Who Would Benefit From Taking Prep
Some groups of people are at higher risk of getting HIV. For example, men who have sex with men, transgender people who have sex with men, and people who have a partner who is living with HIV . High levels of protection from HIV are achieved after PrEP has been taken daily for 7 days. To continue to be effective, it needs to be taken regularly each day. To find out if PrEP is right for you, talk to your doctor. You can also take the interactive quiz: Is PrEP right for me.
Understanding The Risks Of Medication
When deciding who should take PrEP, your doctor will assess the risk factors of the medication with your chances of contracting HIV. Its essential to take this medication as prescribed for the best protection. Always talk to your partners about their HIV status before starting an intimate relationship. If your partner lives with HIV and is regularly taking their treatment, your chance of getting HIV is lower.
How Would I Know If Prep Is Right For Me
PrEP is one of many options for preventing HIV. HIV is passed from one person to another through sharing injection drug equipment or through anal or vaginal sexual intercourse. People can avoid getting HIV by: 1) not sharing drug injection equipment , 2) avoiding anal or vaginal intercourse 3) having only one monogamous sex partner whose HIV status is known to be negative: 4) having only one partner who is living with HIV and has an undetectable viral load. It is important to be aware that a person living with HIV who is on HIV treatment and is virally suppressed for six months or longer cannot pass HIV to a partner through sex. If you have sex with more than one partner, taking PrEP or consistent and correct use of condoms each time you have sex, can prevent you from getting HIV.
New York HIV State Clinical Guidelines indicate that healthcare providers should discuss PrEP as an HIV/STD prevention option for adults or adolescents who:
It is important to weigh the pros and cons and have an open and honest conversation about PrEP with your healthcare provider before beginning PrEP. PrEP is always voluntary and only you can determine if PrEP is right for you.
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Is Prep Safe To Use
PrEP is considered a safe medicine, but some individuals may experience side effects. The side effects are often temporary and will go away with time. The most commonly reported side effects include nausea, diarrhea, fatigue, stomach pain, and headache. Its important to tell your health care provider if these side effects continue or become severe.
How Else Might The 10
Four key strategies are emphasized in the 10-year initiative and backed by the global research community:
- Increase access to HIV testing, and ensure that all people living with HIV know their diagnosis.
- Expand access to effective treatment to get people on medication and virally suppressed, which helps prevent HIV transmission.
- Respond quickly to sites of potential HIV outbreaks and populations at increased risk.
- Prevent those at risk for HIV from becoming infected.
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How Well Does Prep Work
PrEP is very effective when you take it every day. It reduces the risk of getting HIV from sex by more than 90%. In people who inject drugs, it reduces the risk of HIV by more than 70%. PrEP is much less effective if you do not take it consistently.
PrEP does not protect against other STDs, so you should still use latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
You must have an HIV test every 3 months while taking PrEP, so you’ll have regular follow-up visits with your health care provider. If you are having trouble taking PrEP every day or if you want to stop taking PrEP, talk to your health care provider.
Alternative Nrti Backbone: Lamivudine/zidovudine
BASHH guidelines state that zidovudine and lamivudine , twice daily, may be used instead of emtricitabine/tenofovir. This combination may be preferred to emtricitabine/tenofovir in people with abnormal renal function, for example.
The most common reported side-effects of lamivudine/zidovudine taken together are: nausea, vomiting, diarrhoea, tiredness, headache, dizziness, weakness, muscle pain, loss of appetite, fever, abdominal pain, hair loss, insomnia, rash, cough, runny nose, joint or muscle pain, fat loss, anaemia, low white blood cell count and raised liver enzymes.
For more information, read our factsheet on lamivudine/zidovudine.
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Would I Have To Take Prep For The Rest Of My Life What If I Want To Stop
PrEP is not intended to be a life-long program. Rather, it is a program where the healthcare provider works with you to develop an individualized plan with as many renewals of the prescription as you and the healthcare provider agree to. For many people, life circumstances change over time and the risk for HIV may be reduced or eliminated. You should discuss the issue of how long you want to take the PrEP medication with your provider. If for any reason you want to stop taking the PrEP medication, consult with the healthcare provider who prescribed it, or another provider who is familiar with PrEP. Generally speaking, cis-gender men taking on-demand PrEP should continue taking the PrEP medication for at least 2 days after any possible exposure. Anyone taking daily PrEP should continue taking the medication for 28 days after the last possible exposure.
