PrEP & PEP
Pre-exposure prophylaxis (PrEP) is an HIV prevention option for people who are HIV-negative. It involves taking one pill a day of an anti-HIV medication to reduce the risk of becoming HIV infected. Several studies have shown that, when taken as directed, PrEP reduces the risk of becoming HIV infected by 99%. The Center for Disease Control (CDC) and World Health Organization (WHO) recommends PrEP for MSM.
PrEP is only effective against HIV and does not provide any protection against other sexually transmitted diseases STDs. However using PrEP in combination with condoms provides protection against HIV and many STDs.
What’s in PrEP?
Currently, only one pill (containing two medications) called Truvada has been approved by the CDC for use as PrEP.
Is PrEP Safe?
Studies around the world proved that daily Truvada use as PrEP is safe and well tolerated by men and women. Truvada was approved by the Food and Drug Administration (FDA) in July 2012 for the prevention of HIV in HIV-negative adults over the age of 18.
How Effective is PrEP?
For people who take PrEP daily, their estimated level of protection against HIV is 99%.
There is data suggesting that missing several doses of PrEP will still provide some protection against HIV. The Center for Disease Control and World Health Organization recommend PrEP daily.
How Long Does It Take For PrEP To Take Effect?
It takes seven days of taking a daily pill for PrEP to provide maximum levels of protection against HIV in your butt and 20 days for maximum protection in the vaginas of women (studies have not yet been done with transgender men.).
How Do I Get On PrEP?
Truvada must be prescribed by a medical provider.
Required Tests Before You Start PrEP
A medical provider may conduct a thorough medical history and talk to you about your recent sexual behavior, sexual behavior goals, and condom use. Possible side effects will also be discussed with you (see below). The following tests should always be done:
HIV antibody test and HIV viral load (RNA) test via blood draw. These highly sensitive tests make sure you do not have HIV before starting PrEP.
Kidney functioning test to check your Creatinine levels via blood draw.
Hepatitis B & C antibody tests via blood draw
STD screening including Gonorrhea (oral/anal swab and urine), Chlamydia (oral/anal swab and urine), Syphilis (blood draw). Make sure your provider always includes anal and oral swabs when doing these tests.
After your test results come back, the medical provider may want to see you and/or speak to you to discuss the results and possible side effects of PrEP. You may then get a 30 day prescription.
Possible Side Effects
A small number of people using PrEP report that they have headache, nausea, or weight loss when they first started taking Truvada. In most people, these side effects improve or went away after several weeks of continuing the medication.
A small number of people taking Truvada had a decrease in kidney function and/or small decreases in bone density (thickness). Both of these types of issues got better when they were detected early and the individuals stopped taking Truvada.
A medical provider should order the following tests to check on your health and tolerance for PrEP medication:
HIV antibody test (blood test) every 3 months
Kidney functioning test to check your Creatinine levels (blood test) every six months
STD screen including Gonorrhea (oral/anal swab and urine), Chlamydia (oral/anal swab and urine), Syphilis (blood draw). Make sure your provider always includes anal and oral swabs for these tests. These should be ordered at least every 6 months but we encourage all sexually active MSM to be STD tested every 3 months.
A Hepatitis C antibody test may be ordered every year.
Tips on talking to your doctor about PrEP
Many medical providers may not be familiar with PrEP so you may have to educate them as you advocate for yourself. (This is not a fair or comfortable situation, but its reality.) The best way to advocate for yourself is to be educated and confident in your decision to try PrEP.
Be prepared to have an open and honest discussion with your provider about your sexual health and the reasons you believe that you should be prescribed PrEP. The most basic reason may be that you are a sexually active MSM who wants to do all you can to protect yourself from contracting HIV. Let the provider know that there are over 100,000 other MSM worldwide who have also chosen PrEP as an HIV prevention tool.
Uneducated providers may not understand the need for PrEP when use of condoms has been shown to be effective in prevention HIV and other STDs. Let the provider know that consistent condom use among MSM in the last decade has substantially decreased. While condoms are still an effective tool against HIV, PrEP can add exponential effectiveness in protecting your health.
If the provider needs education on PrEP, pass along the following links:
CDC Guidelines for Medical Providers
San Francisco Health Network Guide
If your provider does not know about PrEP and needs guidance from other medical providers, refer them to the Clinical Consultation Center Prepline:
How Do I Find A Provider to Prescribe PrEP
Work with your primary care medical provider, if you have one. If you don't have a primary care provider or need to find a specific provider for PrEP, check the link below.
How do I Pay for PrEP?
PrEP is covered by many private insurance plans and by Medicaid in many states.
If you do not have insurance or need assistance with the costs, your healthcare provider can talk to you about medication assistance programs that help pay for PrEP. Gilead, the company that makes Truvada also has co-pay assistance program that can also help cover the cost of the medication for those who qualify.
Current Research on PrEP
Several other medications are currently being studied as possible options for PrEP use. In addition, trials are being conducted on the effectiveness of one PrEP shot that lasts for 30 days as an alternative to daily pills. However, none of these options has yet been proven to be effective or approved by the FDA.
Check back to this section for updates on research.
For More Information about PrEP
CDC PrEP Fact Sheet
SF Dept of Pubic Health "PrEP: Our Sexual Revolution
San Francisco AIDS Foundation PrEP Facts
GMHC PrEP Facts
PEP stands for post-exposure prophylaxis and is used for someone who is HIV negative after he has had a potential exposure to HIV. Antiretroviral medicines (ART) are started a maximum of 72 hours after a possible exposure. However its best to start the medication as soon as possible. If you’re prescribed PEP, you’ll need to take it daily for 28 days. PEP has shown to be generally effective in preventing HIV when administered correctly.
How to Get PEP
If you think you have had a recent exposure to HIV through sex or a needle, contact a medical provider immediately or go to the emergency room. If the provider has questions about PEP, he/she can call the Clinical Consultation Center Pepline to get guidance from other medical professionals: (888) 448-4911. This line is only for medical providers.