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If you're sexually active and at risk for HIV exposure, PrEP could be one of the most important health decisions you make. Pre-Exposure Prophylaxis (PrEP) is a game-changing medication that reduces your risk of getting HIV from sex by about 99% when taken as prescribed.

Despite being incredibly effective and increasingly accessible, many people who could benefit from PrEP don't know about it or have misconceptions about who it's for. This comprehensive guide breaks down everything you need to know.

What Exactly is PrEP?

PrEP stands for Pre-Exposure Prophylaxis—a daily pill that prevents HIV infection before you're exposed to the virus. Think of it like birth control, but for HIV prevention.

The most common PrEP medications are:

• Truvada (tenofovir disoproxil fumarate + emtricitabine) - FDA approved since 2012
• Descovy (tenofovir alafenamide + emtricitabine) - FDA approved in 2019, fewer side effects for some people
• Apretude (cabotegravir) - Long-acting injectable approved in 2021, given every 2 months

How Does PrEP Work?

PrEP works by blocking an enzyme called HIV reverse transcriptase, which the virus needs to establish infection in your body. When you take PrEP daily, the medication builds up in your bloodstream and prevents HIV from taking hold even if you're exposed.

Who Should Consider Taking PrEP?

The CDC recommends PrEP for anyone who:

Sexual Activity Risk Factors:

• Has a sexual partner who is HIV-positive (especially if they're not virally suppressed)
• Has had anal or vaginal sex without a condom in the past 6 months
• Has been diagnosed with an STI in the past 6 months
• Is in an ongoing sexual relationship with someone whose HIV status is unknown
• Engages in sex work
• Has multiple sexual partners

Injection Drug Use Risk Factors:

• Injects drugs and shares needles, syringes, or other equipment
• Has been in drug treatment for injection drug use in the past 6 months

LGBTQ+ Specific Considerations:

• Men who have sex with men (MSM), especially if you have condomless anal sex
• Trans women, who face disproportionately high HIV rates
• Anyone in the LGBTQ+ community with HIV exposure risk

How Effective is PrEP?

When taken consistently, PrEP is extremely effective:

• 99% reduction in HIV risk from sex when taken daily
• 74% reduction in HIV risk from injection drug use when taken 4+ times per week
• Injectable PrEP (Apretude) is even more effective because there's no daily pill to remember

The key is consistency. PrEP works best when you take it every day at the same time. Missing doses reduces effectiveness significantly.

What Are the Side Effects?

Most people experience mild or no side effects. Common initial side effects (usually temporary) include:

• Nausea
• Diarrhea
• Headache
• Fatigue
• Stomach discomfort

These typically go away within the first few weeks. Serious side effects are rare but can include:

• Kidney problems (monitored through regular testing)
• Bone density loss (more common with Truvada than Descovy)
• Lactic acidosis (very rare)

Your healthcare provider will monitor you with regular blood tests every 3 months to check kidney function and ensure the medication is working safely.

How Much Does PrEP Cost?

PrEP cost varies widely depending on your insurance and location, but there are many ways to get it for free or low-cost:

Insurance Coverage:

• Most insurance plans are required to cover PrEP at $0 copay under the Affordable Care Act
• Medicaid covers PrEP in all 50 states
• Medicare Part D covers PrEP

Assistance Programs:

• Gilead Advancing Access - Patient assistance program for uninsured individuals
• Ready, Set, PrEP - Federal program providing free PrEP medication (if uninsured)
• State PrEP programs - Many states have specific PrEP assistance programs
• Manufacturer copay cards - Cover out-of-pocket costs for insured patients

The bottom line: You should be able to get PrEP for free or very low cost regardless of insurance status.

Where Can I Get PrEP?

You have several options for accessing PrEP:

Traditional Healthcare:

• Primary care doctor - Can prescribe after an HIV test and kidney function test
• Sexual health clinics - Often specialize in PrEP services
• LGBTQ+ health centers - Culturally competent care
• Planned Parenthood - Many locations offer PrEP

Telehealth Options:

• Nurx, MISTR, Folx Health, PlushCare - Online PrEP services with at-home test kits
• Often more convenient and discreet
• Prescriptions shipped directly to your door

Common Questions About PrEP

Can I stop and start PrEP?

Yes, but it's important to plan it properly. You need 7 days of daily PrEP to reach full protection for receptive anal sex, and 21 days for receptive vaginal sex. Talk to your provider about starting and stopping safely.

Will PrEP protect me from other STIs?

No. PrEP only protects against HIV. You still need condoms and regular STI testing for protection against gonorrhea, chlamydia, syphilis, and other infections.

Does PrEP affect fertility or pregnancy?

PrEP is safe to take if you're trying to conceive or are pregnant. In fact, PrEP is recommended during pregnancy if you're at risk for HIV.

Can I drink alcohol on PrEP?

Yes, moderate alcohol consumption doesn't interfere with PrEP. However, heavy alcohol use can affect your liver and kidneys, so drink responsibly.

What if I miss a dose?

Take it as soon as you remember. If you miss multiple doses, contact your healthcare provider. Protection decreases if you're not taking it consistently.

The Bottom Line

PrEP is a powerful tool for HIV prevention, but it's not the only tool. The most effective sexual health strategy combines:

• ✅ PrEP for HIV prevention
• ✅ Condoms for STI and HIV prevention
• ✅ Regular STI testing (every 3 months)
• ✅ Open communication with partners
• ✅ Regular healthcare visits

If you think PrEP might be right for you, talk to a healthcare provider. The conversation is confidential, non-judgmental, and could literally save your life.