black woman pointing at papers

Let's Talk About PrEP!

Did you know there is a pill to prevent HIV? PrEP is a daily pill, available by prescription, for people who do not have HIV and want added protection.

Studies have found that PrEP reduces the risk of getting HIV through sex by 90 percent or more.

Read on to find out more, and click here to find a PrEP provider near you.

WHAT IS PREP?

PrEP is a pill for people who do not have HIV who want added protection. When taken every day, PrEP has been shown to be highly effective in protecting against HIV.1 2

PrEP is available by prescription in the U.S. under the brand name Truvada. Truvada contains two drugs, tenofovir and emtricitabine, and was first approved by the Food & Drug Administration (FDA) in 2004 to treat HIV in combination with other medications.3 Based on the strength of large studies showing Truvada’s effectiveness in protecting against HIV infection, it was approved for use FDA as PrEP in 2012.4

There are studies of other forms of PrEP, such as a long-acting injection, that are in planning stages or underway.5 However, those options likely won’t start to become available for at least a few more years.

  1. Baeten J, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012; 367:399-410. DOI: 10.1056/NEJMoa1108524.
  2. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Tranls Med. 2012; 4(151). doi: 10.1126/scitranslmed.3004006.
  3. HIV/AIDS Historical Time Line 2000 – 2010. Food and Drug Administration Web site. https://www.fda.gov/forpatients/illness/hivaids/history/ucm151081.htm. Updated September 7, 2017. Accessed September 26, 2017.
  4. HIV/AIDS Historical Time Line 2010 – 2015. Food and Drug Administration Web site. https://www.fda.gov/forpatients/illness/hivaids/history/ucm279695.htm. Published December 16, 2016. Accessed October 24, 2017.
  5. Safety and Efficacy Study of Injectable Cabotegravir Compared to Daily Oral Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC), For Pre-Exposure Prophylaxis in HIV-Uninfected Cisgender Men and Transgender Women Who Have Sex With Men. Clinical Trials Government Web site. https://clinicaltrials.gov/ct2/show/NCT02720094?term=cabotegravir&recrs=a&rank=3. Updated September 19, 2017. Accessed September 29, 2017.

HOW EFFECTIVE IS PREP?

Very effective. When taken as prescribed, PrEP blocks HIV from taking hold in the body.

In a major study of gay and bi men as well as trans women, daily PrEP use lowered their risk of HIV by an estimated 99 percent if they took Truvada daily.1 2 Another study focusing on sex between men and women showed PrEP reduced the risk of getting HIV by at least 90 percent.3

PrEP also reduces the risk of getting HIV through injection drug use; however, the data is less clear about how effective. A study of injection drug users found a 74 percent reduced risk of getting HIV among those who reported they were taking PrEP as prescribed and had at least a detectable amount of PrEP in their blood.4 The study was not able to say how frequently participants took PrEP. Consistent, daily use of PrEP is associated with increased effectiveness.

It is also important to understand that PrEP must be taken for some time before it reaches maximum effectiveness. (See: “How quickly does PrEP start working?”)

  1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363:2587-2599. http://www.nejm.org/doi/full/10.1056/NEJMoa1011205.
  2. Anderson P, Glidden D, Liu A, Buchbinder S, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine. 2012; 4(151)151ra125. DOI: 10.1126/scitranslmed.3004006.
  3. Baeten J, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012; 367:399-410. DOI: 10.1056/NEJMoa1108524.
  4. Choopanya, K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet 2013: 381:2083–2090. http://dx.doi.org/10.1016/S0140-6736(13)61127-7.

WHO IS PREP FOR?

PrEP is an option for anyone who does not have HIV and wants to reduce their risk of getting the virus. This may include but is not necessarily limited to people who:

  • have a sexual partner with HIV1
  • are at higher risk (or whose partners are) for HIV, including men who have sex with men, heterosexual women of color, and injection drug users2
  • do not regularly use condoms or who have had a sexually transmitted disease in the past six months3 4

While highly effective at preventing HIV, PrEP does not protect against other sexually transmitted diseases (STDs). Condoms provide protection against other STDs, in particular gonorrhea and chlamydia.5

A health care provider can help you determine if PrEP is a good option for you.

Click here to find a PrEP-friendly provider near you.

