Given that we live in a culture still bent on pitching abstinence-only sex ed to sexually active teens, still sustaining the stigma around STIs and still dealing with the devastating history of the AIDs epidemic, it can be exhausting to worry or even think about contracting HIV. But there's one medication that can help you ease your mind and enjoy a safer, healthier, worry-free sex life.
What is PrEP, exactly?
In 2012, Pre-Exposure Prophylaxis (shortened to PrEP) was approved by the U.S. Food and Drug Administration for HIV prevention. The once-a-day pill for people at high risk of acquiring HIV through sex or intravenous drug use is probably most well-known by men who have sex with men. PrEP jumped from being used by 6 percent of gay and bi men in 2014 to being used by 35 percent of gay and bi men in 2017, according to data released by the Centers for Disease Control and Prevention (CDC) in March 2019. But in reality, PrEP can be useful for everyone. The only qualification is that you must be HIV-negative.
Despite misinformation campaigns against PrEP, the drug is more than 97 percent effective at blocking HIV infection when taken as prescribed, according to a 2015 study in Clinical Infectious Diseases. “PrEP is not an experimental drug," confirmed Kumar Jairamdas, a Tampa-based HIV specialist who owns Integrated Practice Associates, a clinic that focuses on treating homosexual and HIV-positive men. "Many, many people are at risk of HIV exposure. What’s groundbreaking about PrEP is that it presents a real opportunity for people to protect themselves,” he said.
How does PrEP work?
The science of how the drugs work can get very confusing. But what you need to know is this: There are two FDA-licensed versions of PrEP on the market, Truvada and Descovy. Both drugs are made by the same manufacturer, Gilead Sciences, and have very similar efficacy rates—but there are some important distinctions. Truvada is approved for both AFAB (assigned female at birth) and AMAB (assigned male at birth), while Descovy is FDA-approved only for AMAB. There are other factors to consider, including potential side effects, so work with your healthcare provider to determine which medication will be best for you.
Whether you’re taking Truvada or Descovy, PrEP is not a once-a-day miracle pill. Instead, it should be just one part of a continuous sexual health education and STI prevention program. According to Jairamdas, people on PrEP see their medical providers every 30 to 90 days for a full STI panel and sexual wellness education on condom use, STI prevention and general risk reduction.
Taking PrEP was a two-year commitment for Rae, a non-binary 26-year-old. “I was nervous at first," said Rae, who was connected to a local clinic by The Sex Workers Outreach Project. "But I was a full-service sex worker and wanted the extra protection and peace of mind. I got bloodwork done every 3-6 months to monitor my organ functions and levels.”
Where is PrEP available?
There are a number of providers who can prescribe PrEP: primary care, internal medicine, OB-GYN, men’s health, HIV specialists, infectious disease as well as public health clinics. But no matter which provider you see, the most critical part is finding one you can have an open, honest conversation with about your sex life, drug use and other risk factors. It’s normal to be nervous about discussing these matters with a relative stranger, but there is nothing to be ashamed about. You're seeking a way to safely enjoy your sex life, so if your provider is judgmental, move on and find someone else.
One major caveat is that PrEP can be expensive. Truvada can cost those without health insurance about $2,000 per month. However, many states have free or reduced-price PrEP programs through health departments or other organizations. According to the CDC, the pill is still underused by people of color due to the lack of access to health care and insurance.
Who should consider taking PrEP?
People with multiple sex partners or who engage in anonymous sex, those with HIV-positive partners or ones who use injectable drugs and, really, anyone having sex without a condom—including sexually active straight people—should consider taking PrEP. This is probably a much larger population than the people who are actively seeking the pill. Blame misinformation, stigma and lack of information for PrEP’s obscurity; the drug is traditionally classified for gay and bisexual men, even though HIV/AIDs is not a “gay-only” disease.
“I want to encourage everyone—everyone that has sex and/or has a substance use disorder—to think about PrEP," Jairamdas said. "Seek out a medical provider that you feel comfortable with and have an open and honest conversation. I really encourage people to think about PrEP because they deserve protection from this virus. Everyone does. Until we have a cure, PrEP is the next best thing.”