Are you PrEP skeptical?

Maybe you’re not completely sold on this new HIV prevention strategy. You think it’s a hard pill to swallow and not all it’s cracked up to be. Here are the most common questions we’ve heard so far about PrEP:

Will PrEP give people the excuse to not use condoms? Are people who don’t use condoms irresponsible?

There are many methods besides condoms that people are using to reduce their HIV risk. Some people serosort by partnering with people who have the same HIV status, reduce the number of people they have sex with, use female condoms, have sex with HIV-positive partner(s) with undetectable viral load(s), and/or use PrEP. Some methods are more effective than others depending on multiple factors.

What’s important to note is that there are a variety of options for people to protect themselves from HIV infection—also known as the prevention tool kit. Employing any or all of these methods is helpful in reducing risk and is, in fact, a way of taking responsibility for your sexual health.

Aren’t condoms enough?

Condoms are an effective tool against HIV, but they aren’t perfect. Here are just a few reasons people give for struggling to use them consistently.

  • Not having condoms handy and getting caught up in the moment.
  • Assuming your sex partner shares the same HIV status as you.
  • Doing things when drunk or high that we wouldn’t do under normal circumstances.
  • Having reduced sexual pleasure or difficulty sustaining an erection.
  • Feeling that condoms block emotional intimacy with a partner.
  • Having a partner who refuses to wear condoms.

Having a partner who threatens to end the relationship, terminate financial or housing assistance, or even use physical violence if condoms are insisted upon.

In fact, studies consistently show that a high percentage of people (straight, gay, or bi; female, male, or trans) do not use condoms for anal or vaginal sex with a partner whose HIV status they are unsure of.

Some people are going to have challenges with condom use no matter what we do. Wishing that away or blaming them doesn’t help, and only ensures that their risk for becoming infected remains high. PrEP could offer another way for them to protect themselves from HIV.

Why do we need new HIV prevention tools, like PrEP?

Behavior change is very difficult, even when the stakes are high. Despite all that we know about the dangers of tobacco, millions continue to smoke. We also know that we should exercise and eat well, yet obesity is on the rise. We’ve got the same struggles when it comes to HIV prevention and sexual health.

Until now, adopting safer behaviors—including condom use—has been the only option available for people who wished to protect themselves from becoming infected. Lots of people were able to successfully change their behavior in the late 1980s and early 1990s, so much so that the rate of new infections dropped by an amazing degree. Since then, however, helping people maintain safer behaviors or getting younger people to adopt them has gotten a lot harder. In fact, more than 50,000 people are estimated to have become infected each year since the mid- to late-1990s. That’s about 800,000 new infections since then. Among gay and bisexual men, new cases are actually on the rise, especially for young black and Latino men.

And it’s not just individual behaviors that put people at risk for HIV. There are many external factors that contribute, too. These include poverty, homophobia, racism, homelessness—all of these things can significantly increase HIV risk while also contributing to significant health disparities across various racial and socio-economic groups.

We desperately need new tools in order to turn things around. PrEP is a new HIV prevention strategy that puts the power of prevention in the hands of HIV-negative people. Now that PrEP has been shown to be effective in clinical trials, the next step is to determine whether and how PrEP can be used to reduce HIV infections in communities.

Why would someone who doesn’t have HIV decide to take a pill every day?

Taking a pill every day to prevent something from happening to your body is not a new or foreign concept. Currently, there are over 10 million women in the United States who take a pill every day to prevent pregnancy. Think of PrEP as like the birth control pill, except instead of preventing pregnancy, it reduces risk for HIV.

Is it okay to give HIV-negative people anti-HIV medications when we have HIV-positive people who have trouble getting HIV medications?

Both are equally important. It’s not a yes or no question. The science and evidence are there to prove that this HIV prevention strategy works. We would be doing our communities a huge disservice if we didn’t try to simultaneously prevent and treat HIV.

Ethical questions around access, affordability, and distribution are ones we are trying to address with partners at the local, state, and federal levels. Advocates are committed to investing in ending AIDS—which prioritizes making sure all people living with HIV have access to HIV treatment and also that HIV-negative people have access to use the tools they need to prevent them from getting infected in the first place.

Are you PrEP Curious?

You are currently not using PrEP and are interested in learning more about this new HIV prevention strategy. Who is this strategy meant for and how does it prevent HIV?

I’m a gay and bi man and/or transwoman; does PrEP work for me?

