Preventing HIV by Taking One Pill Once a Day: Pre-exposure Prophylaxis (PrEP)

Frequently Asked Questions

  1. Is it true that there is a medication that can actually prevent someone from becoming infected with HIV?
  2. How often are the medical appointments for PrEP?
  3. When I first start taking the medication, how many days do I have to take the medication in order for it to protect me from an HIV exposure?
  4. How well does PrEP work?
  5. How would I know if PrEP is right for me?
  6. Can adolescents consent to PrEP on their own? Does a medical provider need the consent of a parent or guardian in order to prescribe PrEP to an adolescent?
  7. I prefer sex without a condom so I don't always use them. Would PrEP still work to prevent HIV if I don't use condoms?
  8. I have sex partners who are living with HIV and have an undetectable viral load because they are on HIV treatment. Do I still need to take PrEP?
  9. How would I pay for PrEP?
  10. Can I get the PrEP medication from my regular doctor or do I have to go to a special doctor?
  11. What are the side effects of the medicine?
  12. My risk for HIV happens only periodically - like on certain weekends. Can I only take the medication when I am going to have unprotected sex?
  13. Would I have to take PrEP for the rest of my life? What if I want to stop?
  14. If I drink alcohol and/or use recreational drugs, is it safe to take Truvada for PrEP?
  15. Is the PrEP medication effective for treating HIV infection?
  16. Since Truvada alone is not effective at treating HIV, is it possible that taking Truvada for PrEP could lead to my developing drug resistant HIV if I become infected? Could it lead to higher levels of drug resistant virus in the community?

1. Is it true that there is a medication that can actually prevent someone from becoming infected with HIV?

Yes. In 2012, after a series of clinical trials, the FDA approved the use of a medication called Truvada as pre-exposure prophylaxis (PrEP) for HIV.  HIV PrEP is a six-point program that includes taking one pill once a day to prevent a person from getting HIV.  Clinical trials have shown that when a person who is not living with HIV takes the medication consistently, their chance of getting HIV if exposed is greatly reduced.  The PrEP medication, Truvada, must be prescribed by a physician and people interested in PrEP should only take the medication under the guidance of a qualified medical provider.

The six-point PrEP program is for people who are not living with HIV and includes the following:

  • HIV testing, conducted initially and every three months, to make sure the person is not living with HIV; 
  • Taking one Truvada pill, once a day, every day;
  • Using condoms to prevent STDs;
  • Periodic STD testing;
  • Education about how to reduce the risk of getting HIV and STDs through sex; and,
  • Counseling and support for taking the medication regularly (adherence).

2. How often are the medical appointments for PrEP?

Below is the schedule of medical appointments for people who want to take the PrEP medication:

Initial Appointment: This first appointment includes education about PrEP, a discussion about readiness to take PrEP, HIV testing and, if ready, PrEP medication is prescribed for an initial 30-day period.

One Month Follow-Up:  At the first follow-up appointment one month later, the provider will discuss your experience on PrEP, including: adherence; side effects; and, your interest in continuing to take PrEP.  At this visit, a prescription for 60 days may be given.

Three Month Follow-UpAt this visit, HIV testing and STD screening are conducted.  The provider will review the importance of adherence and provide support for taking the medication every day.  At this visit, a prescription for 90 days may be given.

Every Three Months:  HIV testing and other assessments are repeated every three months. If you remain HIV negative and express continued commitment to take the medication daily, a prescription for 90 days may be given every three months for as long as you prefer. 

3. When I first start taking the medication, how many days do I have to take the medication in order for it to protect me from an HIV exposure?

The PrEP medication must reach and maintain a certain level in the blood and the body’s mucus membranes to provide protection.  The amount of time it takes may vary from person to person.  For people engaging in anal intercourse, the medication must be taken each day for 7 days to reach the level needed for full protection.  For the receptive partner in vaginal intercourse, it takes approximately 20 days of taking the medication consistently to reach the level of full protection in the female genital tract.  People of transgender experience should talk with their medical provider about their specific sexual practices to best determine the length of time it will take to be fully protected.

4. How well does PrEP work?

The PrEP medication works very well at preventing a person from getting HIV.  Everyone taking PrEP should be sure to take the medication every day, but it is especially important for cis-gender women to take it consistently to be fully protected during vaginal intercourse.  The more days a person misses a dose, the less protective the medication will be for any exposures that occur during that time period.  It is not recommended that a person start and stop the PrEP medication based on when they anticipate engaging in sex without a condom.  People considering PrEP should only begin once they have made a commitment to taking the medication daily.  If you are interested in more specific data regarding how well PrEP works, below is a list of links to the major clinical trials.