Are There Other Types Of Prep
An injectable form of PrEP, using a drug called cabotegravir, has been tested in gbMSM, transgender women and cisgender women. This long-acting form of PrEP is injected into muscle every two months. Preliminary studies have found long-acting cabotegravir to be generally safe and effective at reducing the risk of getting HIV. Long-acting injectable PrEP is not currently approved for use as PrEP in Canada but is likely to be available in the near future.
Other types of PrEP, including vaginal or rectal gels, intravaginal rings and implants, are currently in experimental stages. These forms of PrEP have not been approved for use by any regulatory agency in the world, and we do not expect them to be available for use in Canada in the near future.
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What Should I Tell My Healthcare Provider Before Taking Descovy For Prep
- All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis.
- All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. DESCOVY may interact with other medicines. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
How Can People Access Pep
The Canadian PEP guidelines recommend that PEP should be readily available in places where it is likely to be needed urgently. These include emergency departments, sexual health clinics and other clinics serving populations at increased risk of HIV.
The decision to provide PEP lies with the healthcare provider and is made on a case-by-case basis. Many healthcare providers are unaware of non-occupational PEP or may be unwilling to prescribe it. The Canadian guidelines outline practical advice for physicians providing PEP, including how to assess risk in people who present for PEP, how to provide monitoring and follow-up, and recommended drug regimens.
People starting PEP may be offered a starter pack of pills, so that PEP can be started right away, along with a prescription that needs to be filled to receive the full 28-day course of medications. Most emergency departments will have PEP starter packs available.
Anti-HIV drugs are expensive: a month-long course of PEP can cost $900 or more, depending on the drugs used. Although occupational PEP is normally covered by workplace insurance, coverage for non-occupational PEP varies across Canada. Non-occupational PEP medications are covered by some private and public health insurance plans coverage varies depending on the province or territory and the type of exposure.
Acknowledgement
We thank Dr. Isaac Bogoch, Toronto General Hospital Research Institute, for expert review.
Resources
References
Arkell C
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How Do I Get Pep
You can get PEP from emergency rooms. It might also be available at some health clinics or Planned Parenthood health centers, and some doctors offices, but call first to make sure they have PEP in stock.
You can start PEP up to 72 hours after you were exposed to HIV, but dont wait its really important to start PEP as soon as possible. So if you cant get to a doctor or nurse right away, go to the emergency room as soon as you can. Every hour counts.
Before you get PEP, the nurse or doctor will talk with you about what happened, to decide whether PEP is right for you. Theyll give you a blood test for HIV . Youll also be tested for Hepatitis B. And if you were exposed to HIV through sex, youll get tests for other STDs like gonorrhea, chlamydia, and syphilis.
Can Prep Be Stopped And Restarted Safely
PrEP can be safely stopped and started again based on a persons risk for HIV. If a person wants to stop taking PrEP, or restart after a period of not taking PrEP, they should talk to their healthcare provider about how to stop and/or restart PrEP safely.
Generally, when stopping daily PrEP, it is recommended that the medication be continued for some time after the last possible exposure to HIV. It is recommended that gbMSM, whose risk for HIV is via anal sex, can stop taking daily PrEP two days after their last sexual encounter. For everyone else , the ideal number of days to take PrEP after their last exposure to HIV is unknown it could be up to 28 days.
GbMSM who use on-demand PrEP should follow the on-demand schedule and continue taking PrEP for two days after the last time they have sex. PrEP can then be stopped safely.
If a person who has stopped taking PrEP wants to restart, they should be tested for HIV before starting again if there has been any possible HIV exposure since they last took PrEP. PrEP is only for HIV-negative people if a person has HIV, they need HIV treatment. People starting daily PrEP should wait seven days after their first dose before having anal, vaginal or frontal sex.
GbMSM also have the option of restarting PrEP using an on-demand strategy, but they may need to be tested for HIV first. This could be a good option for men who know in advance when they will have sex or who find they are having sex less often.
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Prep Prevents Hiv So Why Arent More People Taking It
- By Robert Goldstein, MD, PhD, Contributor
Each year, 1.7 million people globally are newly infected with HIV more than 38,000 in the United States alone. This year, President Trump announced a 10-year initiative aimed at reducing new HIV infections in the US, and ultimately ending an epidemic that has plagued this country, and the world, since HIV first emerged in the early 1980s. A key part of that plan is pre-exposure prophylaxis or PrEP, a daily medication to help prevent HIV that is recommended for people at high risk. Recently, the FDA approved a new formulation of PrEP for many but not all of those at risk.
Important Things To Know About Prep
Before starting PrEP, your doctor will check your health and organise some tests at your first appointment including:
- an HIV test
- kidney and liver function tests.
