PrEP

PrEP may be the most important breakthrough in HIV prevention since the beginning of the epidemic. PrEP is a pill that is taken once daily to prevent getting HIV. This is similar to the way birth control pills are taken daily to prevent pregnancy.

PrEP is an easy and effective way to help prevent HIV and is safe for most people.

Does PrEP fit you?

PrEP does not protect against syphilis, hepatitis C or B, or other sexually transmitted diseases (STDs), but PrEP is highly effective in preventing HIV infection.

Currently, Truvada® is the only medication approved by the FDA to be used as PrEP. It contains Tenofovir and Emtricitabine, and is most effective when:

• Taken once every day
• The person taking it gets tested every few months for HIV and STDs and is monitored for unlikely side-effects

PrEP is a medication used by HIV-negative people who are at high risk of getting HIV. It is an especially helpful tool for:

• Men who have sex with other men
• Transgender individuals who have sex with men
• People who are in an ongoing relationship with someone who is HIV-positive

So you think PrEP will fit you?

The first step in getting it is to talk to a doctor or nurse who knows about and is comfortable prescribing PrEP. All Primary care doctors can prescribe it, but not all know about it, and some may not feel comfortable or confident in prescribing it. That’s why you need a doctor who understands your sexual health needs.

So let’s say you have a doctor or nurse you can talk to about this. They will:

• Talk with you about your risks and a variety of ways to prevent HIV, including taking PrEP.
• Tell you what to expect when taking PrEP.
• Order laboratory tests for HIV, STDs, and other things to make sure it is safe to start PrEP.

If you are HIV-negative and decide to take PrEP, you will need to:

• Get a prescription.
• Take one pill every day.
• Go back for HIV and STD tests every few months.

PrEP is usually covered by health insurance, but there are programs that can help with the cost of the medicine, deductibles, or co-pays.

Visit www.crine.org/prepdap for more information about paying for PrEP.

PEP

PEP (sometimes called nPEP) has been around for a while and is similar to PrEP in that it involves taking medicine to prevent getting HIV. However, PEP is different since it is started right after a potentially high-risk exposure to HIV rather than before the exposures occur.

PEP is taken by HIV-negative people for one month after a high-risk exposure to HIV that occurred within the past 48 hours. A high-risk exposure would include:

• Vaginal or anal sex without a condom with a known (or likely) HIV positive partner
• Sharing needles or syringes
• Sexual assault

Anyone who can write a prescription can provide PEP but, like with PrEP, it’s good to talk about it with a nurse or doctor who is familiar and comfortable with it. If you think you’ve had a high-risk exposure within the last few hours, PEP might fit you well. To get it, go to:

• Your primary care provider
• A community health center
• An urgent care center
• A hospital emergency room

So let’s say you have a doctor or nurse you can talk to about this. They will:

• Ask you questions about what happened that has you concerned about HIV, when it happened, and about the HIV status of you and your partners.
• Talk with you about your risks and a variety of ways to prevent HIV, including taking PEP.
• Tell you what to expect if you decide to take PEP.
• Order laboratory tests for HIV and STDs.

If you are HIV-negative (or don’t know) and decide to take PEP, you will need to:

• Start taking medicine at that visit or right afterward.
• Take pills every day for one month.
• Get tested again for HIV and STDs after the month is over.

Whether or not you decide to take PEP, your doctor will probably also talk to you about taking PrEP. It may be recommended to transition to PrEP as soon as you are done with PEP so you will be protected in case you have future exposures to HIV.

PEP is usually covered by health insurance but there is a program that can cover the cost if you have no health insurance, or you need to get started on PEP on a weekend when your insurance coverage can’t be confirmed. Visit www.crine.org/npep for more information.

TasP

You probably know that treatment for people who are HIV-positive has come a very long way and that people living with HIV now have long, healthy lives with the help of these treatments. But did you know that when they are on successful treatments, it’s virtually impossible for them to pass the virus to anyone else?

Treatment as Prevention (TasP) means that when a person who is living with HIV takes HIV medicines for their own well being, there is an added benefit of preventing others from becoming infected.

Here’s how it works:

When someone living with HIV takes effective HIV medicines every day, the amount of virus in their body becomes undetectable. This is called viral suppression. When someone has a suppressed or undetectable viral load, it doesn’t mean that the person is cured, but it does mean that the amount of HIV is so small that tests looking for it can’t find it. When someone reaches viral suppression, the risk of them passing HIV to someone else is virtually eliminated.

Many men in ongoing relationships where one person is HIV-negative and one person is HIV-positive use this as a primary prevention tool. But it can also be combined with the HIV-negative partner taking PrEP for extra protection. Having a doctor who supports this is having health care that fits you.

If you are HIV-positive, it is important to have a doctor who knows about and is comfortable treating HIV. And it is important to go to all your appointments for exams and lab work, and to stick with your medication routines. This will keep you healthy and keep your partners from getting HIV as well.

If you are HIV-negative, it’s helpful to talk with your partners about their HIV status and if they have an undetectable viral load. Remember, this can change over time, especially if they stop taking their medications, so ongoing discussions about this would be helpful.

Remember, both HIV-positive and HIV-negative people are still at risk for getting or passing STDs, so it’s also important for them to get tested every three months or so, especially if you have more than one partner (or your partner does) and especially if you aren’t using condoms.

HIV medications are usually covered by health insurance but there is a program to help with the cost of insurance premiums, co-pays, and deductibles. Go to www.crine.org/hdap for more information.