What is PrEP?

Pre-exposure prophylaxis (or PrEP) is a once daily medication (brand name Truvada) used to reduce the chances of contracting HIV.

What is PrEP?

PrEP - an HIV Prevention Option

How effective is PrEP?

With sexual transmission of HIV, PrEP lowers the chance of transmission by 92%. For transmission by injection, it reduces the chance of transmission by 70%.

 

Since the approval of PrEP by the FDA in 2012, 79,000 people have used PrEP to protect themselves from transmission of HIV.

 

Who should take PrEP?

If you are at risk of contracting HIV PrEP may be one way for you to prevent HIV, and PrEP isn’t only for gay/bisexual men. PrEP can be used by both straight men and women as well. If you sporadically or never use condoms, or if you are in a relationship with someone who is HIV-positive, or if you inject drugs, PrEP may be an option for you to help prevent an HIV infection.

 

Are there side effects?

There are mild early side effects including nausea, headache, and loss of appetite, though these usually subside within a month.

 

Will PrEP react with my birth control?

No, studies have shown that PrEP does not interact with birth control. You can also continue to take PrEP while on your period without any additional side effects.

 

How can I afford PrEP?

Private health insurance does cover PrEP, but without insurance PrEP will cost $13,000 out of pocket, but if affording PrEP may be a problem there are programs to help like Gilead’s Advancing Access program to help those who may have trouble paying for the medication. Whether on private insurance with co-pay support, government insurance support, or even uninsured support for those without insurance. Since the AIDS Drug Assistance Program (ADAP) is meant to assist people living with HIV, PrEP users without HIV are not eligible for its assistance.

 

Where can I get PrEP?

For those in urban areas, check the HIV advocacy website projectinform.org, where there is a map of all PrEP providers in the United States, or this PrEP Provider Directory: https://www.pleaseprepme.org/.

Stigma

Today there is a stigma around using PrEP, much like the stigma around HIV itself. The phase “Truvada whore” is sometimes thrown around, and doctors will say they don’t want to prescribe PrEP to a person at risk for HIV because then that person might not use a condom. But as Dr. Melanie Thompson points out, “no doctor would refuse to prescribe cholesterol-lowering statins to patients because they’re overweight” (NPR). And this stigma follows at-risk individuals even though all they want to do is take charge of their health. And just like many women who are not sexually active take the birth control pill, many men and women can take PrEP even though they are not “sleeping around.” These stigmas do nothing but bolster HIV’s strength as people who should be taking PrEP aren’t because of slut-shaming.

Women and PrEP

  • Women accounted for roughly 19% of new HIV diagnoses in 2018. 85% of those were attributed to heterosexual sex.

  • One in four people living with HIV is a woman.

  • Only 18,000 of the 79,000 users of PrEP are women even though almost half of those who started PrEP in 2012 when it was first approved were women (2740 out of 6210).

PrEP by Gender:

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As you can see, even though there was an almost even number of men and women who began PrEP in 2012 after it was approved by the FDA, now men account for more than 75% of PrEP users.

PrEP by Race:

Even though African Americans represent only 12% of the population, they account for 45% of HIV diagnoses, but they only account for 10% of PrEP users. Hispanics account for 18% of the population, and 24% of HIV diagnoses, yet only 12% of PrEP users. PrEP usage does not reflect the distribution of the HIV epidemic!

PrEP Internationally

Right now PrEP is an approved preventative medication in 17 countries, and is waiting for approval of a submitted application in 5 more countries.

More Information About PrEP

The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1.2 million people are at high-risk for HIV exposure and could benefit from comprehensive HIV prevention strategies, including PrEP. Data presented on AIDSVu reveal that the growth and distribution of PrEP use has been inconsistent across different sexes, age groups, and geographic regions. For example, the Southern U.S. accounted for more than half (52 percent) of all new HIV diagnoses in 2016 but represented only 30 percent of all PrEP users in 2016. That same year, women comprised 19 percent of all new HIV diagnoses but made up only seven percent of all PrEP users.

“PrEP is a revolution in HIV prevention and has the potential to dramatically reduce new HIV infections; however, significant disparities in the use of PrEP exist across the country,” said Patrick Sullivan, Ph.D., Professor of Epidemiology at Emory University’s Rollins School of Public Health and Principal Scientist for AIDSVu. “Expanding access to PrEP is a core component of Getting to Zero campaigns in cities and states across the country and is one of four key focus areas in the National HIV/AIDS Strategy. We hope that the newly available data on AIDSVu will allow health departments, elected officials, medical professionals, and community leaders to better understand and visualize the realities of who has access to this important prevention tool so they can develop programs and policies to decrease barriers.”

[AIDSVu was developed by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. The project is guided by an Advisory Committee, a Prevention and Treatment Advisory Committee, and a Technical Advisory Group with representatives from federal agencies, state health departments, and non-governmental organizations working in HIV prevention, care, and research.]

PrEP VS PEP

Pre = before.

Exposure = coming into contact with HIV

Prophylaxis = treatment to prevent an infection from happening

Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy where HIV-negative individuals take anti-HIV medications before coming into contact with HIV to reduce their risk of becoming infected. The medications work to prevent HIV from establishing infection inside the body.