You will also receive information about how to reduce your risk of acquiring HIV.
PrEP must be taken as prescribed for maximum effective protection.
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Are You At High Risk
PrEP is a medication that is recommended for people who are at a high risk of HIV transmission. Some of the leading causes of HIV transmission include:
- Engaging in unprotected sex with a partner who is HIV positive or whose HIV status is unknown.
- Engaging in unprotected sex with partners who have additional sexual partners.
- Having unprotected sex if you have been diagnosed with an STI.
- Sharing needles or syringes.
The only way HIV can be transmitted to another person is through contact with blood, semen, or vaginal fluids. It is also important to note that uncircumcised males are at a slightly higher risk of contracting HIV since they are more prone to bacteria and infections. There is evidence that male circumcision can also reduce the risk of HIV transmission.
Homosexual and bisexual males are typically at a higher risk of contracting HIV. The transmission rate through anal sex is more than ten times greater than through vaginal intercourse. Receptive anal sex also has a higher transmission rate, meaning that the risk of HIV transmission is higher for bottoms than for tops.
However, this does not mean that tops are not at risk as the insertive partner may also contract HIV through anal intercourse. So, whether you are a top, a bottom, or versatile, you could be at a high risk of HIV transmission, and you should consider taking PrEP.
When Should I Start Pep And How Long Do I Need To Take It
PEP must be started within 72 hours after a possible exposure to HIV. The sooner you start it, the better every hour counts.
You need to take the PEP medicines every day for 28 days. You will have to see your health care provider at certain times during and after taking the PEP, so you can have an HIV screening test and other testing.
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How Do I Get Prep
PrEP can only be prescribed by a doctor, so you will need to talk to a physician about taking it. Your doctor may ask you some questions to determine your risk factors for HIV transmission and then discuss your options.
You will first need to be tested to ensure that you do not currently have HIV. This involves a simple blood test and the results will be available in a matter of days.If you have insurance, the cost of HIV should be completely covered or you may have to make a small co-pay. Some or all of your medication costs may also be covered under Medicare or Medicaid. If you do not have insurance, there are some options to help you be able to afford PrEP, including the Cost Assistance program from Gilead.
Who Should Use Prep
- PrEP should be used by people who are at high risk of becoming infected with HIV by sexual activity
- PrEP should be part of an overall HIV prevention program including condoms and counseling
- Before taking PrEP, people should be tested to confirm that they are not already infected with HIV
- People using PrEP should continue to be tested to make sure they have not been infected
- They should also be tested for kidney damage, hepatitis B and any sexually transmitted diseases
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What Is Prep And Who Should Consider It
PrEP is a daily pill taken to lower a persons risk for getting HIV. It works best as part of a program of preventive services that includes regular HIV testing.
Global research during the past decade shows that a combination of two antiretroviral medicines is more than 90% effective at preventing HIV. These medicines, emtricitabine and tenofovir disoproxil fumarate, are known by the brand name Truvada. Along with other medicines, they are also used to treat HIV.
The Centers for Disease Control and Prevention and many expert guidelines recommend PrEP for those at high risk for HIV, including
- men who have sex with men
- heterosexual men and women who have high-risk exposure
- people who inject drugs
- transgender women.
Currently, 50% of new HIV cases in the US occur among Black and Latino gay and bisexual men. Slightly more than 15% occur among heterosexual women, roughly three-quarters of whom are women of color.
The CDC estimates that 1.1 million people in the US would benefit from PrEP, including 175,000 women and 780,000 people of color. Yet prescriptions for PrEP are sluggish, particularly in populations at increased risk. Since 2012, only 135,000 PrEP prescriptions have been filled in the US. Almost all were for men largely, white men in the Northeast and on the West Coast who have sex with men.
What Is Prep For Hiv
PrEP is medicine that helps protect you from the human immunodeficiency virus . It stands for pre-exposure prophylaxis.
- âPreâ means before. You take the medicine before you think you might come into contact with the virus.
- âExposureâ means contact with HIV.
- âProphylaxisâ means treatment to stop infection in the first place. This is in contrast to treatment for people who either have signs of the virus in their blood or already have symptoms linked to the illness.
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How Would I Pay For Prep
Medicaid will cover the cost of PrEP without co-pays. This includes the medication, medical appointments and lab tests associated with PrEP. Many health insurance plans with prescription drug coverage also cover all costs associated with PrEP without co-pays. For people without access to health insurance with prescription drug coverage, a number of options for financial assistance are available. If you need information about financial assistance options for PrEP, visit the NYSDOH website.