Yes. Research shows that PrEP works for HIV prevention for gay and bi men and transwomen. To note again, in the clinical research world, researchers use the term “men who have sex with men” (MSM) to describe gay and bi men, transwomen, and others who were born male and who have sex with men but who may or may not identify as gay or bisexual. The clinical studies often lump these groups together.

In case you’re curious to know more about the research, the  iPrEx study compared Truvada with a placebo pill in nearly 2,500 gay and bi men and transwomen in six countries. All of the participants also got safer sex counseling and condoms, regular sexually transmitted infection (STI) check-ups and treatment, and HIV testing.

When the researchers compared people assigned to take Truvada with those assigned to take the placebo, they found that people who were given Truvada had lower HIV infection rates compared to people who were given placebo. When the researchers took it a step further and looked only at people with detectable levels of the drugs in their blood (a sign than the medication was being taken regularly), they found that transmission dropped by as much as 92%. Further analyses indicate that drug levels corresponding to daily use are associated with 99% protection against HIV.

I’m a transwoman or transman who is taking hormones; does PrEP work for me?

More research needs to be done to figure out if hormones interact with Truvada and change its HIV protection effectiveness, but no interactions have been reported to date.

I’m an injection drug user; does PrEP work for me?

Yes. Research shows that Truvada for PrEP works for HIV prevention for people who inject drugs.

In case you’re curious to know more about the research, the Bangkok Tenofovir Study compared Truvada with a placebo pill in more than 2,400 participants who reported injecting drugs during the previous year in Bangkok, Thailand. Truvada was associated with a nearly 49% overall reduction in risk of HIV infection in IDU participants. Protection increased to 74% among those who took the study drug via directly observed therapy during clinic visits. Because participants in the study may have been both injecting drugs and having sex without condoms, it is still unclear whether Truvada specifically prevents “parenteral” HIV acquisition—that is, acquisition through injection rather than sex.

I’m an adolescent under 18 years old; does PrEP work for me?

More research needs to be done to figure out the safety and effectiveness of PrEP for people who are younger than 18 years old. There are studies underway with the Adolescent Trials Network trying to answer this question.

Is PrEP right for me? Who is PrEP meant for?

PrEP is not the right fit for everyone but may be useful for men, women, and transwomen who are at risk for HIV infection through sex and injecting drug use and okay with the idea of taking a daily pill to prevent HIV.

If you can answer yes to any of the questions below, then PrEP may be one HIV prevention strategy to consider.

  • Do you use condoms sometimes or not at all?
  • Do you get often get STIs in your butt?
  • Do you often get STIs in your vagina?
  • Have you taken post-exposure prophylaxis (PEP) more than once in the past year?
  • Are you in a serodiscordant relationship, where your sexual partner is HIV positive and you are HIV negative?
  • Are you in an open relationship or having anal and/or vaginal sex with multiple partners?
  • Are you having sex with someone whose HIV status you don’t know?
  • Are you having sex with someone in a city or region where the HIV prevalence is high—that is, where there are large numbers of people living with HIV?

I think I’ve been accidentally exposed to HIV; is PrEP a good option for me?

No. If you have been exposed to HIV, PrEP is not the best option for you because it is meant to reduce your risk before exposure. If you are reading this within 72 hours after exposure, consider starting PEP (short for post-exposure prophylaxis), a month-long course of drugs that can reduce the likelihood of infection. To access PEP, immediately contact your doctor and/or go to the nearest emergency room. PEP must be started within 72 hours after exposure. If you are in San Francisco, find out how you can get PEP here.

My partner is HIV-positive and I am HIV-negative; is PrEP right for me?

PrEP may be one HIV prevention strategy for you to consider to reduce your HIV risk, and can be used with other HIV prevention methods. We’re all about being proactive about your sexual health choices.

For example, if your HIV-positive partner is already taking HIV medications to treat his/her HIV and reduce viral load to undetectable levels, it reduces his/her chance of transmitting the virus to you. If you add PrEP to the equation, then you would add another layer of protection to reduce your HIV risk. As a disclaimer, remember that PrEP does not protect you against other STIs, like gonorrhea or syphilis, or prevent pregnancy.

It’s important for you to have open communication with your partner and your doctor about whether PrEP may be a good option for you to consider.

My sex partner is taking HIV medications to treat his/her HIV. Will my anti-HIV medications interact with the HIV medications he/she is taking?

