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What is PrEP? Everything to know about the HIV prevention pill

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The field of HIV prevention has witnessed revolutionary developments in recent years, specifically with Pre-Exposure Prophylaxis (aka, PrEP). PrEP is a groundbreaking medicine used to reduce the risk of HIV transmission among individuals at high risk of infection. When taken as prescribed, PrEP can lower an individual’s chance of getting HIV from sex by up to 99%. Using condoms with PrEP is even safer. Read on to learn more about the intricacies of PrEP and its various forms (Descovy, Truvada and Apretude), how it works, who it’s for, how to obtain it, and how to use it effectively.

What is PrEP medication?

Pre-Exposure Prophylaxis, or PrEP, is a preventive approach for individuals at high risk of acquiring HIV. The primary goal of PrEP is to provide a protective shield against HIV before exposure occurs, and it does this by blocking an enzyme HIV needs to make copies of itself inside the body. 

Who and What is PrEP For?

PrEP is an HIV prevention strategy for individuals who are HIV-negative but are at high risk of acquiring the virus. 

Anyone who is sexually active and HIV-negative can use PrEP, but PrEP medication is intended for individuals who are at high risk of HIV infection. This includes:

  • Men who have sex with men
  • Transgender people
  • Individuals of any gender or sexual orientation with a partner that is HIV-positive 

PrEP is also for people who partake in high-risk behaviors like not using condoms regularly, sharing injection drug equipment (needles), or having multiple sexual partners.

How to Use PrEP

PrEP can be used in pill form or as an injectable shot. There are three ways PrEP can be used for HIV prevention.

  1. A pill taken daily.
  2. A shot given every other month.
  3. “On-Demand” PrEP (aka, “event driven” or “non-daily” PrEP) in which an individual takes the pills only at times when they’re at risk of getting HIV.
    • Known as the 2-1-1 method, this involves taking 2 PrEP pills 2-24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose.

Talk to your healthcare provider about which method is best for you. It’s also important to note that individuals on PrEP will need to have regular check-ups while on the medication. 

What Are The Different Types of PrEP Medication? Truvada, Descovy and Apretude

  • Truvada:
    • Truvada is the first FDA-approved medication for PrEP. Developed by Gilead, it is a pill and is prescribed to people at risk of acquiring HIV through sex or injection drug use. It’s also available in its generic form: tenofovir disoproxil fumarate and emtricitabine.

  • Descovy:
    • Descovy is a newer PrEP pill—also developed by Gilead—that is for people who are at risk of acquiring HIV through sex, but not everyone can use it. Descovy is not for people assigned female at birth because its effectiveness on vaginal sex has not been studied.  

  • Apretude:
    • Apretude is an injectable PrEP treatment for HIV. Individuals start Apretude with two initial injections given a month apart, followed by an injection every two months. Apretude is for people at risk of acquiring HIV who weigh at least 77 pounds. 

The side effects of taking PrEP pills can include headaches and nausea in the “start-up” period, and the PrEP shot may cause swelling and redness at the site of injection. While everyone’s body reacts differently to different medications, most people find the side effects of PrEP to be marginal and manageable. 

Can you switch from PrEP pills to a shot? 

If you decide to switch your method of PrEP medication from a pill form to the shot, talk to your healthcare provider first.

How to Get PrEP

The first step in obtaining PrEP is finding a healthcare provider who will prescribe it to you. Medical providers including doctors, nurse practitioners and physicians’ assistants can prescribe PrEP.

Once you’ve found a medical provider who can prescribe PrEP, you’ll go through a medical consultation in which the provider will assess risk factors and suitability for PrEP. It’s important to be honest with your healthcare provider about the sex you have and the types of protection you use in order for the assessment to be as accurate as possible. 

Your medical provider will also give you tests for HIV (you can’t go on PrEP without a negative HIV test) and other sexually transmitted infections before prescribing PrEP. If all the lab work comes back normal, then you can start PrEP. You will be required to test for HIV while on PrEP, and as long as you keep testing negative, you can keep taking PrEP. 

No time to see a healthcare professional in person? No problem! There are online services like Mistr that aim to make obtaining PrEP more accessible. It connects potential users with licensed healthcare professionals who can evaluate their eligibility for PrEP and issue prescriptions from there. If a user’s health insurance doesn’t cover PrEP, Mistr can help them qualify for patient assistance programs to avoid out-of-pocket costs. According to their site, the doctor consults and STI testing is free through Mistr. And if you already have a PrEP prescription, they offer free home delivery in the United States. 

How Much Does PrEP Cost?

Most health insurance plans—including Medicaid—cover PrEP. If you don’t have health insurance, there are options to help cover the cost of PrEP. The Ready, Set, PrEP program provides free PrEP to those who qualify. They also give participants the option to have their PrEP medication sent to their home or healthcare providers.

Gilead, the company that developed Truvada and Descovy, has a medication assistance program where qualified individuals without insurance could obtain PrEP for free, or receive co-pay assistance, patient assistance, or access programs.

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