What is PrEP?
PrEP is a daily pill for people who do not have HIV who want added protection. It is short for pre-exposure prophylaxis. When taken as prescribed, PrEP is highly effective in preventing HIV.
Your health care provider can help you decide if PrEP is a good fit. Some things to consider: how often you (and/or your partners) use condoms; whether you know the HIV status of your partners and if they are on ongoing treatment; and/or whether you have recently had any sexually transmitted diseases (STDs). If you or your partner use injection drugs, PrEP may also provide added protection.
If you are considering getting pregnant and concerned about HIV, talk with your doctor about PrEP. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.
PrEP is available by prescription in the U.S. under the brand name Truvada. Truvada was first approved by the Food & Drug Administration (FDA) in 2004 to treat HIV in combination with other medications. In 2012, the FDA approved Truvada for use as PrEP for people who do not have HIV.
CDC, HIV Basics, PrEP. March 2018.
How effective is PrEP?
Very effective. When taken as prescribed, PrEP works to keep HIV from taking hold in the body.
According to the U.S Centers for Disease Control and Prevention, daily PrEP reduces the risk of getting HIV from sex by more than 90 percent. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70 percent when used consistently.
Some studies have shown even higher effectiveness with consistent PrEP use among gay and bisexual men, and transgender women.
While PrEP is highly effective in preventing HIV, it does not protect against other sexually transmitted infections (STIs). To prevent gonorrhea, chlamydia, syphilis, and other common STDs, use condoms.
PrEP must be taken for some time before it reaches maximum effectiveness.
See: “How quickly does PrEP start working?” below.
CDC, HIV Basics, PrEP. March 2018.
How quickly does PrEP start working?
PrEP must be taken for some time before exposure to HIV to be effective. According to the Centers for Disease Control and Prevention (CDC), PrEP reaches maximum protection from HIV through receptive anal sex after about 7 days of daily use. For receptive vaginal sex and injection drug use, the CDC estimates that PrEP reaches maximum protection after about 20 days of daily use. To maintain maximum effectiveness, PrEP should be taken every day as prescribed.
CDC, HIV Basics, PrEP. March 2018.
How do I get PrEP?
PrEP requires a prescription. Any medical professional who can prescribe medications, including doctors and nurse practitioners, can prescribe PrEP.
If you don’t have a regular health provider, or they don’t know about or are reluctant to prescribe PrEP, there are organizations that can help you get on PrEP. This may include finding a provider and/or identifying financial assistance, whether you have insurance or not.
How much does PrEP cost?
PrEP is covered by most insurance plans and should be covered by Medicaid and Medicare.
If you do not have insurance, or if you have insurance but need help with out-of-pocket costs, there are financial assistance programs that may be able to help. Many people wind up paying very little or nothing at all for PrEP.
See “What about payment assistance for PrEP?” below.
Does PrEP work after HIV exposure?
No. PrEP must be taken for some time before a possible exposure to HIV to be effective. PrEP is short for pre-exposure prophylaxis.
If you think you may have been exposed to HIV, PEP, post-exposure prophylaxis, may be an option within the first 48 to 72 hours of the possible exposure. Contact your health care provider or emergency room for a prescription.
See: “How quickly does PrEP start working? above; What is PEP?” below.
Once I start PrEP, can I stop?
You can go on and off PrEP at different times in your life, but should do so under the guidance of a health care provider. It takes some time after starting PrEP to the same high level of protection against HIV as before.
Before restarting PrEP, you will need to get tested again and renew your prescription.
See: “How quickly does PrEP start working?” above.
What is involved in getting on PrEP?
At your first visit, you will likely be asked some questions to help you determine if PrEP is a good fit. This may include questions about your sexual history and your use of condoms.
You will take an HIV test, as well as have your kidney function checked and be screened for hepatitis B and C viruses.
After you get your prescription for PrEP, you will have regular check-ups, typically every three months, to see how you are doing on the medication. At these visits, you will be re-tested for HIV, as well as have other general health checks as needed, including periodic screens for other STDs.