No, your anti-HIV medications will not interact with the HIV medications that your partner is taking. The anti-HIV medications you are taking work to prevent HIV infection from happening in your body and nobody else’s, and vice versa.

Also on a similar note, sharing medications with each other is a big no-no. Not only does sharing mean your partner could run out of meds unexpectedly (and be at risk for developing drug resistance), the medications your partner takes may not be the same ones used in safe and effective PrEP.

If I use PrEP, do I have to use condoms?

We’re not here to be the condom police and dictate your sex life. To answer this question, it really depends on what you and your partner want and need that will determine whether you “have” to use condoms. There are many options available now to prevent HIV. Who doesn’t love options? Of course, just like condoms, PrEP only works if you use it.

If you use PrEP consistently and correctly, it is 92%–99% effective in reducing your HIV risk, whether you use a condom or not. PrEP does not protect against STIs, like gonorrhea, Chlamydia, or syphilis, and does not prevent pregnancy. (Condoms do protect against HIV, STIs, and pregnancy.)

Condoms have been and continue to be an effective tool in reducing HIV risk, but we know that many people are already not using condoms each and every time they have sex. PrEP is an additional tool to consider for HIV prevention.

I never use condoms; is PrEP right for me?

People don’t use condoms for a lot of different reasons. You might be in a monogamous relationship, or you know your sex partner shares the same HIV status as you, or you don’t like the way they feel, etc. If you never use condoms, are HIV-negative, and are concerned about your HIV risk, then PrEP may be a good HIV prevention option for you to consider.

There are other options available too. Some people seroposition by being the insertive (top) or receptive (bottom) sexual partner, serosort by partnering with people who have the same HIV status, reduce the number of people they have sex with, use female condoms, have sex with HIV-positive partner(s) with undetectable viral load(s), and/or use PrEP. Some methods are more effective than others depending on a variety of different factors. It all depends on what you find works best for you and how comfortable you are with different levels of HIV risk.

I’ve heard about taking a pill for 28 days after you’ve been exposed to HIV (“PEP” or post-exposure prophylaxis). Are PEP and PrEP the same?

PEP, post-exposure prophylaxis, is medication taken immediately after exposure to HIV (within 72 hours) and continued for 28 days.

PrEP, pre-exposure prophylaxis, is taken before exposure to HIV and continued for your “season” of HIV risk.

What does taking PrEP entail?

It’s not just simply taking a pill. It’s taking a pill every single day, getting regularly tested for HIV and STIs, and going into your doctor’s office every 2–3 months to get your labs checked.

Does PrEP protect against other STIs besides HIV?

No, PrEP does not protect against other STIs. PrEP only reduces your risk of getting HIV.

How effective is PrEP at preventing HIV?

If taken correctly and consistently, PrEP is 92%–99% effective in reducing your risk for HIV.

How often should I get tested for HIV when I start PrEP?

Before you start using PrEP, it is essential to make sure you are HIV negative; you run a small risk of developing HIV drug resistance if you are already infected with HIV when you start PrEP. That’s because Truvada is not sufficient on its own for treating HIV; if you are already infected, the virus in your body could become resistant to the two drugs in the Truvada pill. HIV drug resistance means certain medications will no longer keep the virus in check if you are HIV-positive. For this reason, it is really important that before you start using PrEP, you get tested for HIV using an RNA test, which looks for the actual presence of virus in your blood. During early HIV infection, it’s a more reliable test than the standard antibody test, which looks for the presence of antibodies to HIV, not the virus itself.

When you are using PrEP, you are advised to get tested for HIV every three months to make sure this HIV prevention strategy is working for you.

Does PrEP need to be taken with food?

No, you do not need to take this medication with food.

What drugs are being used for PrEP?

Currently, Truvada is the only FDA-approved drug for PrEP. There are studies underway to explore other drug options.

What happens if I contract HIV while taking PrEP?

Remember, HIV today is a manageable disease. Work with your doctor to get linked in to HIV care and start getting the treatment you need to maintain your health. Also remember that it’s important to find a support system and have people you can lean on with the emotional and physical challenges ahead.

If you are located in San Francisco, please check out our Positive Force program, offering easy, understandable, and non-judgmental ways to help you get the healthcare and support you need.

I have a friend who has HIV and he/she is taking Truvada (or other HIV medication); can I just use his/her meds for PrEP? Can we share meds?

