQIA+ medical practice near you.
If you’re wondering how to pay for PrEP, be sure to talk to your doctor, too. Most insurance companies and state health insurance plans cover PrEP, and other options are available for those who qualify.