PrEP has been shown to reduce risk of HIV infection through sex for gay and bisexual men, transgender women, and heterosexual men and women, as well as among people who inject drugs.

It does not protect against other sexually transmitted infections (STI) or pregnancy. It is not a cure for HIV.

 

 

"HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected"

 

Difference between PrEP and PEP

 

 

Post = after

Exposure = coming into contact with HIV

Prophylaxis = treatment to prevent an infection from happening

Post-exposure prophylaxis (PEP) is an HIV prevention strategy where HIV-negative individuals take HIV medications after coming into contact with HIV to reduce their risk of becoming infected. PEP is a month-long course of drugs and must be started within 72 hours after possible exposure.

 

Effectiveness

 

Truvada for PrEP provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed. If a daily dose is missed, the level of HIV protection may decrease. It only works if you take it. People who use PrEP correctly and consistently have higher levels of protection against HIV.

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.

A few things to note:

When starting PrEP, it takes at least seven days to reach high levels of protection against HIV.

When stopping PrEP, individuals should continue using PrEP for four weeks after the last significant exposure.

PrEP does not protect against other sexually transmitted infections (STI) or pregnancy. It is not a cure for HIV.

PrEP is a prevention method used by people who are HIV-negative and at high risk for being exposed to HIV through sexual contact or injection drug use. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing an infection. Learn more about PrEP.

PEP refers to the use of antiretroviral drugs for people who are HIV-negative after a single high-risk exposure to stop HIV infection. PEP must be started as soon as possible to be effective – always within 72 hours of a possible exposure – and continued for 4 weeks.

Healthcare

Reaching the National HIV/AIDS Strategy (NHAS) targets for HIV testing and treatment and expanding the use of daily Pre-Exposure Prophylaxis (PrEP) could prevent an estimated 185,000 new HIV infections in the United States by 2020 – a 70 percent reduction in new infections, according to researchers at the Centers for Disease Control and Prevention


Recent biomedical innovations have significantly expanded HIV prevention options. Numerous studies affirm the efficacy of pre- and post-exposure prophylaxis (PrEP/PEP). PrEP efficacy for preventing HIV acquisition among at-risk individuals is over 90 percent when taken as prescribed. Two AYA-specific PrEP studies confirm the efficacy of PrEP for AYA. However, sub-optimal retention and adherence in both studies resulted in seroconversion in individuals with PrEP concentrations below therapeutic levels


In addition, there are concerns about behavioral adaptation and disinhibition among PrEP users [19,20]. AYA PrEP users are particularly vulnerable to HIV and STI infections when reductions in condom use (i.e., behavioral adaptation) and increased risk behavior (i.e., behavioral disinhibition) occur, given suboptimal adherence. Although 700,000 AYA who are at risk of HIV infection are estimated to have indications for PrEP in the United States, AYA aged 13 to 24 represented merely 12 percent of at least 100,000 PrEP users in 2017.

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Sources

https://www.hiv.va.gov/patient/basics/HIVtreatment.asp

https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/hiv-treatment-overview

 

https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf

 

https://www.cdc.gov/hiv/basics/prep.html

 

https://start.truvada.com/

 

https://prephere.org/

 

https://men.prepfacts.org/the-questions/

 

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/51/hiv-treatment--the-basics

 

http://www.prepwatch.org/scaling-up/country-updates/

 

http://www.prepare.la/?gclid=Cj0KEQjwp83KBRC2kev0tZzExLkBEiQAYxYXOqoC8YnaSV6XZhqWIeIwaqArvt6Y4G7MljDgEm2RMQcaAnkL8P8HAQ

 

http://www.npr.org/sections/health-shots/2014/08/08/338517366/preventing-hiv-with-medicine-can-carry-a-stigma

 

http://www.mdmag.com/medical-news/prep-stigma-and-uncertainty-may-be-hindering-use-of-the-hiv-preventive

 

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--women-and-hiv-aids/

 

http://www.aidsmap.com/PrEP-use-exceeds-79000-in-US-pharmacy-survey-but-some-groups-lagging-behind/page/3072084/

 

http://women.prepfacts.org/the-questions/

 

http://sisterlove.org/wp-contents/uploads/uploads/2013/03/working-group-on-us-women-and-prep-statement.pdf

 

http://prepfacts.org/assets/PrEP_Facts_16-pager_brochure_mech_FINAL.pdf

http://www.who.int/hiv/pub/prep/prep-implementation-tool/en/

https://aidsvu.org/prep/

https://www.cdc.gov/hiv/basics/prep.html


https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis 


https://prepfacts.org 


https://nam.edu/shifting-the-paradigm-in-hiv-prevention-and-treatment-service-delivery-toward-differentiated-care-for-youth/ 


https://www.cdc.gov/hiv/pdf/basics/prep/cdc-hiv-stsh-prep-brochure-english.pdf


https://www.hiv.gov/blog/as-many-as-185000-new-hiv-infections-in-the-u-s-could-be-prevented-by-expanding-testing-treatment-prep


https://www.cdc.gov/vitalsigns/hivprep/infographic.html#infographic
 

All graphics by Jaclyn Saik