While your friend may be taking HIV medications to treat his/her HIV, we do not recommend simply taking his/her medications. Sharing medications is a big no-no. This HIV prevention strategy is something that would need to be discussed with and monitored by your doctor. You will need to have lab work done to monitor side effects and your kidney function. It is definitely not an HIV prevention strategy we recommend doing on your own using another person’s medication that isn’t prescribed for you.

If I take PrEP, does this mean I have to take it for the rest of my life?

No. We recognize that people go in and out of “seasons of risk,” where there are certain times it makes sense to take PrEP and then other times where it doesn’t make sense to take PrEP.

For example, if you start taking PrEP because you are sexually active with multiple partners who are HIV-positive and HIV-negative, and later you find yourself in a relationship where you and an HIV-negative partner are committed to having sex with only each other, then continuing to take PrEP might not make a whole lot of sense for you.

Or maybe you start PrEP when you are in a serodiscordant relationship, then that relationship ends and you have no sexual partner for the next six months; then it might not make sense to take PrEP.

Or more simply, maybe you decide to use other options to reduce your risk for getting infected with HIV, and PrEP doesn’t make the most sense at the moment.

With proper guidance, people can safely start and stop taking PrEP. Think of PrEP as an HIV prevention option where HIV-negative individuals take a pill to prevent HIV infection for the “season” when they are most at risk for being exposed to HIV.

How soon does PrEP become effective after you start it? How long does it take for PrEP to become protective?

It’s estimated that it takes at least seven days for PrEP to reach high levels of protection in the body. When used correctly, Truvada for PrEP provides 92%–99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed.

How soon does PrEP become effective after you start it? How long does it take for PrEP to become protective?

It’s estimated that it takes at least seven days for PrEP to reach high levels of protection in the body. When used correctly, Truvada for PrEP provides 92%–99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed.

What happens if access to PrEP is interrupted? What if I stop taking PrEP and then start taking it again later?

If a daily dose is missed, PrEP is still effective but the level of HIV protection may decrease. It only works if you take it correctly and consistently.

According to data analysis from the iPrEx study that found PrEP to be effective:

  • For people who take 7 PrEP pills per week, their estimated level of protection is 99%.
  • For people who take 4 PrEP pills per week, their estimated level of protection is 96%.
  • For people who take 2 PrEP pills per week, their estimated level of protection is 76%.

There are not enough data available to provide specific timing guidance on non-daily use, so the FDA recommends PrEP be used daily to achieve the highest level of protection.

If I stop taking Truvada for PrEP, will I be more likely to contract HIV than I was before it started?

If you stop taking Truvada for PrEP, it does not make you more vulnerable to HIV infection.

What if I’m not having sex right now; do I still need to take PrEP?

If you feel your risk for HIV has changed recently and it doesn’t make sense for you to take PrEP anymore, then talk to your doctor about discontinuing PrEP. If you’re just experiencing a temporary “lull” in your sex life lasting less than a month or two and expect to be sexually active again in the near future, it may not be advisable to discontinue PrEP. Ask your doctor.

Once you start using PrEP, do you have to use PrEP forever?

No. You can discontinue using PrEP whenever you decide the protection it offers is no longer necessary, if you experience complications related to PrEP, or if you cannot manage to take a pill daily. However, it is advised that you continue taking PrEP for one month following your last possible exposure to HIV.

The pill is making me nauseous. What can I do?

According to studies, most people who experience nausea while taking PrEP stop feeling nauseated after about a month of taking the drug. You might also consider switching the time you normally take your drug; taking it at night might allow you to sleep through the nausea, for example.

What about side effects from taking Truvada for PrEP? How will my body be affected?

For the first few weeks of starting Truvada for PrEP, some people complain about nausea, vomiting, fatigue, and dizziness, with these minor symptoms eventually resolving themselves over time.

Some people in clinical trials had elevations in blood tests that looked at kidney function. With this particular side effect, there were no physical symptoms, so it is important to remember that if you take PrEP, you need to get routinely checked by your doctor to make sure your kidneys are working properly.

Some people in studies had a decrease in bone mineral density within the first month. However, but these changes were small, did not progress over time, and did not increase risk for fracture. Once Truvada was stopped, the bone mineral density returned to normal.

What about the chance of HIV developing drug resistance to Truvada for PrEP?

