Understanding PrEP: A Powerful Tool Against HIV

Explores the science, benefits, accessibility, and impact of PrEP, empowering individuals with accurate, up-to-date information to make informed decisions about their health and safety.

What Is PrEP?

Pre-exposure Prophylaxis (PrEP) is a preventive strategy that involves taking medication to reduce the risk of HIV infection before potential exposure. When taken consistently, PrEP can lower the risk of contracting HIV from sex by about 99% and from injection drug use by at least 74%, according to the CDC.

There are currently two FDA-approved oral PrEP medications:

  • Truvada (tenofovir disoproxil fumarate and emtricitabine): Approved for all populations at risk of HIV.

  • Descovy (tenofovir alafenamide and emtricitabine): Approved for men and transgender women who have sex with men, but not for those assigned female at birth who are at risk from receptive vaginal sex.

In 2021, the FDA also approved a long-acting injectable PrEP called Apretude (cabotegravir), administered every two months.

How Does PrEP Work?

PrEP works by preventing HIV from establishing a permanent infection in the body. When taken as prescribed, the medication builds up in the bloodstream and genital or rectal tissues. If HIV enters the body, PrEP stops the virus from replicating, thereby preventing infection.

This is particularly effective for individuals at higher risk of HIV exposure through:

  • Unprotected sex with partners whose HIV status is unknown

  • Having an HIV-positive partner who is not virally suppressed

  • Multiple sexual partners

  • Recent diagnosis of a sexually transmitted infection (STI)

  • Sharing needles or drug equipment

Who Should Consider PrEP?

PrEP is not for everyone, but it’s a game-changer for those at significant risk of HIV. Healthcare providers use various screening tools and risk assessments to determine if someone is a good candidate. You might consider PrEP if:

  • You are a man who has sex with men (MSM) and do not consistently use condoms.

  • You have a partner living with HIV and are unsure of their viral load.

  • You are a heterosexual man or woman with multiple partners.

  • You inject drugs and share needles or equipment.

  • You have been diagnosed with an STI in the last 6 months.

  • You engage in commercial sex work.

The decision to begin PrEP should be made in consultation with a healthcare provider, based on a comprehensive risk and health assessment.

Effectiveness and Safety of PrEP

Effectiveness

When taken daily, PrEP is extremely effective at preventing HIV:

  • Sexual transmission: Reduces risk by 99%.

  • Injection drug use: Reduces risk by over 74%.

Adherence is key. Missing doses can reduce the drug’s concentration in the body and lower its protective effects.

Safety and Side Effects

PrEP is generally safe and well-tolerated. Some users experience mild side effects when starting the medication, such as:

  • Nausea

  • Headache

  • Weight loss

  • Fatigue

These usually subside within the first few weeks. Long-term use may affect kidney function or bone density, which is why regular lab monitoring is recommended. Healthcare providers perform routine tests every 3 months to ensure safety and effectiveness.

Types of PrEP: Oral vs. Injectable

1. Oral PrEP (Truvada & Descovy)

Advantages:

  • Easy to access

  • Lower cost with insurance or assistance programs

  • Daily routine builds habit

Considerations:

  • Must be taken consistently

  • May not be suitable for those with adherence challenges

2. Injectable PrEP (Apretude)

Advantages:

  • Administered every 2 months

  • Suitable for people with difficulty taking pills

Considerations:

  • Requires clinic visits for injections

  • Not as widely available in all areas

Choosing between oral and injectable PrEP depends on lifestyle, preferences, and medical advice.

How to Get Started With PrEP

Step 1: Consultation and Testing

Before starting PrEP, a healthcare provider will:

  • Conduct an HIV test to confirm negative status

  • Screen for kidney function

  • Test for hepatitis B and C

  • Evaluate risk factors

Step 2: Prescription and Insurance

After approval, you will receive a prescription for PrEP. Most insurance plans cover PrEP, including Medicaid and private insurers. For those without insurance, programs like Ready, Set, PrEP and Gilead’s Advancing Access offer financial assistance.

Step 3: Follow-Up and Monitoring

After starting PrEP, ongoing monitoring is crucial. Patients are advised to:

  • Get tested for HIV every 3 months

  • Monitor kidney function every 6 months

  • Get STI screening as recommended

Myths and Misconceptions About PrEP

Myth 1: “PrEP is only for gay men.”

Truth: PrEP is for anyone at risk of HIV, regardless of sexual orientation or gender.

Myth 2: “PrEP encourages risky behavior.”

Truth: Studies show that people on PrEP tend to maintain or even increase safer sex practices due to frequent check-ins and STI testing.

Myth 3: “If I use condoms, I don’t need PrEP.”

Truth: While condoms are effective against HIV and STIs, they can fail. PrEP offers an additional layer of protection.

Impact of PrEP on Public Health

Since its approval, PrEP has revolutionized HIV prevention strategies worldwide. In cities with high PrEP uptake, new HIV infections have declined significantly. Some key outcomes include:

  • Reduced HIV transmission in high-risk groups

  • Greater engagement in healthcare services

  • Earlier detection and treatment of STIs

Public health campaigns now integrate PrEP into holistic sexual health strategies, especially among youth, Black and Latino MSM communities, and transgender individuals—groups disproportionately affected by HIV.

PrEP and the LGBTQ+ Community

For the LGBTQ+ population, particularly men who have sex with men (MSM), PrEP has become an empowering tool. It provides peace of mind and autonomy in navigating sexual health. Organizations like the Trevor Project, GLMA, and National Black Justice Coalition advocate for PrEP education and access as part of LGBTQ+ health equity.

Challenges in Access and Equity

Despite its effectiveness, access to PrEP remains uneven due to:

  • Stigma and misinformation

  • Lack of culturally competent healthcare providers

  • Insurance and cost barriers

  • Geographical disparities in rural areas

Efforts to close the gap include:

  • Telehealth PrEP services

  • Community-based outreach programs

  • Mobile PrEP clinics

Increasing awareness and normalizing conversations about PrEP are essential for equitable access.

Future of HIV Prevention and the Role of PrEP

Researchers are developing next-generation PrEP options, including:

  • Long-acting implants

  • Monthly pills

  • PrEP vaginal rings for women

Advancements in HIV prevention are moving toward user-friendly, discreet, and accessible options. Combined with education, testing, and treatment, PrEP plays a pivotal role in ending the HIV epidemic.

Conclusion

PrEP is more than just a pill—it’s a symbol of progress, empowerment, and control in the fight against HIV. By understanding how it works, who it’s for, and how to access it, individuals and communities can protect themselves and others. Whether you’re considering PrEP for yourself, a loved one, or simply want to stay informed, knowledge is your first line of defense.

Stay safe. Stay informed. Explore PrEP as part of a holistic, proactive approach to sexual health.