Is PrEP right for me? Who is PrEP meant for?

PrEP is not the right fit for everyone but may be useful for men, women, and trans women who are at risk for HIV infection through sex and injecting drug use and okay with the idea of taking a daily pill to prevent HIV.

If you can answer yes to any of the questions below, then PrEP may be one HIV prevention strategy to consider.

●    Do you use condoms sometimes or not at all?

●    Do you get often get STIs in your butt?

●    Do you often get STIs in your vagina?

●    Have you taken post-exposure prophylaxis (PEP) more than once in the past year?

●    Are you in a serodiscordant relationship, where your sexual partner is HIV positive and you are HIV negative?

●    Are you in an open relationship or having anal and/or vaginal sex with multiple partners?

●    Are you having sex with someone whose HIV status you don’t know?

●    Are you having sex with someone in a city or region where the HIV prevalence is high—that is, where there are large numbers of people living with HIV?

Will PrEP give people the excuse to not use condoms? Are people who don’t use condoms irresponsible?

There are many methods besides condoms that people are using to reduce their HIV risk. Some people serosort by partnering with people who have the same HIV status, reduce the number of people they have sex with, use female condoms, have sex with HIV-positive partner(s) with undetectable viral load(s), and/or use PrEP. Some methods are more effective than others depending on multiple factors.

What’s important to note is that there are a variety of options for people to protect themselves from HIV infection—also known as the prevention tool kit. Employing any or all of these methods is helpful in reducing risk and is, in fact, a way of taking responsibility for your sexual health.

 

 

 

Aren’t condoms enough?

Condoms are an effective tool against HIV, but they aren’t perfect. Here are just a few reasons people give for struggling to use them consistently.

●    Not having condoms handy and getting caught up in the moment.

●    Assuming your sex partner shares the same HIV status as you.

●    Doing things when drunk or high that we wouldn’t do under normal circumstances.

●    Having reduced sexual pleasure or difficulty sustaining an erection.

●    Feeling that condoms block emotional intimacy with a partner.

●    Having a partner who refuses to wear condoms.

●    Having a partner who threatens to end the relationship, terminate financial or housing assistance, or even use physical violence if condoms are insisted upon.

In fact, studies consistently show that a high percentage of people (straight, gay, or bi; female, male, or trans) do not use condoms for anal or vaginal sex with a partner whose HIV status they are unsure of.

Some people are going to have challenges with condom use no matter what we do. Wishing that away or blaming them doesn’t help, and only ensures that their risk for becoming infected remains high. PrEP could offer another way for them to protect themselves from HIV.

 

Why would someone who doesn’t have HIV decide to take a pill every day?

Taking a pill every day to prevent something from happening to your body is not a new or foreign concept. Currently, there are over 10 million women in the United States who take a pill every day to prevent pregnancy. Think of PrEP like the birth control pill, except instead of preventing pregnancy, it reduces risk for HIV.

 

 
I’m a gay or bi man and/or trans woman; does PrEP work for me?

Yes. Research shows that PrEP works for HIV prevention for gay and bi men and trans women. To note again, in the clinical research world, researchers use the term “men who have sex with men” (MSM) to describe gay and bi men, trans women, and others who were born male and who have sex with men but who may or may not identify as gay or bisexual. The clinical studies often lump these groups together.

In case you’re curious to know more about the research, the  iPrEx study compared Truvada with a placebo pill in nearly 2,500 gay and bi men and trans women in six countries. All of the participants also got safer sex counseling and condoms, regular sexually transmitted infection (STI) check-ups and treatment, and HIV testing.

When the researchers compared people assigned to take Truvada with those assigned to take the placebo, they found that people who were given Truvada had lower HIV infection rates compared to people who were given placebo. When the researchers took it a step further and looked only at people with detectable levels of the drugs in their blood (a sign than the medication was being taken regularly), they found that transmission dropped by as much as 92%. Further analyses indicate that drug levels corresponding to daily use are associated with 99% protection against HIV.

I’m a trans woman or trans man who is taking hormones; does PrEP work for me?

More research needs to be done to figure out if hormones interact with Truvada and change its HIV protection effectiveness, but no interactions have been reported to date.

 

 

I’m a heterosexual woman or man; does PrEP work for me?

Yes, studies show that Truvada for PrEP, when used consistently, works for HIV prevention for heterosexual woman and men.

Curious to know more about the research?

●    The Partners PrEP study looked at Truvada or Viread alone compared with a placebo in more than 4,500 heterosexual men and women in Kenya and Uganda who were in couples where one partner was HIV positive and the other was HIV negative (what scientists call “serodiscordant” couples). Focusing just on the men and women assigned to take Truvada, the researchers found a reduction in new infections of up to 75%. In those with detectable drug in their blood, it looked like PrEP cut infections by at least 90%. Again, good adherence mattered.