Before you start using PrEP, it is very important to make sure that you are HIV-negative because you run the small risk of developing HIV drug resistance if you are already infected with HIV when starting PrEP. That’s because Truvada is not sufficient on its own for treating HIV; so if you are already infected, the virus in your body could become resistant to that drug. To develop HIV drug resistance means certain medications will no longer keep the virus in check if you are HIV-positive.

Can you get HIV from Truvada for PrEP?

No, you cannot get HIV from Truvada. The medications in Truvada work to prevent HIV from establishing infection inside the body.

Are there sexual side effects of taking Truvada for PrEP?

From what we know from completed studies, people have not complained about sexual side effects.

If I drink alcohol and/or use recreational drugs, is it safe for me to take Truvada for PrEP?

Alcohol and recreational drugs are not known to interact with Truvada for PrEP. It is safe to take PrEP after a night on the town.

If I take medication for my depression, is it safe for me to take Truvada for PrEP?

Medications for depression have not been shown to interact with Truvada for PrEP.

Will I experience fat redistribution?

Truvada for PrEP has not been associated with any redistribution of fat in the body.

What are the long-term effects of taking Truvada for PrEP?

As of right now, we do not know the long-term effects of taking Truvada for PrEP beyond reducing your risk of HIV. It is important to work with your doctor to monitor any potential long-term effects.

For people who are living with HIV and taking Truvada for long-term HIV treatment, there are concerns about increased kidney function and decreased bone mineral density.

Does PrEP work differently for “tops” or “bottoms”?

Bottoms are already at much greater risk for HIV than tops. One of the great things about Truvada for PrEP is that the drugs are known to be very good at protecting people from infection during receptive anal intercourse. After you swallow the pill and Truvada is absorbed into your body, much of it winds up in your colorectal tissue—ready to fight any HIV that it encounters. That doesn’t mean that PrEP isn’t a good prevention option for tops—it just means it has even greater benefits for bottoms.

I use condoms every time I have sex; is PrEP right for me?

It’s great that you are already taking consistent proactive steps to take control of your sexual health and reduce your risk for HIV. If you are still worried about your risk for HIV and/or considering taking condoms out of the equation, then know that PrEP is available as an additional tool for HIV prevention.

I use condoms sometimes but not always; is PrEP right for me?

A recent study suggest that guys who use condoms “sometimes” for anal sex are just as likely to contract HIV as guys who never use them. If you fall into this camp, PrEP might be right for you.

Are you thinking about starting PrEP?

You are considering using PrEP and you want to know how to prepare and learn about how you can get it. Here are some questions that might come up in conversation:

How often do I have to go to the doctor when taking PrEP?

You should expect to see your doctor every 2–3 months for follow-up. If you are getting PrEP through a clinical trial or demonstration project, then you may see your doctor more often.

What will my doctor’s visits look like for PrEP?

Your doctor’s visits will depend on your particular circumstances and your healthcare provider. In some cases, your doctor may want to see you more frequently when you first start taking PrEP to monitor any potential side effects and to check in with you about how things are going. After that initial period, many providers are comfortable seeing their patients on PrEP less frequently. Because it is important to test for HIV consistently while on PrEP, they will likely want to see you about every three months to test for HIV and to run other laboratory tests to make sure everything is in order. Ultimately, the decision about how frequently you will be seen is between you and your provider.

If I’m using PrEP, do I still have to use condoms?

Like condoms, PrEP is highly effective at preventing HIV when used consistently and correctly. You have to figure out what works best for you, and how comfortable you are with some degree of uncertainty. Some people will keep using condoms while on PrEP and others will decide to stop using them. If you are already using condoms consistently, and doing so makes you feel comfortable and protected, then keep doing what feels right to you. Many people struggle with using condoms consistently, which one reason why PrEP was developed. You have to decide for yourself what level of protection feels right and gives you the peace of mind to lead a sexually fulfilling life.

What happens if you get HIV while on PrEP?

The more consistently you take PrEP, the more unlikely it is that you will contract HIV. It is possible to contract HIV while on PrEP, especially if you frequently forget to take the pill. During your follow-up visits with your healthcare provider while on PrEP, your doctor will test you for HIV to determine your current HIV status. If you do find out that you are infected with HIV, breathe: There are many types of support available for people who are HIV positive. Work with your doctor to get to make sure you get on a treatment regimen that is appropriate for you. If you don’t have a regular doctor, talk with the staff who tested you to find a primary care doctor who is knowledgeable about HIV.

