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PrEP: Preventing HIV/AIDS, One Pill at a Time

Since the early 1990s, a lot has changed regarding protection methods and treatment therapies for HIV/AIDS. Thankfully today, people are living longer, fuller lives. 

While this is certainly worth celebrating, people across the country – of all races, gender, class and sexual orientation – are still being infected with and transmitting HIV. According to the Centers for Disease Control and Prevention (CDC), more than 30,000 Americans were diagnosed with HIV in 2020.

HIV is still a very real problem, but it is preventable. 

PrEP: Pre-exposure prophylaxis medication

If you’ve done any research on HIV prevention and treatments, you may have heard of PrEP, a daily medicine that is used to help reduce the risk of getting HIV-1 infection. 

Studies have shown that PrEP used along with safe sex practices can reduce the risk of contracting HIV from sex by about 99%. For those who inject drugs, it reduces the risk by 74%. 

“There is no denying the effectiveness of the drug preventing an HIV infection,” said Randy S. Gelow, MD, a family medicine physician with Banner Health Center in Phoenix, AZ, who specializes in HIV specialty care. “Unfortunately, PrEP isn’t a perfect solution. There are some stigmas and lack of education and awareness for communities at high risk. We need to get the word out more.”

Knowledge is power and can save your life. Read on as we cut through some of the stigmas surrounding PrEP and how you can protect yourself and others.

What is PrEP?

PrEP was developed for the prevention of HIV infection for HIV-negative individuals. A pill taken once a day works to stop the virus from taking residence and spreading in your body. The constant presence of the medicine in the bloodstream helps keep you HIV-negative. 

Are there different types of PrEP?

There are now three medications approved by the U.S. Food and Drug Administration (FDA) for use: Truvada (and a generic version) and Descovy (both available in pill form) and the newest Apretude (available by injection). 

  • Truvada is for all people at risk through sex or injection drug use.
  • Descovy is for people at risk through sex. Descovy isn’t for people assigned female at birth who are at risk for HIV through receptive vaginal sex (receiving the penis in the vagina).
  • Apretude is for all people at risk through sex who weigh at least 77 pounds and is the only injection approved for use as PrEP.

“Descovy is a newer formulation of Truvada, which combines the same medicine types, has the same efficacy, but a smaller dose of one of the medicines that can reduce side effects seen with Truvada,” Dr. Gelow said. “The newest medicine, Apretude, is injected into the buttock in the doctor’s office every 2 months.”

PrEP is safe. Some people may experience mild side effects like nausea, headache and fatigue, but these usually go away over time. 

Who should take PrEP?

The CDC recommends PrEP for people who are HIV-negative who have had anal or vaginal sex in the past six months and any of the following:

  • Have been diagnosed with a sexually transmitted disease (STD) in the past six months
  • Have not consistently used a condom
  • Have an HIV-positive partner
  • Have injected drugs, shared needles or been in treatment for drug use

“It’s important that the pill version is taken every day for greatest effectiveness, but it’s important to note that any form of PrEP won’t prevent other sexually transmitted infections,” Dr. Gelow said. “You’ll want to make sure you’re still using safe sex practices, such as wearing condoms, and getting tested often.”  

Routine follow-up screenings are recommended at two-month intervals for the injectable version and three-month intervals for the pill versions of PrEP.

Is PrEP expensive?

Most insurance plans and state Medicaid programs cover PrEP. 

“Under the Affordable Care Act Part 47, insurers must cover Grade A Recommended Generic Truvada (or brand name for those with an intolerance),” Dr. Gelow said. “If your insurance company is not in compliance, you can file a complaint, which I recommend all my patients do. The federal mandate was put in place since January 2021 and some insurers just are not up to speed with these mandates yet.”

There are also other programs that provide PrEP for free or at a reduced cost. You may be able to receive co-pay assistance through the Patient Advocacy Foundation (PAF) or through the manufacturer of the medications.

Descovy is more difficult to get covered due to the cost and mostly only covered when there is a significant side effect to Truvada/generic or Truvada/generic is not indicated due to other medical conditions present. 

Apretude hasn’t been given Grade A recommendation yet, so the medication requires a prior authorization almost every time it is ordered and this can be very tedious for some. It often requires a new prior authorization every few months, which can sometimes result in missed doses.  

Making sure that the provider you’re seeing has experience with these medications will result in the fewest missed injections and the smoothest experience.

Why do people choose not to take PrEP?

There are some stigmas and fears surrounding the use of PrEP. One stigma, for example, is the belief that people who use PrEP are somehow promiscuous or reckless. 

“Stigmas have been worsening as we are seeing more people on PrEP have unprotected sex or forcing sexual partners to go without condoms,” Dr. Gelow said. “In addition, there are thoughts that those people that are on PrEP are also hypersexual even though they are trying to protect their health, which is unfortunate. The stigma has now gone the other way it appears where people are getting shamed for protecting themselves.”

The CDC and other advocacy groups are working hard to change perceptions of the medications and increase awareness and adherence to using PrEP.  

How can I start PrEP?

It’s important to speak with your health care provider, so they can answer any questions you may have about PrEP and work to find the right HIV prevention strategy for you. You must take the pill every day to ensure it works, and regularly follow up with your provider. You’ll also get tested for HIV, hepatitis B as well as other STDs, like gonorrhea, chlamydia and syphilis, depending on your risk. 

If you’re having challenges getting access to the medication, you still have options. “Some providers don’t know about PrEP, or they don’t prescribe it because they don’t know the facts. You can always go to your local Planned Parenthood,” Dr. Gelow said. “Another option is to visit preplocator.org to locate a knowledgeable provider in your area. There should always be a way to get this medicine.”

Takeaway

PrEP, or pre-exposure prophylaxis, is a family of medications that can help people who are HIV negative prevent and reduce the risk of contracting HIV. When taken as prescribed along with safe sex practices, it can reduce the risk of getting HIV by about 99%.

To see if PrEP is right for you, schedule an appointment with your health care provider. If you don’t have a provider, you can find a Banner Health specialist at bannerhealth.com.

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