Date: July 23rd, 2019
Author: Dylan Higgins
What’s in Your HIV Prevention Toolbox?
“With perfect use, condoms (like PrEP) may approach 100 percent effectiveness, but in the real world, people often use them improperly, or do not use them through the entirety of intercourse, or “forget” to use them despite an intent to do so.”
-NY Times, “Is Truvada, the Pill to Prevent HIV, 99 percent Effective?”, 7.16 14
What is PrEP and is it right for me?
Remember daydreaming as a kid about what the future may look like? Well, the future has arrived in the form of a small blue pill called PrEP, and should be regarded as a powerful tool in your HIV prevention toolbox.
Pre-Exposure Prophylaxis (PrEP) is a prescription medicine known as TRUVADA that provides a powerful HIV prevention tool for HIV-negative individuals to reduce their risk of becoming infected with HIV if they are exposed to the virus.
How Does it Work?
PrEP interferes with the biological pathways that HIV uses to infect cells in your body. For HIV to cause infection, the virus must i) gain entry into the body, ii) infect certain immune cells, iii) make copies of itself (i.e., replicate) within the infected immune cells, and iv) spread to other cells throughout the body.
When used in combination with safer sex practices (such as condom use), PrEP is a highly advanced and effective strategy against acquiring HIV.
For PrEP to be effective at reducing your risk of getting HIV, adherence and consistency are key. PrEP can provide 92%-99% reduction in HIV risk for HIV-negative individuals who take PrEP daily as directed. In other words, you must take the PrEP pill every day, at approximately the same time every day, as prescribed by your health care professional. This will ensure that you have sufficient and consistent levels of the medicine in your body to effectively reduce your risk of acquiring HIV. Keep in mind that PrEP only works after the medication in PrEP has reached certain levels in your blood and remains effective only if these levels are maintained consistently. If a daily dose is missed, the level of HIV protection may decrease. Higher adherence (e.g., taking PrEP daily as directed as recommended by the FDA) is associated with the greatest level of protection.
Are there side effects or risks associated with taking PrEP?
Side effects of taking PrEP are mild, generally temporary, and include diarrhea, headache, nausea, and dizziness. PrEP may also cause small decreases in kidney, liver, and bone health. As a precaution, users of PrEP are required to have regular kidney function tests. Although current research suggests that extended use of PrEP is safe, studies on long-term effects of Truvada use are limited at this time.
PrEP does not prevent other sexually transmitted infections or pregnancy
By itself, PrEP does not provide 100% protection from the risk HIV infection. While PrEP is a highly effective tool in preventing HIV on its own, best practices recommend taking PrEP in combination with practicing safer sex by using condoms.
Importantly, PrEP does not protect you from other sexually transmitted infections (STIs), such as viral hepatitis, gonorrhea, syphilis, or chlamydia. STIs have increased significantly in recent years, affecting the LGBTQ+ community at disproportionate rates. While most sexually transmitted infections are treatable (such as with antibiotics to treat bacterial infections), drug-resistant forms are being identified more frequently. In addition, many sexually transmitted infections can go unnoticed and if left untreated can result in serious health consequences.
PrEP, used in combination with safer sex practice of using condoms, provides the best level of protection available to reduce the risk of HIV and other STI infections, ensuring you continue to have sexual health and wellness.
Where can I get PrEP? List of providers who prescribe PrEP is Central Oregon!
If you are interested in learning more about PrEP and/or to see if PrEP is right for you, speak to your health care provider or reach out to Deschutes County Health Services.
Most health insurance plans cover the cost of PrEP. Co-pay assistance programs are available from Gilead (the pharmaceutical company that provides PrEP) for those who qualify. HIV Alliance in Eugene provides PrEP Navigation services for individuals who need assistance in paying for PrEP. Additionally, the cost of PrEP is heavily subsidized for individuals who qualify for Medicaid under Oregon Health Plan
● PrEP Facts: https://prepfacts.org/prep/the-basics/
● HIV Information and Facts, Canada: www.catie.ca/en/fact-sheets/prevention/pre-exposure-prophylaxis-prep
● Truvada Guide: https://www.positivelyaware.com/drug-guides/truvada-prep)
● Sexual Behavior Among Men: How Truvada is Changing Gay Sex https://thewire.in/health/how-an-hiv-prevention-pill-is-changing-sexual-behaviour-among-men
● Deschutes County Health Services: https://www.deschutes.org/health/page/hiv-program-0
● HIV Alliance: https://hivalliance.org/prevent/prevention-meds/