PrEP 101: All About the Medication that Prevents HIV

Have you heard of PrEP? Maybe you’ve seen commercials about it or Gilead pamphlets in your medical providers' office? Heard about it via word of mouth but weren’t too sure of the basics about it? Well if that is the case then don’t fear! Here is a short and handy guide for how you can get your hands on the most modern form of HIV protection science has to offer!

What is PrEP?

PrEP is the shorthand for Pre-exposure Prophylaxis medications. PrEP medications are used for preventing HIV. When individuals take a PrEP pill every day as prescribed they have a 99% chance of preventing themselves from becoming HIV positive. People take PrEP for different reasons. Some people take it because they have an HIV positive partner with a detectable viral load. For clarification, an undetectable viral load is when an HIV positive individual has less than 20 copies of the virus per mL of their blood and essentially can no longer transmit the disease to others. A detectable HIV viral load means the individual can pass along the disease to other people. You don’t have to have an HIV positive partner to take PrEP. Some individuals take it as a part of a general sexual health and protection routine. Others take it simply to add another layer of HIV protection, in addition to using condoms and getting tested every few months. Think of it as one more option in your sexual health toolkit!

How Does PrEP Work?

PrEP medications work similar to malaria prevention pills, or birth control pills. Individuals who take PrEP medications gain high levels of ARVs in their bloodstream. ARVs are antiretroviral medications that suppress the HIV virus and prevent it from replicating. Because of the high amount of ARVs in their bloodstream, genital and rectal areas, if there is any exposure to an HIV infection, the ARVs will stop the virus from entering the cells and replicating. This makes it impossible for the HIV infection to manifest in a person’s body and make them HIV positive.

Who Can Use PrEP?

PrEP medications can be used by anyone who believes that they may be at risk for contracting HIV. Medical providers are not allowed to determine whether someone is at risk- this is a decision made by the patient- you! While PrEP medications tend to be heavily advertised to the MSM population and folks with an HIV positive partner, PrEP can be used by anyone. And if at any point you stop being sexually active or feel you are no longer at risk, you feel free to stop taking it.

What Kinds of Drugs Can Be Used for PrEP?

Right now, there are two drugs that have been approved by the FDA to be used as PrEP: Truvada and Decovy. They more or less work the same, with a few small differences:

• Truvada was the first PrEP medication to come out and is 99% effective. While great at prevention, the pill is a bit larger than Descovy, and sometimes has side effects, such as nausea. These symptoms are uncommon and are usually gone in a couple of weeks
• Descovy is a newer, smaller pill, and is said to have less side effects than Truvada. It’s also equally as effective. Because it is newer clinical trials have not come out confirming it works for folks having receptive vaginal sex, so those having that type of sex should stick to Truvada.

Both are great options, depending on what your needs are!

What are the risks with PrEP?

All medications have side effects and risks, and PrEP is no exception. The main side effects that were noted with Truvada during clinical trials were: nausea, headaches, weight loss and an increase in serum creatinine. Descovy, the newest PrEP med, has less severe side effects than its Truvada predecessor. In clinical trials, less than 10% of participants noted any side effects.

How can I Pay for PrEP?

Truvada and Descovy are both produced by the drug company Gilead. Prescription assistance from this company depends on what kind of insurance you have:

• Private insurance: these companies have varying coverage for PrEP, and copay costs can be high. Gilead offers co-pay cards that cover up to $7,200 worth of co-pay cost per 12 months. You can get these cards from your medical provider.
• Public insurance: folks with Medicaid insurance typically have complete coverage for PrEP, with little to no co-pay. Folks with Medicare insurance may have a co-pay depending on what Part D pharmacy plan you have. Because of government restrictions, folks with Medicare cannot receive Gilead prescription assistance, but there are groups like Good Days and the PAN foundation that have some support options.
• Uninsured folks: Gilead offers an Advancing Access program that enables individuals to get their medications for free. Coverage is unlimited but must be renewed with your medical provider every 6 months. Certain community clinics also have programs to cover lab and appointment costs for uninsured folks. The Department of Health and Human Services also recently started a Ready, Set, PrEP program to further help uninsured individuals get PrEP for free.

Where Can I Get PrEP?

All primary care providers have the capacity to prescribe PrEP to their patient, so if your interested ask about it in your next appointment. If you’d like to talk to a medical provider with specialized experience in HIV/STI prevention and treatment, the PrEP Locator database has a list of PrEP providers broken down by zip code. Most places will have you take an HIV test to ensure you are negative before writing the prescription but once you get the confirmation you are good to go. During your next medical appointment talk to your provider about if PrEP would be a good option for you!