5. How would I know if PrEP is right for me?

PrEP is one of many options for preventing HIV.  HIV is passed from one person to another through sharing injection drug equipment or through anal or vaginal sexual intercourse.  People can avoid getting HIV by: 1) not sharing drug injection equipment (needle, syringe, cooker, cotton, etc), 2) avoiding anal or vaginal intercourse or having only one monogamous sex partner whose HIV status is known to be negative.  If you have sex with more than one partner, consistent and correct use of condoms every time you have sex can prevent you from getting HIV.  It is important to be aware that if a person who is living with HIV is on HIV treatment and is virally suppressed for six months or longer there is effectively no risk of passing HIV to a partner through sex. 

New York HIV State Clinical Guidelines indicate that medical providers should discuss PrEP as an HIV/STD prevention option for adults or adolescents who:

  • Have unprotected anal or vaginal intercourse with: 1) a partner whose HIV status is unknown; 2) a partner who is living with HIV but not on HIV treatment; or 3) a partner who is living with HIV but not virally suppressed (i.e. does not have an undetectable viral load);
  • Have unprotected anal or vaginal intercourse with a partner who is living with HIV, on treatment and virally suppressed but wishes to be on PrEP for additional protection;
  • Are attempting to conceive with a partner who is living with HIV;
  • Have multiple or anonymous sex partners or, have partners who have multiple or anonymous sex partner;
  • Participate in sex parties or have partners who do this;
  • Are involved in transactional sex, such as sex for money, drugs, or housing, including commercial sex workers and their clients, or have partners who do this;
  • Have been diagnosed with at least one STI in the previous 12 months;
  • Use of mood-altering substances during sex, such as alcohol, methamphetamine, cocaine, and ecstasy;
  • Inject substances, or have partners who inject substances, including illicit drugs and hormones;
  • Are receiving post-exposure prophylaxis (PEP) and have ongoing high-risk behavior or have used multiple courses of PEP.

It is important to weigh the pros and cons and have an open and honest conversation about PrEP with your medical provider before beginning PrEP.  PrEP is always voluntary and only you can determine if PrEP is right for you.

6. Can adolescents consent to PrEP on their own? Does a medical provider need the consent of a parent or guardian in order to prescribe PrEP to an adolescent?

2017 amendments to NYSDOH’s regulations allow minors to consent to their own HIV treatment and HIV preventive services such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) without parental/guardian involvement (10 NYCRR Part 23).  In addition, in May of 2018, the FDA approved Truvada® (Emtricitabine and Tenofovir Disoproxil Fumarate) for reducing the risk of acquiring HIV-1 among adolescents.  These developments, along with updated New York State Clinical Guidelines, mean that adolescents who are at risk for HIV may consent to PrEP and health care providers are able to prescribe PrEP to adolescents who can benefit from it without the involvement of the young person’s parent or guardian. 

7. I prefer sex without a condom so I don't always use them. Would PrEP still work to prevent HIV if I don't use condoms?

If a person takes the PrEP medication consistently, it provides a high level of protection against HIV.  Condoms are a part of the six-point PrEP program in order to provide protection against STDs.  People who are on the PrEP medication but are not using condoms may be exposed to an STD.  It is important to be aware that having an STD can increase a person’s chance of getting HIV if exposed to the virus.  Some STDs don’t have symptoms or symptoms may disappear on their own for periods of time.  If you are not using condoms regularly, it would be especially important to have regular testing for STDs and to get treated as soon as possible if you have an STD.  Learning about the signs and symptoms of STDs can be helpful in identifying whether you or one of your partners has an STD.  Condom use is recommended as part of PrEP but choosing to not use condoms routinely should not prevent you from being prescribed Truvada.

8. I have sex partners who are living with HIV and have an undetectable viral load because they are on HIV treatment. Do I still need to take PrEP?

Individuals living with HIV who are taking HIV treatment consistently and have an undetectable viral load for longer than 6 months have effectively no risk of transmitting the virus to an HIV-negative partner through sexual activity.  In sero-discordant or magnetic couples (one person is living with HIV and the other not living with HIV), PrEP may be used by the HIV-negative partner for additional protection.

