Dear Sexpert,

I’ve seen a couple of ads for a drug for people at risk for HIV. What exactly qualifies as “at risk” and how safe/effective is this drug?

Signed,
Curious & Careful

Dear Curious & Careful,

You’re right, PrEP, or Pre-Exposure Prophylaxis, can be used in prevention of human immunodeficiency virus (HIV). PrEP is a prescription pill (commonly sold under the name Truvada®) designed for daily use by people who are HIV-negative and at substantial risk for HIV exposure. PrEP is a combination of two drugs, tenofovir and emtricitabine. If used correctly and consistently, it has been shown to reduce risk by up to 92%. Additionally, many health insurance plans cover PrEP.

There are several situations that can qualify a person to be considered at substantial risk. The Centers for Disease Control and Prevention (CDC) recommend PrEP for anyone who meets any of the following circumstances:

• is in an ongoing relationship with an partner who is HIV-positive;
• is not in a mutually monogamous relationship with a partner who recently tested HIV-negative;
• is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the last six months;
• is a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status, who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners); and
• has injected illicit drugs in the past 6 months and who has shared injection equipment or been in drug treatment for injection drug use in the past 6 months.”

If you fall into any one of these categories, or feel that you may benefit from PrEP, schedule an appointment at Sexual Health and Wellness (SHAW) or your primary health care office to discuss with a clinician whether this is an option for you. It’s important to keep in mind this is solely a preventative drug for people with on-going risk of being infected with HIV, and is not recommended for those who have had a single incidence of potential, high-risk exposure.  (There is a different medication, called PEP, or post-exposure prophylaxis, in those instances.)

Additionally, PrEP is a drug that needs to be taken on a daily basis. Like birth control or other daily-prescribed drugs, irregular use will decrease its effectiveness. Anyone prescribed PrEP should return

to their health care provider every three months for consistent HIV monitoring and follow up. PrEP is not 100% effective at preventing HIV acquisition and does not protect you from other sexually transmitted infections (STIs). Precautions should still be taken to reduce your risks, including using a condom with every intercourse, getting HIV tested with your partner(s), practicing less risky sexual behaviors (e.g., oral sex while using a barrier method), reducing your number of partners, and/or sterilizing injection equipment or joining a substance treatment program.

Best of luck and be safe,
The Sexpert

Information regarding PrEP retrieved from Centers for Disease Control and Prevention (CDC).