What is HIV PrEP?

HIV pre-exposure prophylaxis, commonly known as PrEP, is a preventive medication that significantly reduces the risk of contracting HIV. PrEP contains antiretroviral drugs to block HIV from establishing an infection if you are exposed to the virus. When taken as prescribed, PrEP can reduce the risk of HIV transmission by greater than 90% in people with sexual exposure and greater than 70% among people who inject drugs.

Approved by the FDA in 2012, PrEP has become an essential tool in the fight against HIV. Over the years, PrEP options have expanded, offering individuals different ways to incorporate HIV prevention into their lives. This includes a daily pill, an on-demand dosing method, and a long-acting injectable. It's important to note that while PrEP is highly effective against HIV, it does not protect against other sexually transmitted infections (STIs) or replace the need for regular sexual health check-ups and other safer sex practices.

Different Ways to Take PrEP

1. Daily Oral PrEP
   This is the most common and well-known form of PrEP. It involves taking a single pill every day. When taken consistently, it offers maximum protection against HIV - up to 99% with optimal adherence. Daily oral PrEP is ideal for individuals who prefer a simple, once-daily routine. There are two FDA approved medications that are on the market, Tenofovir DF-emtricitabine (Truvada) and Tenofovir alafenamide-emtricitabine (Descovy). It’s important to know that Descovy should not be used in those who have receptive vaginal sex as its efficacy has not been well established in this population.

2. On-Demand (Event-Driven) PrEP
   Also known as "2-1-1 dosing," on-demand PrEP is an alternative, non-FDA approved, method primarily recommended for cis-men who have sex with cis-men (MSM). This regimen involves taking two pills of Truvada 2-24 hours before sex, one pill 24 hours after the first dose, continued every 24 hours until 48 hours after the last sexual encounter. On-demand PrEP can be a good option for individuals who have infrequent and predictable sexual encounters or those who are unable to commit to daily continuous therapy. This method has been shown to be up to 86% effective at preventing transmission of HIV. However, it's crucial to discuss this method with a healthcare provider to ensure it's suitable for your specific circumstances.

3. Injectable PrEP
   A newer option, injectable PrEP involves receiving an injection of a long-acting antiretroviral drug, cabotegravir (Apretude) every two months. Injectable PrEP offers the same high level of protection against HIV as daily oral PrEP and may be an ideal option for individuals who have difficulty adhering to a daily pill regimen or who prefer not to take pills.

Who Should Consider Taking PrEP?

PrEP is recommended for individuals who are at a higher risk of HIV infection, but is offered to all who request a prescription. Your doctor may recommend PrEP if you fall into any of the following categories:

1. Individuals in a Sexual Relationship with a Partner Living with HIV
   If your partner living with HIV is adherent to their antiretroviral therapy (ART) and have a reliably undetectable viral load, there is no risk of HIV transmission. This is known as “Undetectable = Untransmittable” (U=U). However, if your partner is not consistently on ART, has a detectable viral load, or if their viral load status is unknown, you may be at increased risk and PrEP can provide an extra layer of protection. This is particularly relevant in ‘serodiscordant’ relationships, where one partner is living with HIV and the other is not. PrEP can offer peace of mind and additional security for both partners, especially during times when viral suppression might be uncertain.

2. Cisgender Men Who Have Sex with Cisgender Men (Cis-MSM)
   Cis-MSM communities have been disproportionately affected by the HIV epidemic. If you are a cis-man who has sex with cis-men and do not consistently use condoms, or if you've been diagnosed with a bacterial STI in the past six months, you would likely benefit from PrEP. Both daily and on-demand PrEP are viable options for cis-MSM, depending on individual preferences and lifestyle.

3. Transgender Women
   Studies have shown that transgender women, in particular, are at a higher risk of HIV acquisition. Transgender women who are sexually active, particularly those who have condomless sex with sperm producing partners of unknown HIV status are likely to benefit from PrEP as part of their sexual health strategy.

4. Individuals Who Engage in Condomless Sex with Multiple Sexual Partners
   If you often engage in sex without using condoms with more than one partner whose HIV status you do not know, PrEP can be a highly effective tool in reducing your risk of HIV. This applies to individuals of any gender or sexual orientation.

5. People Who Inject Drugs
   Individuals who inject drugs and share needles or other injection equipment are at a heightened risk of HIV. PrEP can reduce this risk significantly, particularly when combined with access to clean syringes and other harm reduction strategies.

6. Sex Workers
   Individuals who engage in sex work may have an increased risk of HIV exposure due to the nature of their work. PrEP can serve as an additional protective measure, alongside other safer sex practices.

7. Individuals Recently Diagnosed with an STI
   A recent STI diagnosis can indicate an increased risk of HIV. If you have been diagnosed with an STI in the past six months, particularly a bacterial STI like syphilis, gonorrhea, or chlamydia, PrEP may be a beneficial addition to your sexual health routine.

Is PrEP Right for You?

PrEP is a powerful tool in HIV prevention, but it's not one-size-fits-all. The right method of PrEP depends on your lifestyle, preferences, and specific risk factors. Whether you’re prescribed daily dosing, on-demand dosing, or long-acting injections, to be effective, PrEP requires good adherence to the regimen and regular follow-up appointments with your doctor for routine testing and refills.

Ready to Take Control of Your Sexual Health? Get Started with PrEP Today!

If you’re looking to lower your risk for HIV and think PrEP might be right for you, schedule a free meet & greet with us at PridePoint Health! We offer expert STI prevention and treatment strategies to help you enjoy a healthy and fulfilling sex life. Our all-inclusive PrEP and STI services include comprehensive consultations, prevention strategies for other STI’s, including DoxyPEP, lab orders, prescription management, and in-person care in the comfort of our private clinic in Portland, OR. You can also ask us about injectable PrEP (cabotegravir/Apretude) and the option to use Home STI Testing Kits with no blood draws required.

Let us help you find the best PrEP option so you can take charge of your health and feel confident every step of the way!

Ryan Coe, MD
PridePoint Health

Nothing in this post creates a physician-patient relationship with the reader. 
Speak with your own health care provider prior to making any changes regarding your medications.