  1. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Updated 2017. Accessed August 2, 2017.
  2. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Updated 2017. Accessed August 2, 2017.
  3. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Updated 2017. Accessed August 2, 2017.
  4. PrEP. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/basics/prep.html. Updated June 6, 2017. Accessed October 3, 2017.
  5. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61. https://www.ncbi.nlm.nih.gov/pubmed/15356939.

WHERE CAN I GET PREP?

You need a prescription. Any medical professional who can prescribe medications, including doctors and nurse practitioners, may prescribe PrEP.

If you don’t have a regular health provider or they don’t know about or are reluctant to prescribe PrEP, there are organizations across the country that specialize in helping people get on PrEP. Part of the assistance these groups can provide is to help you figure out options for covering the costs of getting on PrEP, whether you have insurance or not.

Click here to find a PrEP-friendly provider near you.

HOW MUCH DOES PREP COST?

PrEP is covered by most insurance plans and should be covered by Medicaid and Medicare. There are financial assistance programs that may be able to help if you do not have insurance; or, if you have insurance, but need help with out-of-pocket costs. Many people wind up paying very little or nothing at all for PrEP. (See: “What about payment assistance for PrEP?”)

Will My Insurance Cover PrEP?

PrEP is covered by most insurance plans, and should be covered by Medicaid and Medicare. There are multiple sources of assistance with any remaining out-of-pocket costs for PrEP for those with insurance. (See: “What about payment assistance for PrEP?“) Many people pay very little or nothing for PrEP.

What About Payment Assistance for PrEP?

There are various sources of payment assistance, both for people with insurance – to help cover copay and deductible costs – as well as for those who don’t have insurance, including:

  • Gilead’s Medication Assistance Program for PrEP: If you don’t have health insurance this program from the manufacturer of Truvada (PrEP’s brand name), may provide the medication at no cost, based on your income. This program may also be available to those on Medicare who don’t have Part D prescription drug coverage. To determine if you are eligible, your medical provider needs to submit an application for you. For more information call (855) 330-5479.1 2 3
  • Gilead’s Co-Payment Assistance Program: If you have private health insurance, this program provides up to $3,600 per year, with no monthly limit, to cover out-of-pocket expenses for PrEP, including copays, coinsurance and deductibles. The program does not restrict benefits based on income, however it is not available for those on Medicaid, Medicare Part D or any other government prescription drug programs. For more information call (877) 505-6986.4
  • Patient Advocate Foundation: If you get PrEP covered by insurance, including Medicare, you may receive up to $7,500 per year from this resource to help pay for costs related to the prescription. Approval is based on your income. If you earn less than 400 percent of the federal poverty level (or about $47,500 for an individual with no dependents) you may qualify for this program. For more information call (866) 512-3861 and select option 1.5
  1. Truvada for PrEP. Truvada Web site. https://start.truvada.com. Accessed August 2, 2017.
  2. Truvada for PrEP Medication Assistance Program. Gilead Web site. http://www.gilead.com/responsibility/us-patient-access/truvada%20for%20prep%20medication%20assistance%20program. Accessed September 29, 2017.
  3. Gilead Advancing Access Program. Gilead Advancing Access Web site. https://www.gileadadvancingaccess.com/. Accessed September 29, 2017.
  4. The Gilead Advancing Access® Co-pay Program. Gilead Advancing Access Web site. https://www.gileadadvancingaccess.com/copay-coupon-card. Accessed September 29, 2017.
  5. HIV, AIDS and Prevention Information and Resources. Co-pay Relief Program Web site. https://www.copays.org/diseases/hiv-aids-and-prevention. Accessed August 2, 2017.

Does Medicaid Cover PrEP? What About Medicare?

Yes, both public insurance programs should cover PrEP. Depending on what state you live in, Medicaid may require your physician to obtain a pre-approval for PrEP before you fill your prescription. If you are on Medicare but do not have Part D prescription drug coverage, you may be able to receive PrEP for free from its manufacturer if you have a low income. You may also be eligible for co-pay assistance if you are on Medicare. (See: “What about payment assistance for PrEP?“)

I Don’t Have Insurance – Can I Still Get PrEP?

If you are uninsured, there may be resources available that can help pay for PrEP and the necessary clinic visits and tests.

One such source is Gilead’s Medication Assistance Program for PrEP. You can apply for this program, provided by PrEP’s manufacturer, to see if you can get PrEP at no cost, based on your income. For more information call (877) 505-6986.1 2 3

You may be able to find affordable health insurance. To find out more about health insurance coverage options in your state, go to: healthcoverage.greaterthan.org.

