How to Get on PrEP: Quick Tips
HIV presented one of the deadliest epidemics in the United States in the 1980s. Today, estimates suggest that over 1.1 million people in the country live with HIV, though about one out of seven of those individuals has no idea they even have an infection. About 700,000 people with AIDS have died since the epidemic initially started. The virus predominantly affects gay and bisexual men of color.
There is currently no cure for HIV, but breakthroughs in medicine have led to effective treatments that can help to control infections and significantly suppress the virus. PrEP is an innovative medication that can help to prevent HIV. Let’s take a closer look at this treatment and tips on how and where to get PrEP medication.
Understanding HIV and AIDS
Human immunodeficiency virus more commonly known as HIV, is a virus that specifically attacks a type of white blood cell known as CD4 or T-helper cells. These cells play an important role in your body’s immune system, helping you fight off diseases, harmful bacteria, and other germs that invade your system. However, your body has no natural defenses against HIV, unlike other viruses.
HIV can’t reproduce or make copies of itself on its own. It requires CD4 cells to grow and spread. In the process, it destroys the CD4, which in turn damages your immune system. If left untreated, HIV will gradually weaken your immune system, which eventually opens you up to a variety of diseases and certain forms of cancer.
The virus develops within your system over several years, though the exact amount of time varies from person to person. It generally occurs in three stages:
- Acute HIV infection – This stage is noted by flu-like symptoms, which begin two to four weeks after the initial exposure to the virus. This “flu” is a natural response to the infection and comprises a variety of symptoms, including fever, rash, sore throat, swollen lymph glands, fatigue, and aches and pains in your joints and muscles. However, not everyone experiences the same symptoms, and some people show no symptoms at all. During this stage, the virus is reproducing in your body at an accelerated rate, making you highly contagious. Eventually your natural immune response will bring the virus levels back down and begin to increase your CD4 cells again, but your immune system may not return to its original strength prior to the infection. As the viral load and your CD4 cells begin to level out, you will move to the next stage of the infection.
- Clinical latency – Alternately known as asymptomatic or chronic HIV infection, the stage of clinical latency is mainly characterized by the virus’ slow rate of reproduction. Due to this slow rate, you may show no signs during this stage, though some people experience more mild symptoms. Despite the lack of noticeable symptoms, you can still transmit the virus to others. If left untreated, the clinical latency stage has been shown to last 10 years or longer, but some people have been shown to progress faster through this stage. This means that, if you have not yet been tested or received treatment, you may have HIV for years without even knowing it. By the end of the clinical latency stage, your viral load will begin to increase again as your CD4 cells begin to decrease in number again. As this happens, you will show more obvious symptoms, eventually moving you into the last stage of the infection.
- Acquired immunodeficiency syndrome (AIDS) – AIDS is the most severe stage of an HIV infection. At this point, your immune system has become so badly damaged that you begin to suffer a greater number of severe diseases known as opportunistic infections. These opportunistic infections are often the first sign that your HIV has progressed to AIDS, though you are officially diagnosed with the disease when your CD4 cell count drops below 200 cells per cubic millimeter. A health individual usually has a CD4 cell count of 500 to 1,600 cells per cubic millimeter. If left untreated, people with AIDS have a life expectancy of about 3 years. Once you contract a particularly dangerous opportunistic illness, your life expectancy drops to just one year.
There is still no known cure for HIV or AIDS, but in the United States, most people infected with HIV don’t progress to AIDS thanks to antiretroviral therapy. Those who are diagnosed early can live long, healthy lives.
What Does PrEP Do?
PrEP, or pre-exposure prophylaxis, is a medication for people who are currently HIV-negative but may be at a high risk of getting infected. The medication is approved by the FDA, and studies show that it can reduce the risk of contracting HIV from sex by more than 90 percent. It also reduces the risk of getting the virus from injected drug use by over 70 percent.
PrEP is actually a combination of two HIV medications, tenofovir and emtricitabine, contained in a single daily pill that is sold under the brand name Truvada. PrEP works to prevent HIV by protecting your CD4 cells, preventing HIV from even penetrating the cells. Without being able to infect CD4 cells, HIV cannot reproduce or make copies of itself, which prevents it from ever spreading or causing an infection in your system. However, you need to take PrEP every single day to give your body enough medicine to protect your CD4 cells.
