PrEP : The Right Choice for You?

by Family Health Centers of San Diego

Rage Monthly

Saturday June 14, 2014

PrEP : The Right Choice for You?

Have you heard of PrEP -- or, as it's formally known, Pre-Exposure Prophylaxis?

PrEP is a way for people who are HIV-negative to help prevent HIV infection by taking a pill every day. According to the Centers for Disease Control (CDC), when used consistently, PrEP has been shown to greatly reduce the risk of HIV infection.

PrEP is a good step in the right direction, but it is not the "be-all and end-all" answer to preventing the transmission of HIV. It is not perfect.

The key word is "reduce," because PrEP does not eliminate all risk of HIV infection. And it certainly does not prevent a person from getting sexually transmitted diseases like syphilis, gonorrhea or chlamydia. But when combined with condoms and other safer sex practices, it can be a powerful new prevention tool.

So what is PrEP?

It is a medication sold under the name Truvada that combines two medications currently used to treat HIV in those already infected. When taken daily by someone who is HIV-negative, the risk of contracting HIV can go down by 92 percent. However, PrEP is much less effective if it is not taken consistently. Before considering PrEP, you should have an honest conversation with your physician regarding your ability to take it every day. It is not intended to be a pre-party weekend savior.

Truvada was approved by the U.S. Food and Drug Administration (FDA) for use as an HIV treatment in 2004, and was approved as PrEP in July, 2012. The U.S. Public Health Service released the first comprehensive clinical practice guidelines for PrEP on May 14, 2014. Truvada can only be prescribed by a licensed healthcare provider.

The guidelines recommend that PrEP be considered for people who are HIV-negative and have risk factors for the contraction of HIV through sexual exposure and needle sharing.

The risk factors include:

1. Anyone in an ongoing relationship with an HIV-positive partner.

2. Anyone who is not in a mutually monogamous relationship with a partner who is HIV-negative and is a gay or bisexual man who has unprotected anal sex or has had an STD in the past six months; or, a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs, commercial sex work, or have bisexual male partners).

3. Anyone who shares needles and/or other injection equipment when injecting substances, including illicit drugs and hormones.

The guidelines further state that prior to PrEP being prescribed, patients must document that they are HIV-negative, do not have any signs or symptoms of acute HIV infection, have normal renal function, are not taking any contraindicating medications and have a documented hepatitis B virus infection or vaccination status.

After it is prescribed, the medication must be taken daily and patients must return for follow-up visits at least every three months for HIV testing, medication adherence counseling, risk reduction behavioral support, side effect assessment, STD assessment and testing, and renal function assessment.

Follow-up is necessary.

The drug lowers risk of HIV infection, but does not eliminate risk, so you need to continue getting tested for HIV regularly. In addition, other STD's remain a key threat. Especially when you consider that in San Diego, 61 percent of MSM (men who have sex with men) syphilis cases also had HIV infection.

A one month supply of Truvada ranges in price from $1,300 to $1,700. Please speak to your physician or health insurance provider to determine if it is a covered benefit and appropriate for you.

For more information about PrEP, please visit or

Family Health Centers of San Diego (FHCSD) is a system of community health centers that provides caring, affordable, high quality healthcare to everyone, with a special commitment to people who are low income, uninsured and medically under-served. FHCSD is the largest provider of HIV-related services, including testing, treatment, care and prevention services in San Diego County. For more information or to schedule an appointment, please call 619.515.2449 or go to

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Living Well with HIV

This story is part of our special report titled Living Well with HIV. Want to read more? Here's the full list.