●    A similar smaller study in Botswana, called TDF2, looked at Truvada compared with a placebo in more over 1,200 heterosexual men and women found similar rates of efficacy as Partners PrEP. For participants who were assigned to take Truvada, risk of HIV infection dropped by around 62%.

 

I’m an injection drug user; does PrEP work for me?

Yes. Research shows that Truvada for PrEP works for HIV prevention for people who inject drugs.

In case you’re curious to know more about the research, the Bangkok Tenofovir Study compared Truvada with a placebo pill in more than 2,400 participants who reported injecting drugs during the previous year in Bangkok, Thailand. Truvada was associated with a nearly 49% overall reduction in risk of HIV infection in IDU participants. Protection increased to 74% among those who took the study drug via directly observed therapy during clinic visits. Because participants in the study may have been both injecting drugs and having sex without condoms, it is still unclear whether Truvada specifically prevents “parenteral” HIV acquisition—that is, acquisition through injection rather than sex.

I’m an adolescent under 18 years old; does PrEP work for me?

More research needs to be done to figure out the safety and effectiveness of PrEP for people who are younger than 18 years old.

 
 I think I’ve been accidentally exposed to HIV; is PrEP a good option for me?

No. If you have been exposed to HIV, PrEP is not the best option for you because it is meant to reduce your risk before exposure. If you are reading this within 72 hours after exposure, consider starting PEP (short for post-exposure prophylaxis), a month-long course of drugs that can reduce the likelihood of infection. To access PEP, immediately contact your doctor and/or go to the nearest emergency room. PEP must be started within 72 hours after exposure. If you are in San Francisco, find out how you can get PEP here.

 

My partner is HIV-positive and I am HIV-negative; is PrEP right for me?

PrEP may be one HIV prevention strategy for you to consider reducing your HIV risk and can be used with other HIV prevention methods. We’re all about being proactive about your sexual health choices.

For example, if your HIV-positive partner is already taking HIV medications to treat his/her HIV and reduce viral load to undetectable levels, it reduces his/her chance of transmitting the virus to you. If you add PrEP to the equation, then you would add another layer of protection to reduce your HIV risk. As a disclaimer, remember that PrEP does not protect you against other STIs, like gonorrhea or syphilis, or prevent pregnancy.

It’s important for you to have open communication with your partner and your doctor about whether PrEP may be a good option for you to consider.

 

Can I still take PrEP when I have my period?

From what we know so far, being on your period should not impact the effectiveness of PrEP.

 

I’m the HIV-negative partner in a heterosexual, serodiscordant relationship and we’re trying to get pregnant and start a family; can PrEP help us do that safely?

Yes, PrEP is one of many options available to you as you make decisions about how to safely conceive and have a family. While there is research showing that PrEP works for HIV prevention for adult heterosexual women and men, more research needs to be done on women using PrEP during pregnancy.

As the hopeful soon-to-be dad or soon-to-be mom, there are many things to consider that you should discuss with your partner and doctor— general health, fertility, STIs, HIV viral load of the HIV-positive partner, and risk of HIV transmission—before trying to get pregnant. For example, research shows if your partner has an undetectable viral load with effective HIV treatment and you limit sex without a condom to the woman’s most fertile days, then PrEP may not have additional protective benefits. It is essential to discuss with your partner and doctor what HIV prevention strategy works best for you to ensure a healthy pregnancy and minimize your risk of acquiring HIV.

When considering PrEP, it is important to remember that medications used for HIV treatment and prevention are different, so it is not as simple as sharing medications between partners. Read: Do not try this on your own; sharing medications with each other is a big no-no. While using PrEP, the HIV-negative partner will need to work closely with a doctor for monitoring. For more information on your options for having a baby and referrals to clinics offering assisted reproduction services to HIV-affected couples, please contact 

 

What happens if I contract HIV while taking PrEP?

Remember, HIV today is a manageable disease. Work with your doctor to get linked to HIV care and start getting the treatment you need to maintain your health. Also remember that it’s important to find a support system and have people you can lean on with the emotional and physical challenges ahead.

 

If I take PrEP, does this mean I have to take it for the rest of my life?

No. We recognize that people go in and out of “seasons of risk,” where there are certain times it makes sense to take PrEP and then other times where it doesn’t make sense to take PrEP.

For example, if you start taking PrEP because you are sexually active with multiple partners who are HIV-positive and HIV-negative, and later you find yourself in a relationship where you and an HIV-negative partner are committed to having sex with only each other, then continuing to take PrEP might not make a whole lot of sense for you.

Or maybe you start PrEP when you are in a serodiscordant relationship, then that relationship ends, and you have no sexual partner for the next six months; then it might not make sense to take PrEP.

Or more simply, maybe you decide to use other options to reduce your risk for getting infected with HIV, and PrEP doesn’t make the most sense at the moment.

With proper guidance, people can safely start and stop taking PrEP. Think of PrEP as an HIV prevention option where HIV-negative individuals take a pill to prevent HIV infection for the “season” when they are most at risk for being exposed to HIV.