Does PrEP prevent against STIs?

No, taking PrEP does not prevent you from contracting sexually transmitted infections such as gonorrhea or syphilis. It is important for you to be regularly tested for these infections and to be treated promptly if you find out that you are infected.

How do I know if the pill I’m taking for PrEP is working?

If only there was some magical indicator for you to know! The best part about PrEP is that most people don’t feel any different when they’re taking it. Most people don’t experience side effects. However, rest assured that if you are taking PrEP correctly and consistently, the drug is in your body, ready to fight HIV if you come into contact with it.

I talked to my doctor about PrEP and they won’t prescribe it to me because they don’t know what it is. What can I do?

Unfortunately, a lot of general practitioners and even some HIV specialists still don’t know about PrEP. You don’t have to talk to an HIV specialist to get PrEP. You can talk to any general health provider who is qualified to write a prescription, including doctors, nurse practitioner, physician assistants.

If your doctor simply doesn’t know what it is and is uncomfortable prescribing it, ask them for a referral to someone who might be better able to meet your needs. Some doctors are also resistant to prescribing PrEP. If they say they don’t know anyone to refer you to, ask whether it might be possible to be referred to an HIV specialist.

If they still can’t help you, there are a few things you can try.

  • If your city has a local LGBT center, they might have a list of LGBT-friendly providers that might be more knowledgeable about PrEP.
  • There may also be an AIDS service organization nearby that might be able to refer you to a provider who can help.
  • If your provider is not knowledgeable about PrEP but would like to learn more, they can consult with the Centers for Disease Control and Prevention (CDC) for guidance on prescribing PrEP and/or also contact the National HIV/AIDS Clinicians’ Consultation Center’s Warmline for expert clinical advice (for clinical providers only).
  • My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP. If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid, please send an email to myprepexperience@gmail.com.

I have friends who are already taking HIV drugs. Can I share meds with my friend who is taking HIV drugs and take them for PrEP? It’s basically the same thing, right?

It’s never a good idea to share prescription drugs.

I have private health insurance. Will my health insurance coverage cover PrEP?

To date, we have not heard any reports of health insurance companies denying requests to fill prescriptions for PrEP in the United States. Some health insurance companies have pre-authorization requirements to determine if you are eligible to have it covered under insurance. This doesn’t necessarily mean that your particular plan will cover it—we can’t guarantee that! However, reports indicate that most people have no trouble getting their private healthcare insurance to cover PrEP.

My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP.  If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid, please send an email to myprepexperience@gmail.com.

I have private health insurance. How much does PrEP cost?

If you have private healthcare insurance, you can expect to pay your normal co-pay associated with brand-name drugs. This varies from plan to plan. PrEP is not cheap. Without insurance, out-of-pocket costs can be as high as $13,000 per year.

I have private health insurance. My insurance coverage charges me a high co-pay for Truvada. Is there any way I can get assistance to help cover my co-pay?

Yes! Gilead’s co-pay assistance program is specifically set-up for this purpose and can help those eligible cover the cost of co-pays. Contact Gilead for more information and to find out if you are eligible.

My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP.  If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid or Gilead, please send an email to myprepexperience@gmail.com.

I have private health insurance but is there a way that I can get PrEP for free?

There are many clinical studies and demonstration projects happening across the country where you can get PrEP for free. AVAC has a compiled an up-to-date handy list of all ongoing PrEP studies here.

I’m nervous about talking to my doctor about PrEP. How should I bring it up?

Talking to your doctor about sex can often be a nerve-wracking experience. Relax. It’s their job to provide the best care possible to you as their patient. Tell them that you heard about a new HIV prevention option called pre-exposure prophylaxis and you’re interested in discussing it with them to figure out if it’s right for you. They will probably ask you why you think it’s a good option for you. Be honest with them. Tell them that you heard it is highly effective, and that you’re concerned you might be at risk for contracting HIV. You can refer them to this website, too.

I don’t have private health insurance and PrEP is too expensive. Can I get Truvada for PrEP at low cost or for free?

Yes! If you don’t have insurance, there are ways to get Truvada for PrEP at no or low cost.

My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP.  If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid or Gilead, please send an email to myprepexperience@gmail.com.

I have Medicaid. Does Medicaid cover PrEP?