You can go on and off PrEP at different times in your life, but should do so under the guidance of a health care provider.
See: “How do I get PrEP?” above.
I don't have insurance. Can I still get PrEP?
If you are uninsured, there may be resources available that can help pay for PrEP and the necessary clinic visits and tests.
One such source is Gilead’s Medication Assistance Program for PrEP. To see if you are eligible for this program provided by PrEP’s manufacturer call (877) 505-6986. Eligibility is based on income.
There are organizations that can help you get on PrEP, even if you don’t have insurance. Click here to search for “PrEP for Uninsured.”
To find affordable health insurance coverage options, go to: https://www.nolahealthlink.com/prep.
What is PEP?
PEP, short for post-exposure prophylaxis, is a prescription medication to be taken in emergency situations to protect against HIV after exposure.
It must be taken within 72 hours after a possible exposure to HIV. The sooner you start PEP the better. If you are prescribed PEP you will need to take it once or twice daily for 28 days.
Contact your health care provider or emergency room for a prescription.
For ongoing protection, consider PrEP, a prescription pill for those who do not have HIV. PrEP must be taken for some time before exposure to be effective.
See: What is PrEP? above.
CDC, HIV Basics, PEP. April 2016.
What about the side effect of PrEP?
Many people on PrEP report no or minimal side effects. PrEP may cause nausea at first for some people, but these generally go away over time. According to the U.S. Centers for Disease Control & Prevention, no serious side effects have been observed and these side effects are not life threatening.
If you are taking PrEP and experiencing side effects that are severe or do not go away, tell your health care provider.
CDC, HIV Basics, PrEP. March 2018.
Does PrEP protect against any other STIs?
No. While highly effective in preventing HIV, PrEP does not protect against other sexually transmitted infections (STIs). Condoms should be used to prevent gonorrhea, chlamydia, syphilis, and other common STDs.
CDC, HIV Basics, PrEP. March 2018.
What about condoms?
Condoms are an easily accessible, highly effective means of preventing the sexual transmission of HIV and many other sexually transmitted infections (STIs). Condoms are also the only method of protection that prevents both pregnancy and disease. To be effective, condoms must be used correctly and consistently.
Condoms come in lots of colors, textures, lengths, widths, and thicknesses. There are also female condom options that are inserted into the vagina. The most important thing when choosing a condom is that they are made of latex or polyurethane (plastic). Animal skin (or “natural”) condoms do not offer the same degree of protection.
Here are some more tips for using condoms correctly:
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Check the label of the condom before using it and don’t use it if it is past the labeled expiration date, or if it is over five years past the manufacture date. Also check the appearance of the condom. If it’s ripped or looks dry or brittle use another one.
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If not already pre-lubricated, apply a small amount of water-based lubricant outside the condom can help prevent rips. Oil-based lubricants (for example petroleum jellies, body lotions, mineral or vegetable oils) should NOT be used with latex condoms because they can cause the latex to break down, and reduce or eliminate the condom’s effectiveness.
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Open the package, tear gently on the side (not with teeth or scissors, which could rip the condom itself).
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Pull the condom out slowly (with care) to prevent ripping.
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Place the rolled condom over the head of the penis when it is hard.
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Pinch the tip enough to leave a half-inch space for semen to collect.
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Holding the tip, unroll the condom all the way to the base of the penis. The condom should fit snugly – but not too tight – so that it won’t slide off or break during intercourse.
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If you start to put on a condom inside-out, don’t use it. Throw it away and use a new one. You’ll know it’s inside out because it won’t roll down the length of the penis easily.
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If the condom rips at any time, throw that one out and use a new one.
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Immediately after ejaculation, hold the base of the condom (so it stays in place and semen cannot spill out), and slowly withdraw the penis – while it is still hard. The condom should be wrapped in tissue and thrown away in the garbage (not in the toilet as it may clog).
Keep your condoms in a cool, dry place to prevent breakage or leakage. Don’t store condoms in a location that can get very hot, like in your car. If you keep a condom in your wallet or purse, replace it with a new one every few months. Re-check the expiration date and condition before you use it.