9. How would I pay for PrEP?

You can find detailed information about payment options for PrEP on the NYSDOH website. Medicaid and many private health insurance plans will cover the cost of PrEP, including the medication, medical appointments and lab tests associated with PrEP.  If you have Medicaid, your medical provider must apply for prior approval to pay for the medication.  Prior approval is granted for three months at a time and must be renewed in order for Medicaid to continue paying for the medication. If you have private health insurance, check with your plan to see if PrEP is covered and ask about the amount of any medication co-pay.  For people without access to health coverage, a medication assistance program is available from the drug manufacturer.  To find out if you are eligible for the Gilead medication assistance program, visit http://www.truvada.com/truvada-patient-assistance or call 1-855-330-5479.  If you have health coverage but the amount of medication co-pay would present a financial challenge, you may be eligible for a Co-pay Coupon Card from the drug manufacturer. Visit http://www.gileadcopay.com/ or call 1-877-505-6986 for more information.

The NYSDOH PrEP Assistance Program (PrEP-AP) fills an important gap for people who are uninsured or underinsured by covering the cost of PrEP-associated health care and laboratory services provided through enrolled providers.  PrEP-AP does not pay for the cost of medications but will provide you with information about how to apply to the drug manufacturer’s patient assistance program, co-payment assistance program, or other resources that help cover the cost of medications.  To find out more about PrEP-AP, call 1-800-542-2437.
Without health coverage or financial assistance from the drug manufacturer, the cost of the PrEP medication is between $15,000 and $18,000 per year.

10. Can I get the PrEP medication from my regular doctor or do I have to go to a special doctor?

It depends on your doctor.  Any physician, nurse practitioner or physician assistant can prescribe PrEP but not all will be familiar with the six-point program.  The New York State Department of Health is preparing a directory of medical providers that prescribe PrEP.

11. What are the side effects of the medicine?

The PrEP medication, Truvada, has been included in different HIV treatment regimens for ten years and it is recognized as a well-tolerated medication with few side effects.  The main side effect felt by people in the PrEP clinical trials was mild nausea.   Only a small number of people found the side effects serious enough to stop taking the medication.  Lab tests to monitor kidney functions every six months are part of the medical protocol for PrEP.  People who are on PrEP, or considering PrEP, should discuss possible side effects with the medical provider and weigh side effects against the potential benefits of PrEP in reducing the chance of HIV infection and the resulting life-long antiretroviral treatment.

12. My risk for HIV happens only periodically - like on certain weekends. Can I only take the medication when I am going to have unprotected sex?

You should not start and stop the PrEP medication based on when you think you will be exposed to HIV.  For more information about how long a person has to be on PrEP for it to provide protection, see question 3.  In addition, it is generally believed that a person should continue to take PrEP for 28 days after their last possible exposure.  Therefore, only people with a strong commitment to taking PrEP regularly should take the medication. 

13. Would I have to take PrEP for the rest of my life? What if I want to stop?

PrEP is not intended to be a life-long program.  Rather, it is a program where the medical care provider prescribes the medication for up to three months at a time, with as many renewals of the prescription as you and the provider agree to.  For many people, over time life circumstances may change and the risk for HIV may be reduced or eliminated.  You should discuss the issue of how long you want to take the PrEP medication with your medical provider.   If for any reason you want to stop taking the PrEP medication, consult with the doctor who prescribed it for you or another doctor familiar with PrEP.  Generally speaking, people should continue taking the PrEP medication for 28 days after any possible exposure to provide protection from that exposure.

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

Alcohol and recreational drugs are not known to interact with Truvada for PrEP.  It is safe to take PrEP before, after and on days when you are “partying.”  In fact, it is important to take extra steps to make sure you take PrEP consistently every day when you are “partying.”

15. Is the PrEP medication effective for treating HIV infection?

Truvada, the PrEP medication, is not effective alone for treating HIV infection.  If you get HIV while taking Truvada, the provider who conducted the HIV test should either provide HIV medical care or refer you to a medical provider who can provide HIV care.  The HIV care provider will conduct lab tests and determine the most effective regimen to treat your HIV infection.  There is no evidence that having taken PrEP will impact the effectiveness of your HIV treatment.  People who were on PrEP and become infected can be successfully treated with HIV medications.

16. Since Truvada alone is not effective at treating HIV, it is possible that taking Truvada for PrEP could lead to my developing drug resistant HIV if I become infected? Could it lead to higher levels of drug resistant virus in the community?

HIV testing is a critical component in the six-point PrEP program.  HIV testing is done before a person begins PrEP to ensure that only HIV negative people are prescribed the PrEP medication for prevention.  Periodic HIV testing for everyone taking PrEP ensures that anyone who gets HIV will be identified quickly so they can be put on an effective treatment regimen.  If a person on PrEP gets HIV, drug resistance testing is done to determine an effective treatment regimen.  There is no evidence supporting the concern that PrEP can lead to higher rates of drug resistant virus in the community.