Medicaid is covering PrEP in states like New York and Florida, but actual Medicaid coverage varies from state to state, so check with your benefits counselor. Public policy advocates will have to tackle this issue in the coming months and years to make sure PrEP is accessible to everyone who needs it.

My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP.  If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid or Gilead, please send an email to myprepexperience@gmail.com.

I don’t have private health insurance. How much does PrEP cost?

PrEP is not cheap. Without insurance, out-of-pocket costs can be as high as $13,000 per year.

I don’t have private health insurance. How do I find a doctor to prescribe Truvada for PrEP? How do I bring it up?

Since you will need a prescription for Truvada for PrEP, you will need to get connected with a healthcare provider to access it. If you do not have insurance and do not regularly see a doctor, please locate a community health center near you.

Unfortunately, a lot of general practitioners and even some HIV specialists still don’t know about PrEP. You don’t have to talk to an HIV specialist to get PrEP. You can talk to any health care provider who is qualified to write a prescription, including doctors, nurse practitioner, physician assistants.

If your doctor simply doesn’t know what it is and is uncomfortable prescribing it, ask them for a referral to someone who might be better able to meet your needs. If they say they don’t know anyone to refer you to, ask whether it might be possible to be referred to an HIV specialist.

If they still can’t help you, there are a few things you can try.

  • If your city has a local LGBT center, they might have a list of LGBT-friendly providers that might be more knowledgeable about PrEP.
  • There may also be an AIDS service organization nearby that might be able to refer you to a provider who can help.
  • If your provider is not knowledgeable about PrEP but would like to learn more, they can consult with the Centers for Disease Control and Prevention (CDC) for guidance on prescribing PrEP and/or also contact the National HIV/AIDS Clinicians’ Consultation Center’s Warmline for expert clinical advice (for clinical providers only).
  • My PrEP Experience has a wonderful resource monitoring insurance and Medicaid coverage of Truvada for PrEP.  If you have trouble getting a prescription for Truvada as PrEP, or getting a PrEP prescription covered by insurance or Medicaid, please send an email to myprepexperience@gmail.com.

Are you currently taking PrEP?

You are already taking Truvada (or other approved anti-HIV medication) for PrEP and have some pressing questions about this HIV prevention strategy. First off, kudos to you for taking proactive steps in reducing your risk for getting infected with HIV and coming here to (hopefully) find answers to your questions.

If I’m taking Truvada every day for PrEP, can an HIV-positive sex partner with an undetectable viral load infect me?

HIV risk varies depending on a variety of factors—some of which are more consistent from person to person, and some of which are different for each individual. For example, the risk of having receptive anal intercourse is—on average—about ten times higher than the risk of having insertive anal intercourse.

We don’t yet know exactly how much less risky it is to have sex with someone who has an undetectable viral load compared with someone with a detectable viral load. Studies with heterosexual couples suggest that being on treatment reduces the risk of transmission between men and women by about 96%. That number might be different for gay men, but it is reasonable to assume that the risk of transmission from someone who is on treatment and has an undetectable viral load is much less risky than having sex with someone not on treatment and/or whose viral load is detectable.

That isn’t the same as saying it is impossible. Remember that viral load tests based on the amount of virus in blood, which may differ from the amount of virus in semen. Viral load can also fluctuate day to day and even from morning to night. If your partner contracts an STI, such as syphilis, it can cause their viral load to spike unexpectedly.

That said, all the evidence suggests that the risk is very low. You have to decide for yourself what level of risk feels acceptable.

Can I get a generic version of Truvada for PrEP?

In the United States, generic versions of Truvada for PrEP are not yet available.

Since I am getting routinely tested for HIV while on PrEP, should I be worried about the testing “window period” when I get my HIV test results? How confident can I be in my HIV test results?

If you are using PrEP consistently on a daily basis, then you should be fairly confident in your HIV test results, and using a rapid HIV antibody test should be fine.

If you are not using PrEP consistently on a daily basis and worried that you might be seroconverting, then using an RNA test might be more reliable in case you are in the “window period” in early HIV infection.

If you want to learn more about specific window periods for the different types of HIV tests, click here.

What happens if I accidentally miss a dose of Truvada for PrEP?

It’s important to take your pill every day, but every now and then it’s perfectly human to forget. If you routinely take your pill at night, for example, and remember when you wake up in the morning, it is fine to take your missed dose with breakfast. If you don’t remember until the next evening, it’s not necessary to take a double dose. The opposite scenario also works: If you usually take your pill in the morning but forget to do so, just take it when you remember that same day. If you don’t remember until the next morning, just pick up where you left off, and do your best to remember next time.