CDC, HIV Basics, Prevention. February 2018.
What if I have another STI? Can I go on PrEP?
There is no evidence that having a sexually transmitted infection (STI) lowers how well PrEP works, though if you have an STI you should get it treated. Many STIs are curable and all are treatable. For some, including HPV and Hep B, vaccines are available.
PrEP only protects against HIV. Condoms protect against other common STIs, in particular gonorrhea and chlamydia.
What if I miss a dose of PrEP?
If you forget to take your PrEP, try to get back on a daily schedule as soon as possible. If you don’t make a habit of missing doses, missing one will most likely not effect the level of protection PrEP offers from HIV.
Missing multiple days can be more problematic, particularly for women who have been found to need to take PrEP more consistently to get maximum protection. For all people, daily use of PrEP has been shown to provide the maximum effectiveness.
If you are having difficulty keeping up with the daily schedule you should talk with your health care provider.
Do alcohol or drugs affect how PrEP works?
Alcohol and drug use should not directly affect how well PrEP works; however, substance use may affect how consistently you take the medication. Missing doses can lower PrEP’s effectiveness.
See: What if I miss a dose of PrEP? above.
Is it OK to take PrEP if I'm on antidepressants?
The Food and Drug Administration (FDA) does not list any antidepressants as potential conflicts on its official safety information on Truvada, PrEP’s brand name.
You should let your doctor know all medications, supplements, and vitamins you are taking to avoid potential drug interactions.
FDA, Highlights of Prescribing Information [PDF]. July 2012.
Can PrEP be used during pregnancy?
PrEP is one of several options available to help protect individuals not living with HIV (male or female) during attempts to conceive.
No adverse effects have been found among infants exposed to Truvada, the brand name of PrEP, when the medication was taken as part of treatment for HIV.
Does PrEP affect hormone therapy (or the reverse)?
There are no known drug interactions between PrEP and gender affirming hormones.
Available data on PrEP use among transgender women suggests that it is very effective in protecting against HIV when taken as prescribed.
University of San Francisco, California Center of Excellence for Transgender Health, Transgender Health and HIV. June 2016.
Why do I have to get tested for HIV before starting PrEP?
If someone who does have HIV takes PrEP, their virus can develop resistance to some medications used to treat the virus, which may limit future treatment options.
What about payment assistance for PrEP?
There are various sources of payment assistance for PrEP for people with and without insurance coverage.
If you don’t have insurance, depending on your income, you may be eligible to get PrEP at no cost as part of a program offered by the manufacturer of Truvada (PrEP’s brand name). Gilead’s Medication Assistance Program for PrEP may also be available to those on Medicare who don’t have Part D prescription drug coverage.
To determine if you are eligible, your medical provider needs to submit an application for you. For more information call (855) 330-5479.
For those with insurance who need help with copay and deductible costs, Gilead’s Co-Payment Assistance Program provides up to $3,600 per year, with no monthly limit, to cover out-of-pocket expenses for PrEP, including copays, coinsurance, and deductibles. The program does not restrict benefits based on income, however it is not available for those on Medicaid, Medicare Part D or any other government prescription drug programs. For more information call (877) 505-6986.
Another option for people who get their PrEP covered by their insurance, including Medicare, is the Patient Advocate Foundation, which provides up to $7,500 per year to help pay for costs related to the prescription. Approval is based on your income. If you earn less than 400 percent of the federal poverty level (or about $47,500 for an individual with no dependents) you may qualify for this program. For more information call (866) 512-3861 and select option 1.
Does Medicaid cover PrEP? What about Medicare?
Yes. Both Medicaid, as well as Medicare, should cover PrEP.
Depending on what state you live in, Medicaid may require your physician to obtain a pre-approval for PrEP before you fill your prescription.
If you are on Medicare but do not have Part D prescription drug coverage, you may be able to receive PrEP for free from its manufacturer if you have a low income. You may also be eligible for co-pay assistance if you are on Medicare.
See: What about payment assistance for PrEP? above.