  1. Truvada Support and Resources. Truvada Web Site. http://www.truvada.com/truvada-patient-assistance. Accessed August 2, 2017.
  2. Truvada for PrEP Medication Assistance Program. Gilead Web site. http://www.gilead.com/responsibility/us-patient-access/truvada%20for%20prep%20medication%20assistance%20program. Accessed September 29, 2017.
  3.  Gilead Advancing Access Program. Gilead Advancing Access Web site. https://www.gileadadvancingaccess.com/. Accessed September 29, 2017.

HOW QUICKLY DOES PREP START WORKING?

PrEP must be taken for some time before exposure to HIV to be effective. CDC guidelines state that PrEP reaches maximum protection against getting HIV through receptive anal sex after about 7 days of daily use. For receptive vaginal sex and injection drug use, the CDC says that PrEP reaches maximum protection after about 20 days of daily use. 1

  1. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 Clinical Practice Guideline. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf. Updated May 14, 2014. Accessed December 15, 2017.

ONCE I START PREP, CAN I STOP?

You can go on and off PrEP, but should do so under the guidance of a health care provider. Before restarting PrEP you will need to get tested again to make sure you do not have HIV.1 (See: “Why do I have to get tested before starting PrEP?”)

Also, remember you need to take PrEP for a while for it to reach maximum effectiveness. So if you go off of and later restart PrEP, you’ll need to take it daily for some time before you achieve the same high level of protection against HIV as before.2 (See: “How quickly does PrEP start working?”)

  1. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Updated 2017. Accessed August 2, 2017.
  2. PrEP. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/basics/prep.html. Updated June 7, 2017. Accessed August 2, 2017.

What if I Miss a Dose of PrEP?

If you miss any doses, try to get back on a daily schedule as soon as possible. But as long as you don’t make a habit of missing doses, missing one will not likely effect the level of protection PrEP offers from HIV.1

Missing multiple days can be more problematic, particularly for women who have been found to need to take PrEP more consistently to get maximum protection. For all people, daily use of PrEP is associated with increased effectiveness as compared with less consistent use.2 3 4

If you are having difficulty keeping up with the daily schedule you may want to discuss this with your health care provider.

  1. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Tranls Med. 2012; 4(151). doi: 10.1126/scitranslmed.3004006.
  2. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Tranls Med. 2012; 4(151). doi: 10.1126/scitranslmed.3004006.
  3. Grant RM. Review of clinical studies of intermittent PrEP. 9th International AIDS Society Conference on HIV Science, Paris, symposium presentation MOSY0804, July 2017. http://programme.ias2017.org/PAGMaterial/PPT/76_89/Bob%20Grant%20On-demand%20review%202017%20v4.pptx.
  4. Kashuba ADM. Does pharmacology support on demand PrEP? 9th International AIDS Society Conference on HIV Science, Paris, symposium presentation MOSY0803, July 2017. http://programme.ias2017.org/PAGMaterial/PPT/75_88/Kashuba%20IAS%202017%20Event%20Driven%20Final.pptx.

What Are the Potential Side Effects of PrEP?

Many people on PrEP report no or minimal side effects. Others may at first experience mild symptoms such as headache, abdominal pain and weight loss.1 These side effects tend to go away after about a month of being on PrEP. If you have any questions or concerns about side effects, consult your physician.

  1. Highlights of Prescribing Information. Federal Drug Administration Web site. http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021752s030lbl.pdf. Published 2012. Accessed August 2, 2017.

What About Longer-Term Health Effects of PrEP?

PrEP may lead to a modest decline in kidney function and bone density.1 2 3

However, research of people taking PrEP has found that both of these declines are likely reversible after stopping PrEP.4 5 6

Also, the kidney function and bone density declines have not led to significant problems with kidney health or bone fractures in PrEP studies.7 8 9 10