If I missed a dose yesterday, is it okay to take two pills on the same day?

There’s no reason to double dose.

I know it’s really important for me to take Truvada every single day for it to be highly effective. What can I do to remind myself to take Truvada every day?

There are a variety of tools that can help you remember. One of the easiest is the power of association. Tie your pill-taking to something you already do every day—like brushing your teeth, washing your face before bed, or eating breakfast. If you prefer a more technological approach, there are dozens (perhaps hundreds) of mobile apps that can remind you take your mediation. Options vary by operating system. Just do a search for “medication reminder” in your phone’s app store. Read the reviews and feature list carefully to determine which one sounds best for you. Finally, you can always do it the old-fashioned way by getting a pill box that has a compartment for each day of the week. Just make sure to refill it each week!

I’ve already started using PrEP; what if I want to take my pill at a different time?

No problem! For example, if you decide to start taking it before bed rather than in the morning, just make the switch. On the day you make the switch, you can either take a dose in the AM, and then again in the PM to get on the new schedule, or just skip the AM dose and take it in the PM to get on the new schedule.

I’m traveling and will be in a different time zone. How can I figure out when to take my pill?

No worries! Just take the pill at the same time you would at home.

What if I have a hard time remembering to take the pill?

Until we have other options, PrEP currently works best for people who can fit daily pill-taking into their lives. You can try one of the options listed in the previous FAQ question about pill reminders. If you find that taking a pill every day just isn’t working out, PrEP might not be right for you.

Does it matter what time of day I take Truvada?

No, although it is best to find a consistent time to take it daily to help you to remember.

When do I stop using PrEP?

Deciding when to stop PrEP is a personal decision. If you are considering discontinuing PrEP, talk to your doctor. Are you in a new, monogamous relationship with another HIV-negative person? After three months into the relationship, consider getting tested for HIV together to ensure that you’re both still negative. You may want to talk with your partner about the fact that you’re thinking about stopping PrEP.

Is it safe to take Truvada after I’ve been drinking?

Yes! It is perfectly safe to take Truvada after a night on the town. Alcohol is not known to interact with Truvada in any harmful ways.

Can I use drugs when I’m taking Truvada for PrEP?

Truvada is not known to interact with any recreational drugs.

Do I need to tell my sex partners and/or friends that I’m on PrEP?

No. It is completely up to you who you tell. For some people, keeping that information private is important. Others may wish to talk about it with their partners or friends. That decision is completely yours to make.

What can I do if taking Truvada makes me nauseous?

Maybe switching the time of day you are taking your drug. If the problem persists, bring up to your doctor.

What are the long-term effects of taking Truvada for PrEP?

HIV-positive individuals have been taking Truvada to assist in treating HIV for many years now. Although it is important to be monitored for any potentially negative side-effects, we know that taking Truvada is generally very safe. Negative side effects generally appear when you start taking Truvada.

Are you a provider who is trying to become more PrEP-friendly?

Here you'll find everything you need to inform yourself about PrEP and talking about it with your patients as a potential option to reduce their risk for HIV.

Is there a handout available for me to talk to patients about PrEP?

Check out this handy resource from Project Inform for medical and non-medical service providers in English and Spanish to talk to your patients about PrEP.

What are the current CDC guidelines for PrEP?

CDC is in the process of developing comprehensive guidelines for PrEP.  Until then, they have provided these interim guidelines for providers interested in providing PrEP for gay and bisexual men, heterosexually active adults, and injecting drug users.

Are you interested in receiving print materials for your provider office?

We have palm cards and posters that we would be happy to send to you, and/or you can download at your convenience in our digital library. You can also contact us at feedback@sfaf.org to receive materials.

I have questions that aren’t addressed on this website. Who can I call to get immediate advice about PrEP as a provider?

If you have any questions that are not addressed here and you would like to learn more, you should consult with the Centers for Disease Control and Prevention (CDC) for guidance on prescribing PrEP and/or also contact the National HIV/AIDS Clinicians’ Consultation Center’s Warmline for expert clinical advice.

Have more Questions?

If you have any questions that are not addressed here, please feel free to contact us at feedback@sfaf.org.

Until now, adopting safer behaviors—including condom use—has been the only option available for people who wished to protect themselves from becoming infected.