PrEP is an acronym for Pre-Exposure Prophylaxis. The acronym in French is PPrE (prophylaxie préexposition). PrEP is an additional tool used to prevent HIV for HIV negative individuals.
A prophylaxis is a means of preventing an infection. Pre-exposure means before being exposed to the risk of infection. PrEP, for HIV, consists of taking an antiretroviral pill when you are HIV negative to minimize the risk of HIV infection through potential exposure (sexual intercourse through anal penetration without condom protection for example, etc.). The medical world already uses this concept for different diseases (Malaria protection for travellers for example). The drug needs to be sufficiently concentrated in your body to prevent the infection of HIV. It has been shown that only taking one pill 10 minutes before sex is not enough.
You have to keep in mind that PrEP does not prevent against other STIs like gonorrhea, chlamydia, hepatitis C, syphilis, etc. It is therefore important to use PrEP in combination with other STI prevention methods, such as: condoms and lube, regular and frequent STI testing (you can consult websites like Jack & Jacques or Ready for action as an online tool for testing reminders), disclosure with your partners, etc.
How does PrEP work?
When there are sufficient levels of the drug present in your body (i.e. when it is concentrated enough), it slows down HIV‘s ability to reproduce during exposure.
More specifically, the molecules of the antiretroviral block the virus’ attempt to attack white blood cells which it uses to replicate itself. Keep in mind that white blood cells exist to protect you against infections. HIV works to destroy white blood cells, a process which PrEP blocks or works against. You can watch a video to see how this happens from whatisprep.org by clicking here.
Once again, for PrEP to be successful, you must take it before, the day of, and after risky sexual behavior. See section “Should I be taking PrEP daily, or on an on-demand basis?“.
When we are using the term ‘at risk’, it is describing a situation where your body may have been in contact with HIV. Kissing an HIV positive person is not a risk! There are various modes of transmission of HIV: by human bites or by being exposed to blood or genital secretions on a mucus membrane (eye, nose) or on skin where there is an unhealed wound or scrape (entry point into the body). It is also possible to be pricked accidentally by the needle of an unknown person found lying around.
To this day, the only treatment officially recognized for PrEP is a mix between two antretroivirals in one tablet: Truvada®. They are the same kind of drugs that people living with HIV take.
You want to talk about PrEP with a RÉZO Counsellor?
Is PrEP for me?
PrEP is an extra tool to help prevent HIV. It is ultimately up to you to decide if it suits your lifestyle and needs in regards to sexual behavior that may put you at risk of contracting HIV. Typically, PrEP is meant for HIV negative men that engage in risky sexual practices with HIV positive men or with partners whose statuses are unknown. PrEP can also be used by HIV negative men that are in a relationship with an HIV positive man who has a detectable viral load.
PrEP can also be used by men that, for whatever reason, do not use condoms consistently. You can discuss the possibility of using PrEP, your tolerance to the medication, and your risk level with a doctor or a nurse.
Don’t forget that PrEP doesn’t protect you from other STIs. It is highly recommended that you use additional protection strategies when you engage in sexual activities. For example, if you don’t consistently use condoms when having sex, it is strongly recommended to get tested every three months for STIs.
Should I take PrEP on-demand or on a daily basis?
To this day, two protocols have been proven to be effective when taking PrEP: taking it every day (continuously) or taking it when needed in prevision of a period of sexual activity (on demand). In both cases, it is the same prescribed drug.
Daily PrEP: This protocol is approved in the United States by the Food and Drug Administration (FDA). The drug is used every day, at the same time, so that it is firmly integrated inside of your system (at a high level of concentration).
PrEP on demand: The drug is taken at least 2 hours before the sexual encounter / activity, and for the next 2 days following the sexual encounter /activity. In the ANRS-IPERGAY essay, PrEP usage was tested 2-24 hours prior to a potential exposition of HIV and for the following 48 hours.
In any case, it is with your doctor that you will be able to discuss which protocol is most suitable for you.
Who can decide if I can be on PrEP or not?
The decision of taking PrEP starts with you: you need to be comfortable to talk about it openly with a doctor. You will be able to see together if this strategy is suited to your needs, if there are any contraindications between PrEP and any other medications that you may already be taking, and what clinical follow up will be required.