 

How soon does PrEP become effective after you start it? How long does it take for PrEP to become protective?

It’s estimated that it takes at least seven days for PrEP to reach high levels of protection in the body. When used correctly, Truvada for PrEP provides 92%–99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed.

 

What happens if access to PrEP is interrupted? What if I stop taking PrEP and then start taking it again later?

If a daily dose is missed, PrEP is still effective, but the level of HIV protection may decrease. It only works if you take it correctly and consistently.

According to data analysis from the iPrEx study that found PrEP to be effective:

●    For people who take 7 PrEP pills per week, their estimated level of protection is 99%.

●    For people who take 4 PrEP pills per week, their estimated level of protection is 96%.

●    For people who take 2 PrEP pills per week, their estimated level of protection is 76%.

There are not enough data available to provide specific timing guidance on non-daily use, so the FDA recommends PrEP be used daily to achieve the highest level of protection.

 
If I stop taking Truvada for PrEP, will I be more likely to contract HIV than I was before it started?

If you stop taking Truvada for PrEP, it does not make you more vulnerable to HIV infection.

 

 
What if I’m not having sex right now; do I still need to take PrEP?

If you feel your risk for HIV has changed recently and it doesn’t make sense for you to take PrEP anymore, then talk to your doctor about discontinuing PrEP. If you’re just experiencing a temporary “lull” in your sex life lasting less than a month or two and expect to be sexually active again in the near future, it may not be advisable to discontinue PrEP. Ask your doctor.

 

 
What about side effects from taking Truvada for PrEP? How will my body be affected?

For the first few weeks of starting Truvada for PrEP, some people complain about nausea, vomiting, fatigue, and dizziness, with these minor symptoms eventually resolving themselves over time.

Some people in clinical trials had elevations in blood tests that looked at kidney function. With this particular side effect, there were no physical symptoms, so it is important to remember that if you take PrEP, you need to get routinely checked by your doctor to make sure your kidneys are working properly.

Some people in studies had a decrease in bone mineral density within the first month. However, these changes were small, did not progress over time, and did not increase risk for fracture. Once Truvada was stopped, the bone mineral density returned to normal.

 

If I drink alcohol and/or use recreational drugs, is it safe for me to take Truvada for PrEP?

Alcohol and recreational drugs are not known to interact with Truvada for PrEP. It is safe to take PrEP after a night on the town.

 

 

I use condoms every time I have sex; is PrEP right for me?

It’s great that you are already taking consistent proactive steps to take control of your sexual health and reduce your risk for HIV. If you are still worried about your risk for HIV and/or considering taking condoms out of the equation, then know that PrEP is available as an additional tool for HIV prevention.

 

 
I use condoms sometimes but not always; is PrEP right for me?

Looking at studies, the level of protection against HIV from condoms is less when condoms are used “sometimes” than if condoms were used 100% of the time during sex. If are concerned about your HIV risk and your level of protection from HIV during the instances when condoms aren’t used, then PrEP may be a good HIV prevention option for you to consider.

 

One study suggested that guys who use condoms “sometimes” for anal sex are just as likely to contract HIV as guys who never use them. If you fall into this camp, PrEP might be right for you.

 

 
Does PrEP prevent against STIs?

No, taking PrEP does not prevent you from contracting sexually transmitted infections such as gonorrhea or syphilis. It is important for you to be regularly tested for these infections and to be treated promptly if you find out that you are infected.

 
 
I don’t have private health insurance and PrEP is too expensive. Can I get Truvada for PrEP at low cost or for free?

Yes! If you don’t have insurance, there are ways to get Truvada for PrEP at no or low cost.

 
How often do I have to go to the doctor when taking PrEP?

You should expect to see your doctor every 2–3 months for follow-up. If you are getting PrEP through a clinical trial or demonstration project, then you may see your doctor more often.

 
What happens if I accidentally miss a dose of Truvada for PrEP?

It’s important to take your pill every day, but every now and then it’s perfectly human to forget. If you routinely take your pill at night, for example, and remember when you wake up in the morning, it is fine to take your missed dose with breakfast. If you don’t remember until the next evening, it’s not necessary to take a double dose. The opposite scenario also works: If you usually take your pill in the morning but forget to do so, just take it when you remember that same day. If you don’t remember until the next morning, just pick up where you left off, and do your best to remember next time.

 

 
Do I need to tell my sex partners and/or friends that I’m on PrEP?

No. It is completely up to you who you tell. For some people, keeping that information private is important. Others may wish to talk about it with their partners or friends. That decision is completely yours to make.

 

What are the long-term effects of taking Truvada for PrEP?

HIV-positive individuals have been taking Truvada to assist in treating HIV for many years now. Although it is important to be monitored for any potentially negative side-effects, we know that taking Truvada is generally very safe. Negative side effects generally appear when you start taking Truvada.

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