  1. Gandhi M, Glidden D, Mayer K, et al. Association of age, baseline kidney function, and medication exposure with declines in creatinine clearance on pre-exposure prophylaxis: an observational cohort study. The Lancet. 2016;3(11)e521-e528. DOI: 10.1016/S2352-3018(16)30153-9.
  2. Liu A, Vittinghoff E, Sellmeyer E, et al. Bone mineral density in HIV-negative men participating in a tenofovir pre-exposure prophylaxis randomized clinical trial in San Francisco. Plos ONE. 2011; 6(8): e23688. DOI:10.1371/journal.pone.0023688.
  3. Mulligan K, Glidden DV, Anderson PL, et al. Effects of emtricitabine/tenofovir on bone mineral density in HIV-negative persons in a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2015; 61(4):572-80. doi: 10.1093/cid/civ324.
  4. Grant R, Mulligan K, McMahan V et al. Recovery of bone mineral density after stopping oral HIV preexposure prophylaxis. Conference on Retroviruses and Opportunistic Infections, Boston, abstract 48LB, 2016. http://www.croiconference.org/sessions/recovery-bone-mineral-density-after-stopping-oral-hiv-preexposure-prophylaxis.
  5. Mulligan K, Hosek S, Kapogiannis BG, et al. Changes in bone mass after discontinuation of PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in young men who have sex with men (YMSM): extension phase results of Adolescent Trials Network (ATN)110. International AIDS Conference, Durban, 2016. http://programme.aids2016.org/Abstract/Abstract/10431.
  6. Mugwanya KK, Wyatt C, Celum C, et al. Reversibility of glomerular renal function decline in HIV-uninfected men and women discontinuing emtricitabine-tenofovir disoproxil fumarate pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2016; 71(4):374-80. DOI: 10.1097/QAI.0000000000000868.
  7. Gandhi M, Glidden D, Mayer K, et al. Association of age, baseline kidney function, and medication exposure with declines in creatinine clearance on pre-exposure prophylaxis: an observational cohort study. The Lancet. 2016;3(11)e521-e528. DOI: 10.1016/S2352-3018(16)30153-9.
  8. Mugwanya KK, Wyatt C, Celum C, et al. Reversibility of glomerular renal function decline in HIV-uninfected men and women discontinuing emtricitabine-tenofovir disoproxil fumarate pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2016; 71(4):374-80. DOI: 10.1097/QAI.0000000000000868.
  9. Liu A, Vittinghoff E, Sellmeyer E, et al. Bone mineral density in HIV-negative men participating in a tenofovir pre-exposure prophylaxis randomized clinical trial in San Francisco. Plos ONE. 2011; 6(8): e23688. DOI:10.1371/journal.pone.0023688.
  10. Kasonde M, Niska R, Rose C, et al. Bone mineral density changes among HIV-uninfected young adults in a randomised trial of pre-exposure prophylaxis with tenofovir-emtricitabine or placebo in Botswana. Plos ONE. 2014;9(3): e90111. DOI: 10.1371/journal.pone.0090111.

What If I Have Another STD, Can I Go on PrEP?

There is no evidence that having a sexually transmitted disease (STD) lowers how well PrEP works, though if you have an STD you should get it treated. Many STDs are curable and all are treatable. For some, including HPV and Hep B, vaccines are available.1 2

PrEP only protects against HIV. Condoms protect against other common STDs, in particular gonorrhea and chlamydia.3

  1. HPV (Human Papillomavirus) VIS. Centers for Disease Control Website. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv.html. Updated December 2, 2016. Accessed September 29, 2017.
  2. Hepatitis B Vaccination: What Everyone Should Know. Centers for Disease Control Website. https://www.cdc.gov/vaccines/vpd/hepb/public/index.html. Updated March 1, 2017. Accessed October 3, 2017.
  3. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61. https://www.ncbi.nlm.nih.gov/pubmed/15356939.

Does PrEP Protect Against Any Other STDS?

No, PrEP only protects against HIV. However, since twice-yearly STD screening is part of maintaining a prescription to PrEP, going on PrEP can help you more promptly diagnose and treat any sexually transmitted diseases (STDs) you may contract.1 Condoms provide protection against other STDs, in particular gonorrhea and chlamydia.2

  1. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Published 2014. Accessed August 2, 2017.
  2. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61. https://www.ncbi.nlm.nih.gov/pubmed/15356939.

DOES PREP WORK AFTER HIV EXPOSURE?

No, PrEP is pre-exposure prophylaxis, which means it must be taken before a possible exposure to HIV.

Also, PrEP must be taken for a certain number of days before it reaches maximum effectiveness. (See: “How quickly does PrEP start working?”)

If you think you may have been exposed to HIV, post-exposure prophylaxis, or PEP, is an emergency option to reduce the risk of contracting the virus. PEP involves starting a triple-drug combination of HIV drugs within 48 to 72 hours of the possible exposure and staying on the daily regimen for a month. Contact your health care provider or emergency room for a prescription. If the ER doesn’t understand your request, tell them to follow the same protocol as they would if they had a needle stick.1

  1. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV – United States, 2016. Centers for the Disease Control Web site. https://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf. Published 2016. Accessed September 29, 2017.