To make your consideration on the matter easier, you can also discuss PrEP with a nurse while getting tested for STIs. Share with them the types of risk present in your sex life and the potential benefits that being on PrEP could bring to your sexual health.
Only a doctor can perform your evaluation and give you a prescription for Truvada®.
RÉZO counsellors are available to talk about whether PrEP is suitable for you or not.
Where can I have access to PrEP?
Here are some clinics that are specialized in sexual health that offer PrEP:
*We highly recommend that you call in advance and make sure to schedule an appointment with a doctor that is open to evaluating a possible PrEP prescription for you.
How effective is PrEP?
Many clinical studies have been done to verify the effectiveness of PrEP. For high risk men, PrEP greatly diminishes the risk of HIV transmission. These studies have looked at both clinical effectiveness as well as their effectiveness in day to day life. The defining factor is adhesion: taking the medication diligently and in the right way (as prescribed).
- Recently, the French clinical study ANRS-IPERGAY (in which RÉZO was a partner for the Quebec site), confirmed that PrEP taken on-demand (taken specifically only within the period surrounding sexual encounters) decreases the risk of HIV infection by 86%;
- The British study PROUD, confirmed that taking PrEP continuously every day decreases the risk of HIV infection by 86%;
- In the United States, the CDC (Centers for Disease Control and Prevention) acknowledge that high risk men taking PrEP continuously every day would decrease the risk of HIV infection by 92% ;
- More recently, the results of iPrEX OLE demonstrated that men that take PrEP diligently (minimum 4 to 7 times a week) has an effectiveness estimated at 86% to 99.9%!
In conclusion to these studies, what they all point to is this: the more consistently a person takes PrEP, the more efficient PrEP is in preventing HIV.
That being said, it is always difficult to talk about “the actual risk” of being infected by HIV. Risk may vary according to the HIV status and/or the viral load of your partner(s) but also regarding your sexual practices.
PrEP is not a drug that is sold over the counter. It needs to be prescribed by a doctor who will provide regular follow-ups.
What are the side effects of PrEP?
To this day, taking Truvada® to prevent HIV is safe and is generally well tolerated by patients.
This drug can cause gastrointestinal side effects, such as nausea, cramps, etc. These side effects are often temporary and are mostly seen during the beginning of the medication. This is due to the body’s adjustment to a new medication and for most people these side effects go away quickly. In rare cases, Truvada® may have an effect on kidneys and/or bones. These side effects are far less common and are generally reversible.
How much does it cost to be on PrEP?
Without insurance (public or private), the monthly cost for PrEP on a daily basis (30 pills per month) is between $907 to $995 (price subject to change without notice).
If you are covered by the Régie de l’assurance maladie du Québec (RAMQ), PrEP is covered under your plan. Unless you have received an exemption, the maximum fee per month (in 2021 – price subject to change without notice) is $95.31. You can consult the RAMQ websitefor more details. If you are currently taking prescribed medication, it won’t cost you more than the maximum fee; the rest of your medication will be covered entirely.
For people with private insurance, the price will depend on the insurance policy. Generally, annual coverage starts on January 1st. The refunds can vary according to your plan. You need to keep in mind that every insurer has a maximum fee that you will need to pay. In Quebec, these scales are determined by the government. You can find this maximum fee in your insurance policy.
In both cases, PrEP is essentially covered here in Quebec.
What is the difference between PrEP and PEP?
As explained previously, Pre-Exposure Prophylaxis (PrEP) is taking a preventive medicine before exposition to HIV to reduce the risk of infection. Post-Exposure Prophylaxis (PEP) is taking a medication after being exposed to HIV. It is another HIV prevention method that an HIV negative individual can take after being exposed to HIV to minimize the risk of the virus integrating itself to your immune system. This medication needs to be taken within a maximum of 72 hours of being at risk of contracting HIV. The sooner, the better, as the medication becomes less effective with each hour that passes! In the case of PEP, antiretrovirals are also used, but for a month (28 days).
Resources consulted for this article and other additional resources :