Prevention with PrEP

by Robert Phillips

Protecting against HIV is a concern for pretty much anyone who has sex, especially for gay and bisexual men, who make up about two thirds of all HIV positive people in the US. On top of other methods and lifestyle changes, PrEP is a medication that can help prevent the spread of HIV.

What is PrEP?

PrEP is a daily medication that reduces your risk of contracting HIV if you are not HIV-positive. It stands for pre-exposure prophylactic, meaning that it works to prevent you from contracting HIV before you are exposed to the virus. It’s recommended for people who are at high risk for HIV, especially gay and bisexual men, people whose partners are HIV positive, and people who use IV drugs.

How does it work?

If you are in an at-risk group, you would take PrEP pills daily. PrEP contains the same mix of medications that’s used to treat HIV for people who are HIV positive, emtricitabine and tenofovir, under the brand name Truvada. Although there are multiple drugs to treat HIV in people who test HIV-positive, this medication is the first to be approved for use in PrEP for people who don’t yet have HIV. It works by blocking the enzyme that the HIV virus uses to reproduce itself, so it can suppress the virus in people who are positive and prevent it from infecting others who are exposed to HIV. Other HIV medicines are still being studied to see if they can work for PrEP treatment as well.

How effective is PrEP?

When it’s taken exactly as directed, PrEP is 92- 99% effective at protecting against HIV. It’s important to take the pill daily at around the same time because missing or skipping a dose lowers PrEP’s effectiveness. According to the San Francisco AIDS Foundation, if you remember to take PrEP 4 times a week, it will be 96% effective in preventing HIV. If you only take 2 pills per week, that drops to only 76%.

What can put me at risk of getting HIV?

HIV is transmitted through having contact with the bodily fluids, like blood, semen, or rectal fluids, of someone who is HIV-positive. Having sex without a condom, especially if you are having anal sex and especially if both you and your partner are men or transgender women, is one of the most common ways to transmit HIV in the United States.

Having sex with multiple partners, especially unprotected sex, increases the odds that you will have sex with someone who is HIV positive. IV drug use and sharing needles or using dirty needles also increases your risk of contracting HIV.

Are there side effects to taking PrEP?

Scientists are still studying the long-term effects of PrEP and other HIV medications. In drug trials for Truvada as PrEP, most people reported few or no side effects. It’s common to have some nausea especially in the first one to two weeks of taking the medication, but it typically goes away with time.

Some of the biggest concerns are that it could cause damage to your kidneys or reduce your bone density. In one and two year studies, they observed only a small risk of negative effects on patients’ kidneys. They found that bone density was affected, but only in a small percentage of patients. The researchers agreed that more research needs to be done on people who take PrEP for longer than two years.

It’s important to weigh the pros and cons of these possible side effects with a potentially higher risk of getting HIV without PrEP.

Will taking PrEP lead to taking more sexual risks?

Some critics are concerned that if people are protected from getting HIV by taking PrEp, they’ll be more likely to skip other precautions against HIV like using condoms. Even though some especially high-risk groups, like gay and bisexual men who regularly have sex without condoms, may continue to do so, other men who usually use condoms tend to continue using them while on PrEP. Feeling more confident that you won’t contract HIV because of PrEP may make you less concerned about using other prevention techniques, but PrEP works best combined with them.

If I start taking PrEP, do I have to keep taking it forever?

It’s common to stop taking PrEP when your situation changes and puts you at a lower risk of contracting HIV. If you start taking PrEP when you’re single and seeing different people, but you get into a long-term monogamous relationship with someone who’s also negative, you might not need PrEP as much as before. If you break up a few years later and start casually dating again, you might consider starting PrEP again. These types of life changes and changing needs can also be a factor in your concerns about long term side effects from HIV treatment, since you don’t necessarily have to be on PrEP long term.

How can I start PrEP?

PrEP is a prescription treatment, so you need to talk to a doctor before you start it. You can tell your doctor that you’re interested in PrEP, and talk more about your potential risk factors for getting HIV. To start PrEP, you have to be sure that you’re HIV-negative, so you’ll need an HIV test. Once you’re on PrEP, you usually need to get re-tested every three months.

Truvada for PrEP costs about $1,300 out of pocket, but it’s covered by most health insurance, so you can get it for your regular prescription copay. If you don’t have insurance coverage, you might be able to get financial assistance from the drug’s manufacturer, or you can consider participating in a study about PrEP.

What can I do with or instead of PrEP to reduce my risk of contracting HIV?

You can use any other methods of HIV prevention with or without PrEP. One of the biggest factors is using a condom with every partner, especially if you’re not sure about their HIV status. With that said, it’s important to be able to talk to your partners about HIV and other STIs, and for both of you to be able to talk about your needs and concerns.

Doctors and researchers also recommend being cautious about casual sex, since it can increase your risk of exposure to HIV. Getting tested regularly will keep you informed about your status. It’s recommended for gay and bisexual men to be tested for HIV at least once a year, and if you know that you’re at higher risk for HIV you may want to get tested more often.

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