When you think of HIV prevention, condoms are probably the first thing that comes to mind (which is great, because they should! Condoms are a proven method to reduce your risk for HIV and other sexually transmitted infections during intercourse.) But there is another option for those who may be at higher risk for HIV—pre-exposure prophylaxis, or PrEP.
PrEP involves taking medication to prevent HIV infection. Oral PrEP involves taking a pill once daily to prevent HIV infection in someone who is HIV-negative. Currently there are two pills approved for PrEP:
- Truvada (for anyone at-risk for HIV) and
- Descovy (for those at risk except for people assigned female gender at birth who may be at risk for HIV from vaginal sex).
When taken consistently, every day, oral PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by about 99%.
The newest PrEP option—Apretude—is given as an injection every two months (following two initiation doses given a month apart). This option is approved to reduce the risk of sexually acquired HIV in at-risk adults and adolescents weighing at least 77 pounds.
Who should take PrEP?
So who is PrEP recommended for? The Centers for Disease Control and Prevention (CDC) offers these guidelines on people who should consider taking PrEP:
- Anyone who is in an ongoing relationship with someone who is HIV-positive.
- Gay or bisexual men who have had anal sex without a condom or have been diagnosed with an STI in the past 6 months.
- Heterosexual men or women who do not regularly use condoms with partners with an unknown HIV status who are at substantial risk for HIV infections (e.g. people who inject drugs).
- People who have injected illicit drugs in the past 6 months and have shared injection equipment or have been in treatment for injection drug use in the past 6 months.
While PrEP is recommended for different groups, it has received the most attention in the gay community. Gay and bisexual men are disproportionately affected by HIV: in 2013, they accounted for 81% estimated HIV diagnoses among all males aged 13 years and older and 65% of all persons receiving an HIV diagnosis that year. Given these alarming statistics, PrEP has been endorsed as an important prevention tool by a number of prominent activists and organizations, including the Human Rights Campaign, the Gay Men’s Health Crisis, AIDS United, and the World Health Organization.
However, PrEP has garnered some controversy as well. Among the criticisms is one that echoes the controversy that surrounds HPV vaccines—the assumption that PrEP will lead to risky sexual behavior and promote promiscuity. But as with HPV vaccination, research has shown that such fears are unfounded. A study of the multinational iPrEx study that first established the effectiveness of a daily dose of Truvada to prevent HIV found “no evidence of risk compensation that would offset the benefits of PrEP.” In other words, no evidence that taking PrEP led to risky sexual behavior. In fact, the reverse was true. As the study authors note, “Indeed, participation in the study was associated with safer sexual behavior.”
Another concern voiced is that PrEP will cause gay and bisexual men to abandon condoms, which have been a mainstay of HIV prevention efforts. But an analysis by CDC shows condom use on the decline before the approval of Truvada as PrEP in 2012. The CDC data indicate that in 2011, 57 percent of men who have sex with men reported having unprotected anal sex at least once in the previous 12 months, up from 48 percent in 2005. Given the decline in condom use, the availability of another prevention method should be welcomed.
But this not to suggest that PrEP replaces condoms. Far from it. Rather, PrEP offers a new option to those at high risk—another tool in the HIV prevention toolbox that fits alongside condoms, not as a replacement. After all, while PrEP helps prevent HIV infection, condoms offer protection against a host of other STIs as well.
Despite the promise offered by PrEP, it is necessarily the right choice for everyone. In addition to requiring taking a pill every day consistently, those on PrEP are also advised to see healthcare provider regularly for follow up and get tested for HIV every 3 months. But for those willing to take on the commitment, PrEP offers the promise of a highly effective way to prevent HIV.
Where to Find PrEP
If you are interested in PrEP, you’ll want to find a provider who is both knowledgable about PrEP and supportive of your decision. If you have a regular healthcare provider, you can start there. The Centers for Disease Control and Prevention offers a brochure with questions to ask your doctor about PrEP. If you don’t have a healthcare provider, you can check our site sayyestoprep.org to search for a provider in your area.
Planned Parenthood clinics also offer PrEP. You can search for a clinic near you here.
The Ready, Set, PrEP program provides access to PrEP medications for free to people who qualify. You can apply for the Ready, Set, PrEP program if you:
- Don’t have health insurance coverage for prescription drugs.
- Have taken an HIV test and received a negative result before starting the program.
- Have a prescription for PrEP.
- Live in the United States including tribal lands and territories.
Learn More about PrEP
- The Advocate series “31 Days of PrEP”
- FAQs about PrEP from CDC
- Stories from men who explain why they take PrEP from the Advocate
- We>AIDS offers information on getting and paying for PrEP, as well as stories from people about why they chose to take PrEP.