Do Alcohol or Drugs Affect How PrEP Works?

As long as you are taking PrEP as prescribed, alcohol and drug use should not directly affect how well PrEP works. However, substance use may affect how consistently you take the medication. Missing doses can lower PrEP’s effectiveness.1 2 3  (See “What if I miss doses of PrEP?”)

The one major study of PrEP among injection drug users (IDUs) suggests that it may not be as effective at preventing the transmission of HIV through needle, syringe and drug-works sharing as through sex. The IDUs in the study who reported they were taking PrEP as prescribed and at least had detectable PrEP in their blood had a 74 percent reduced risk of HIV.4 However, it is possible that those who took PrEP daily were better protected than that. (See: “How effective is PrEP?“)

  1. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Tranls Med. 2012; 4(151). doi: 10.1126/scitranslmed.3004006.
  2. Grant RM. Review of clinical studies of intermittent PrEP. 9th International AIDS Society Conference on HIV Science, Paris, symposium presentation MOSY0804, July 2017. http://programme.ias2017.org/PAGMaterial/PPT/76_89/Bob%20Grant%20On-demand%20review%202017%20v4.pptx.
  3. Kashuba ADM. Does pharmacology support on demand PrEP? 9th International AIDS Society Conference on HIV Science, Paris, symposium presentation MOSY0803, July 2017. http://programme.ias2017.org/PAGMaterial/PPT/75_88/Kashuba%20IAS%202017%20Event%20Driven%20Final.pptx.
  4. Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013;381(9883)2083-2090. http://dx.doi.org/10.1016/S0140-6736(13)61127-7.

CAN PREP BE USED DURING PREGNANCY?

Many women who have partners with HIV have used PrEP to conceive babies free from the virus. Research has led experts to conclude that there are no safety-based reasons that expecting or breastfeeding women should not take PrEP. There is considerable data on pregnant and nursing women with HIV safely taking the antiretroviral drug, Truvada, the same medication used in PrEP. 1

  1. Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding. AIDS. 2017; 31(2):213-232. https://www.ncbi.nlm.nih.gov/pubmed/27831952.

Is It OK to Take PrEP If I’m on Antidepressants?

The drug manufacturer’s official safety information on Truvada, PrEP’s brand name, does not list any antidepressants as potential conflicts.1 If you are concerned about combining any medications with PrEP, discuss this with your health care provider. It’s a good idea to always disclose all medications, supplements and vitamins you are taking to your clinician and pharmacist.

  1. Highlights of Prescribing Information. Federal Drug Adminstration Web site. http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021752s030lbl.pdf. Pp6-7. Published 2012. Accessed August 2, 2017.

DOES PREP AFFECT HORMONE THERAPY (OR THE REVERSE)?

There are no known drug interactions between PrEP and gender affirming hormones.1 2

Available data on PrEP use among transgender women suggests that it is very effective in protecting against HIV when taken as prescribed.3

  1. Transgender health and HIV. University of San Francisco, California Center of Excellence for Transgender Health Web site. http://transhealth.ucsf.edu/trans?page=guidelines-hiv. Accessed October 12, 2017.
  2. HIV/AIDS for Veterans and the Public. United States Department of Veterans Affairs Web site. https://www.hiv.va.gov/patient/faqs/prep-and-hormones.asp. Updated January 11, 2017. Accessed October 12, 2017
  3. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363:2587-2599. http://www.nejm.org/doi/full/10.1056/NEJMoa1011205.

What’s Involved with Getting on PrEP?

You will need to obtain a prescription for PrEP from a health care provider, such as a medical doctor or nurse practitioner. (See: “Where can I get PrEP?“)

Once you have found a provider or health center that provides PrEP, you will likely be asked some questions to help you determine if PrEP is a good fit for you. This may include questions about your sexual history and your use of condoms.

Before you can start PrEP you will need to take an HIV test to ensure you do not already have the virus, as well as have your kidney function checked and be tested for hepatitis B and C viruses.1 (See: “Why do I have to get tested before starting PrEP?“)

Once the test has confirmed you don’t have HIV, you can get a prescription for PrEP. Sometimes the first supply will be for one month, after which you may be asked to come back so your provider can see how you are responding to PrEP. If all is going well, you should receive three-month prescriptions from there on out. This means you’ll need to have check-ups four times a year, at each of which you’ll be re-tested for HIV.