Talking to Your Doctor
PrEP can only be prescribed by a doctor or other health care provider. Some doctors don’t know about PrEP or otherwise don’t have enough information to prescribe the medication confidently, but don’t worry. You can still get information and prescriptions for PrEP from community health centers, local health departments, and Planned Parenthood health centers.
When you talk to your doctor, they will ask you about the sex you have, the types of protection you use, and your general medical history. This is all to determine if PrEP is right for you. They will also test you for HIV as you cannot go on PrEP if you are already infected. They may also test for hepatitis B and C and other sexually transmitted diseases. During this visit make sure you:
- Give your doctor all the necessary details. Your doctor needs to know these details to gauge your health and determine if PrEP is the right treatment for you. Talking to your doctor about your sex life can be intimidating or daunting, but don’t worry about being judged. It can help to start by telling your doctor that your sex life is a difficult topic to talk about.
- Take notes throughout the appointment so that you can remember exactly what your doctor said and review them later.
- Ask plenty of questions. This is about you and your body, so you should understand everything that your doctor is telling you. If you need any clarification, don’t be afraid to ask.
What to Consider
PrEP is a safe and incredibly effective treatment to prevent HIV, but it’s not necessarily for everyone. It is specifically for people who do not have HIV but are at a high risk of contracting it. You should consider PrEP if you:
- Have multiple sexual partners, especially if you don’t regularly use condoms
- Have a partner who is HIV positive
- Recently had other sexually transmitted diseases
- Perform sex work that includes anal or vaginal sex
- Use injected drugs or shared needles
- Have a sexual partner who does not have HIV but may be at a high risk
One study shows that PrEP is overall as safe as aspirin. It is considered safe in both the short- and long-term, but does come with certain side effects, including nausea, headaches, and upset stomach. While these side effects subside on their own in a short amount of time and are not life threatening, they may be uncomfortable or interfere with your life.
The most important thing to keep in mind: PrEP is only effective when taken every single day as directed. If you don’t want to take a daily pill or expect that you will forget to take it every day, you may want to consider other forms of treatment. PrEP also necessitates regular visits to your doctor. You will need to go to you doctor at least every three months to get tested for HIV. This may not be ideal if your schedule does not allow for regular doctor visits.
Paying for PrEP
Once you know that PrEP is right for you, it’s time to think about finances. If you have insurance, you are in luck. Most major health insurance companies cover PrEP. However, even if you do not have health insurance or if your copay is too expensive, you can find financial assistance through Gilead, the pharmaceutical company responsible for creating and selling Truvada, and their Gilead Advancing Access program.
The company offers assistance programs that can help to cover the cost of copays, identify other insurance plans that do cover PrEP, or provide financial support to pay for your treatment outright.
You have a PrEP prescription that is all paid for. Now it’s just a matter of taking the pill. As mentioned many times, the medication has to be taken every day to be effective. You can take it with or without food, though some people find that taking the pills with a meal reduces certain side effects. You can also take it at any time of day, though the pill works best if taken at the same time every single day. If possible, try to work it into your routine. For example, always take a pill after breakfast or before you brush your teeth at night. Store your pills at room temperature.
Of course, not everyone is perfect, and it’s okay if you forget. Just make sure to take your pill as soon as you remember. For instance, if you normally take your pill in the morning, but realize in the afternoon that you forgot to take it, immediately take a pill and then resume your normal schedule the next day. It helps to keep a pill on you, either in a pill box or wrapped in tin foil, just in case you do forget. Do not double up on pills as a means of “catching up.”
Even if you are taking PrEP, you should always use a condom or other type of barrier. PrEP prevents HIV, but it has no effect on other sexually transmitted diseases. Condoms can prevent a variety of STDs passed through bodily fluids, like chlamydia and gonorrhea. Combining PrEP with regular condom use further reduces the risk of contracting HIV.
PlushCare offers expert health care with a single phone call or video chat. We have a team of doctors who can diagnose and treat a variety of conditions and write any necessary prescriptions. Answers to frequently asked questions can be found online here. If you need to get tested for HIV or are curious about starting PrEP, please book an appointment with us today.
Read more from our PrEP and HIV Prevention Series: