PrEP (pre-exposure prophylaxis) is a type of medication taken before possible contact with Human Immunodeficiency Virus (HIV). HIV is a virus that can weaken the immune system by attacking certain white blood cells. PrEP generally refers to a once daily pill taken to lower your chances of getting an HIV infection from anal or vaginal sex or sharing injection equipment, such as needles.
Certain groups have a greater chance of contracting HIV than others. This might include anyone who:
- Has a sexual partner who is HIV positive and has detectable virus in the blood or a partner whose HIV status is unknown
- Has another sexually transmitted infection, such as gonorrhea (this weakens the lining of internal organs, making it easier for the HIV virus to get through)
- Uses condoms inconsistently or not at all
- Has vaginal / front hole atrophy or another infection (like gonorrhea, syphilis, urethritis, BV or even a current HSV flare), which can cause small breaks in the skin, allowing more of a chance for a virus, like HIV to get through
- Shares injection equipment with people who may be HIV positive
Keep reading for 9 facts you should know about PrEP, one of the most commonly prescribed HIV prevention methods.
1. There are two kinds of daily PrEP medication.
The first pill introduced had the brand name Truvada (emtricitabine-tenofovir disoproxil fumarate) or TDF/FTC for short. A newer brand name pill is called Descovy, which isn’t any easier to pronounce—emtricitabine-tenofovir alafenamide, also abbreviated to TAF/FTC. Both were created by pharmaceutical manufacturer Gilead Sciences. Both have been expensive and not always covered by health insurance plans. However, the patent for Truvada recently expired in 2021, which means it can finally be manufactured for a lower cost. Generic Truvada, or TDF/FTC, is the form of daily PrEP offered by us here at FOLX.
This brand of PrEP can be taken with or without food and can be taken when drinking alcohol or using drugs. It can also be split in half or crushed if needed to help take the pill.
2. The important thing with PrEP is to make it a daily routine.
Those on PrEP need to take just one daily pill. Many people find it helpful to take their pill at the same time each day alongside something else you do normally, like brushing teeth or drinking coffee. You can also opt for a daily alarm or calendar reminder. According to the CDC, daily PrEP is 99% effective at preventing an HIV infection through anal or vaginal sex. It’s also at least 74% effective when exposed to HIV through injection drug use.
When routines may be disrupted (traveling, staying out overnight, etc), you can carry extra pills to ensure you still take your PrEP pill daily. In that case, we recommend carrying a pill box. There isn’t any evidence that more than one daily pill offers extra protection. In fact, taking too many pills could be detrimental for your health.
3. It takes one to three weeks for PrEP to adequately provide protection.
Once you start taking PrEP, it unfortunately doesn’t provide maximum protection on the first day. It takes about seven days for PrEP (TDF/FDC) to provide protection from HIV from anal sex, and 21 days to provide protection for vaginal sex or injectable drug use.
4. It’s okay to accidentally miss a dose, but it’s important to get back into the routine as soon as possible.
No matter what type of routine medication you’re on, universally, humans sometimes forget to take our meds. Typically, if it’s under 12 hours from when you normally take your daily pill, you can still take it. However, if it’s been more than 12 hours from the normal time, it’s recommended that you wait for your next dose.
5. PrEP generally has few side effects, but they’re often easily managed.
About 1 out of 10 people experience side effects. These side effects can include gas, bloating, softer/more frequent stools, or nausea. Often, these are mild side effects that generally go away after the first month on PrEP. Taking the pill with food (such as a snack or meal) or at bedtime can help with side effects. If lactose intolerant, it may help to take PrEp with Lactaid to help digest it as expedients in PrEp can be similar to lactose.
If you’re experiencing other side-effects, don’t hesitate to follow up with your health care provider with any questions or concerns.
6. PrEP is not 100% effective and doesn’t protect against other STIs.
Since PrEP is 99% effective at preventing an HIV infection (when taken as prescribed), it unfortunately doesn’t protect against other sexually transmitted infections (STIs) like chlamydia, syphilis, or gonorrhea. For those sharing injection equipment, PrEP does not protect against hepatitis C. We recommend seeking additional forms of protection to supplement PrEP, such as condoms and regular STI testing.
7. Check in with a clinician before stopping PrEP.
We encourage those who would like to stop taking PrEP to contact the clinician who prescribed it to ensure it’s safe to stop. To be fully protected, PrEP should be taken for 7 days after a likely exposure to HIV. After stopping PrEP, it’s advised to get an HIV test four weeks later to ensure you're still HIV negative.
8. When starting or restarting PrEP, it’s very important to get an HIV test first.
If someone is already positive for HIV and starts taking PrEP (TDF/FDC), this would be an incomplete treatment or regimen for HIV infection and can lead to resistance over time unless another medication, or different combination is added. Therefore, it’s required to be tested for HIV when starting or restarting PrEP after being off of it for seven days or more.
9. Taking PrEP also requires lab HIV testing every few months for safety.
People taking PrEP should stay in touch with their clinician as long as they are on the medication. HIV testing is required every three months after starting. Additionally, creatinine (kidney function) tests are required when starting PrEP and then every six to twelve months.
Interested in being prescribed PrEP with TDF/FTC? The FOLX process begins here. For existing FOLX members interested in adding a PrEP prescription to their plan, you can reach out to your clinician through your Athena patient portal or our member advocates at firstname.lastname@example.org. Read up on all things sexual health here (including FAQs about PrEP and PEP) and feel free to reach out with any further questions at email@example.com.