  1. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Published 2014. Accessed August 2, 2017.

Why Do I Have to Get Tested for HIV Before Starting PrEP?

If someone who does have HIV takes PrEP, their virus can develop resistance to some medications used to treat the virus, which may limit future treatment options.1

  1. Lehman D, Baeten J, McCoy C, et al. Risk of drug resistance among persons acquiring HIV within a randomized clinical trial of single- or dual-agent preexposure prophylaxis. J Infect Dis. 2015; 211 (8):1211-1218. DOI: 10.1093/infdis/jiu677.

Why Do I Have to Come Back Every Three Months?

If for some reason a person with a PrEP prescription does contract HIV, it’s important to make sure they see a physician as soon as possible. If someone uses PrEP while they have HIV, their virus may develop resistance to some medications used to treat it.1 This may limit their options for treating HIV.

As long as you take PrEP daily as prescribed, your risk of contracting HIV is very low. (See: “How effective is PrEP?“)

At the routine visits required to stay on PrEP, your health care provider will also likely monitor you for any side effects of the drug and may provide helpful counseling on lowering your risk of HIV and other STDs.2 Also, you’ll get kidney function and STD tests every six months, more frequently if necessary. (See: “What are the potential side effects of PrEP?“)

  1. Lehman D, Baeten J, McCoy C, et al. Risk of drug resistance among persons acquiring HIV within a randomized clinical trial of single- or dual-agent preexposure prophylaxis. J Infect Dis. 2015; 211 (8):1211-1218. DOI: 10.1093/infdis/jiu677.
  2. Preexposure Prophylaxis For The Prevention of HIV Infection in The United States-2014. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Published 2014. Accessed August 2, 2017.

Why Do We Hear Different Figures About How Well PrEP Works?

Different studies have looked at different population groups – including gay men, trans women, heterosexual couples, and injection drug users.1 2 3 4

Figures of how well PrEP works may be a factor of crunching the numbers. For example, some studies only looked at whether people had detectable amounts of drug in their blood, while others looked at how consistently people used PrEP.5 6 7

Overall, when taken as prescribed, PrEP has been shown to be highly effective in protecting against getting HIV across all populations.8 9 10 11

(See: “How effective is PrEP?“)

  1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who Have sex with men. N Engl J Med. 2010; 363:2587-2599. http://www.nejm.org/doi/full/10.1056/NEJMoa1011205.
  2. Baeten J, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012; 367:399-410. DOI: 10.1056/NEJMoa1108524.
  3. Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. The Lancet. 2014;13(9)820-829. http://dx.doi.org/10.1016/S1473-3099(14)70847-3.
  4. Choopanya, K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013: 381:2083–2090. http://dx.doi.org/10.1016/S0140-6736(13)61127-7.
  5. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010; 363:2587-2599. http://www.nejm.org/doi/full/10.1056/NEJMoa1011205.
  6. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Tranls Med. 2012; 4(151). doi: 10.1126/scitranslmed.3004006.
  7. Choopanya, K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet 2013: 381:2083–2090. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61127-7/abstract.
  8. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of pragmatic open-label randomised trial. Lancet. 2016; 387:53-60. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00056-2.pdf.
  9. Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. The Lancet. 2014;13(9)820-829. http://dx.doi.org/10.1016/S1473-3099(14)70847-3.
  10. Baeten JM, Ndase P, Mugo MR, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl Med. 2012;367:399-410. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1108524.
  11. Choopanya, K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet 2013: 381:2083–2090. DOI: http://dx.doi.org/10.1016/S0140-6736(13)61127-7.

How Long Has PrEP Been Available?

The U.S. Food and Drug Administration (FDA) approved daily Truvada as PrEP in July 2012.1 Truvada is a blue tablet containing two medications, tenofovir and emtricitabine, and was first approved in 2004 as treatment for HIV in combination with other drugs.2

  1. HIV/AIDS Historical Time Line 2010 – 2015. Food and Drug Administration Web site. https://www.fda.gov/forpatients/illness/hivaids/history/ucm279695.htm. Published December 16, 2016. Accessed October 24, 2017.
  2. HIV/AIDS Historical Time Line 2000 – 2010. Food and Drug Administration Web site. https://www.fda.gov/forpatients/illness/hivaids/history/ucm151081.htm. Accessed August 2, 2017.