PrEP or pre-exposure prophylaxis, is a pill taken every day to help protect people who don’t have HIV but have a greater risk of being exposed, such as people with an HIV-positive partner.
When taken consistently, the PrEP regimen can dramatically
PrEP is a powerful preventive tool that should be explored by all people who feel like they have a risk of contracting HIV.
With approximately 40 million people worldwide living with HIV or AIDS in 2023, PrEP is a hugely impactful drug. However, due to stigma and lack of knowledge — especially among the cisgender, heterosexual community — lack of awareness remains a big problem.
It’s important for everyone to know what PrEP is and how it works, and to feel comfortable talking about it openly so more people can get the care they need.
PrEP, sometimes known by the brand name Truvada, has been approved by the Food and Drug Administration for HIV prevention since
Truvada started by marketing to the LGBTQ community, because the rates of HIV and AIDS have historically been much higher in this group since the discovery of the virus in the early 1980s.
Truvada is not the only type of PrEP medication.
HIV is transmitted through certain bodily fluids: blood, semen, pre-seminal fluids, vaginal fluids, rectal fluids, and breast milk.
In the United States, HIV is mainly transmitted through anal or vaginal sex without barrier methods and sharing needles. Men who have sex with men are the most severely affected population and are considered to have a higher risk. Taking PrEP daily can help prevent transmission of the virus during anal or receptive vaginal sex without a condom.
However, this doesn’t mean straight, cisgender people who do not engage in anal sex aren’t at risk. In fact, according to the
But even the members of the LGBTQ community who are using PrEP have been the target of backlash and “slut-shaming,” both from within the community and outside. The stigma some people feel from taking PrEP, as well as potentially limited access to the clinicians who will prescribe them, hinder increased uptake.
Misinformation about the drug’s safety and side effects may also deter potential PrEP users.
PrEP has been shown to be safe. Although it can cause some side effects, such as nausea or vomiting, these tend to be mild and go away over time.
It’s important for everyone, regardless of sexual orientation or lifestyle, to understand what the drug is and how it works, so that those who benefit from taking it can access it. Widespread knowledge and awareness of the drug is crucial for HIV prevention.
One example of the PrEP pill (taken daily) is a combination of two HIV medications: tenofovir and emtricitabine. These work by having different systems in the body store antiretrovirals (ARVs). Other medications include descovy and cabotegravir.
When the body is exposed to HIV, these ARVs kick into gear and stop the virus from entering cells in the system. Without the virus being able to enter cells and replicate, the PrEP user stays HIV-negative.
PrEP is an effective way to prevent HIV if you have known risk factors. Like birth control pills, PrEP should be taken daily to make sure it’s as effective as it can be. The medication’s effectiveness at preventing HIV won’t disappear if a user misses a daily dose, but users should try their best to make sure they are taking it every day.
The number of days you need to take PrEP will depend on the nature of your possible exposure to HIV. For example, maximum protection from HIV following anal sex happens after
The injectable number of days to maximum efficacy is not yet known.
The risk of contracting HIV through sex can even be lower for users who combine PrEP with condoms and other protection methods.
It depends. PrEP is recommended for people who have known risk factors for HIV infection. Some known risk factors include:
- having an HIV-positive partner
- being a person with a penis who has anal sex without a condom
- using injectable drugs
The
Clinicians are directed to talk about PrEP to all sexually active people, no matter their sexuality, who engage in anal or vaginal sex.
PrEP may also be appropriate if you are sexually active and your partner is HIV-positive, you have multiple partners but are not sure of their status, or you have had any sexually transmitted infection in the last 6 months.
You may also consider PrEP if you inject IV drugs.
You can also talk to your clinician to find out if you should take PrEP. They will do baseline testing, including checks to make sure you do not have HIV, before prescribing PrEP. They will also talk to you about which formulation of PrEP could work best for you.
When learning about PrEP, the word “undetectable” will come up. While LGBTQ folks may be familiar with the term, those outside the community may not know what it means.
“Undetectable” refers to an undetectable viral load, or the amount of the virus in the blood. A blood test can measure it. Undetectable doesn’t mean there’s no virus in a person’s blood or that they’re cured of HIV. Rather, it means there’s a very low level of virus.
The virus usually becomes undetectable when antiretroviral therapy is working well, usually after 6 months of consistent treatment.
People who have an undetectable viral load have effectively no risk of transmitting HIV. However, viral load can change quickly, so it’s important for people with undetectable viral loads to have it monitored every 3 to 6 months by a healthcare professional.
Studies have found that “blips” in viral loan happen, and they can be quite common. These are spikes in viral load that can occur even in people with undetectable viral loads. After a blip, the viral load usually goes back to undetectable levels as long as medication is taken consistently.
If a person has frequent blips, it may be because of inconsistent medication use, or it can be a sign that something is wrong.
Blips can also occur when the immune system is under stress, such as contracting the flu.
People with undetectable viral loads should be vigilant and make sure they follow their drug regimen.
If your partner is undetectable, you may not need PrEP. But you should still use condoms and check your status. If you worry about your partner’s status, it may be helpful to talk with a doctor about PrEP.
You can’t get PrEP over the counter; you need a prescription from a doctor.
Once a doctor prescribes PrEP and you start taking it, you’ll have to check in with a doctor every 3 months to check your HIV status and viral load. This may make it difficult for some people to access the drug, but following up is an essential part of the PrEP regimen.
However, the stigma around HIV and even sex can make talking to a doctor about PrEP daunting — and just because a doctor can prescribe it doesn’t always mean they’re LGBTQ-friendly, which may hinder folks in this community.
Talking to a doctor you already know and trust may help if you’re nervous about bringing up the subject. You can also ask them for a referral if you’d like to see another doctor with more experience treating LGBTQ patients.
Once at the doctor, make sure to be clear and forthcoming. Don’t be afraid to ask questions. Tell your doctor you’re interested in PrEP, and say you want to discuss its use. Make sure to mention any behaviors or activities that may increase your risk for HIV, such as sex without condoms or sharing needles. Remember, it’s a confidential conversation.
If you feel like your doctor doesn’t know about PrEP or won’t prescribe it, many community health centers can provide up-to-date, accurate, nonjudgmental information about PrEP and help you get a prescription if you qualify.
Most health insurance plans, including Medicaid, cover PrEP, but for many uninsured Americans, paying for PrEP out-of-pocket can get very expensive. For more information about assistance, click here.
Don’t know where to start? Try the Gay and Lesbian Medical Association’s provider directory, which lists doctors who are knowledgeable about PrEP, or use this LGBTQ-friendly provider guide.
Knowledge is power. Being educated, as well as talking openly about PrEP, can help normalize a safe, effective drug that can have an enormous positive impact.
Eliminating the stigma surrounding PrEP, both within the LGBTQ community and among cisgender heterosexuals, only helps get the drug to people with known risk factors faster.
HIV affects all types of people. Being able to talk to your partners, friends, and doctor about your risk factors and PrEP can help you and the community as a whole.
Rosa Escandón is a New York-based writer and comedian. She is a contributor to Forbes and a former writer at the Tusk and Laughspin. When she isn’t behind a computer with a giant cup of tea, she’s on stage as a stand-up comedian or part of the sketch troupe Infinite Sketch. Visit her website.