Everything you need to know about the pill that’s changing HIV prevention.
Approximately 36.7 million people are HIV positive today — a number that continues to grow to epidemic numbers, both in the U.S. and around the world.
Fortunately, new highly effective pre-exposure prophylactic measures like PrEP are making prevention easier than ever. Sold under the name Truvada, PrEP is a pill shown to be between 92 and 99 percent effective when used correctly by HIV-negative people at a high risk of infection, with some studies showing 100 percent effectiveness — an unprecedented success rate in contrast to other preventative measures.
PrEP: A Brief History
A combination of two HIV medicines called tenofovir and emtricitabine, PrEP has gained significant popularity since the FDA approved the drug in 2012. Research from Gilead Sciences suggests that at least 80,000 people started taking Truvada between 2012 and 2015. If used correctly by those currently prescribed, PrEP stands to reduce new cases of HIV by a third in the U.S. over the next ten years.
Who is PrEP Right for?
How can you decide if PrEP is right for you? It’s designed for people with a high risk of HIV infection who have not already contracted HIV — a group that may include gay and bisexual men and injectable drug users, in addition to heterosexual adults whose sexual partners may have HIV.
Those at the highest risk are intravenous drug users who share needles, individuals sleeping with someone who is HIV-positive, and those who don’t regularly use condoms with multiple partners.
What are some PrEP side effects?
PrEP may bring with it a variety of side effects, including nausea, fatigue, and dizziness. Clinical trials have also found that some individuals experience elevations in blood tests that look at kidney function — a side effect with no physical symptoms.
But don’t write off the drug just like that — only 10 to 30 percent of people starting PrEP experience side effects, and they’re typically mild and last only a few days or weeks. Individuals taking PrEP are also advised to check in with their doctor every three months to retest for HIV and STIs, and to ensure continued kidney health. When considering starting PrEP, it’s best to find a doctor that you trust who understands your specific needs; use our provider search engine to find a gay-friendly or gay-identifying doctor to help determine if PrEP is right for you.
How Much Does PrEP Cost?
While out-of-pocket costs for the drug can be hefty — upwards of $1,600 for a 30-day supply — PrEP is widely covered by Medicaid and insurance providers. For individuals without insurance or who are otherwise unable to afford this medication, there are a number of resources at your disposal. The Patient Advocate Foundation’s co-pay relief program, for example, helps offset costs for low-income insured people, and Gilead’s co-pay coupon card reduces payments for those not on Medicaid or Medicare Part D.
A Note on PEP
PEP (post-exposure prophylaxis) provides a way for individuals who may already have been exposed to HIV to retroactively reduce their risk of infection. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. If you think you’ve recently been exposed to HIV during sex, through sharing needles, or if you’ve been sexually assaulted, talk to your healthcare provider or an emergency room doctor about PEP as soon as possible.
An Uncertain Political Future
We don’t know for sure how the Trump administration’s healthcare overhaul will impact access to PrEP, but it’s very likely that budget cuts to Medicaid will make the drug less affordable. Restricted access has the potential to not only halt the progress that’s already been made to decrease new HIV diagnoses, but turn the tide in the other direction, which would perpetuate the ongoing silent HIV epidemic among gay black and Latino men in America.
Continued Medical Advancement
While PrEP and other prevention tools have the power to dramatically decrease the rate of HIV infection, a safe and effective vaccine would be transformative — with the potential to reduce the number of people with HIV by 36 percent over 15 years. Progress is being made on the vaccine, with an efficacy trial launched on World AIDS Day 2016 and two multinational clinical trials on antibody-mediated prevention also underway.
The National Institute of Health (NIH) has also announced the first-ever global clinical trial of a long-acting injectable HIV-prevention drug called cabotegravir — a single flu shot-like injection that patients would receive at the doctor’s office once every two months. The trial is taking place in eight countries and researchers are enrolling 4,500 gay and bisexual men along with transgender women, pulling from groups with the highest rates of new infections.
The Right Care
Until these emerging advancements become widely available, it’s essential for those on PrEP to work closely with healthcare providers to understand their risk of HIV and test regularly for HIV and other STIs.
Talking to your doctor about PrEP can be intimidating, but it shouldn’t be. That’s why Lighthouse offers patients a network of LGBTQ-affirming healthcare and wellness providers who are knowledgeable and nonjudgemental about PrEP.