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HIV can spread easily between people during sex or by sharing needles. However, certain medications can help stop new infections. When a treatment is used to prevent a disease rather than to treat it, it’s called prophylaxis.
There are two main types of prophylaxis for HIV. Preexposure prophylaxis, or PrEP, is taken to lower the chances of getting HIV in the future. PrEP is meant to protect the health of people at higher risk of contracting HIV, such as those with multiple sexual partners or those who use injectable drugs. Postexposure prophylaxis (PEP) is taken after a possible exposure to HIV to help prevent infection.
Talk to your doctor or healthcare team if you want to learn more about HIV prevention methods.
Both PrEP and PEP help prevent infection, but they are used in different situations. PrEP is taken before exposure to HIV, and PEP is taken after.
Doctors may suggest PrEP for people who are HIV-negative (don’t have an infection) but have a high risk of being exposed to the virus. However, not everyone with an HIV-positive partner needs PrEP. Research shows that people with HIV who are on treatment and have an undetectable viral load cannot pass the virus to others.
One group especially affected by HIV transmission (spread) is men who have sex with men (MSM). The Centers for Disease Control and Prevention (CDC) report that 1 out of 6 MSM in the U.S. have a risk of contracting HIV. Transgender women — women who were assigned male at birth — who have sex with men are at even higher risk of HIV.
About 1 in 8 people who inject drugs have also been infected with HIV. If you’re in one of these groups, it’s especially important to consider using PrEP.
PrEP can help protect anyone who is at risk of HIV infection, no matter their gender or sexual identity. Talk to your doctor about PrEP if any of these factors apply to you:
If you and your partner are trying to get pregnant, ask your care provider about PrEP medications. PrEP protects you from HIV during pregnancy and may also help prevent HIV from being passed to your baby.
PrEP can help keep you safe and healthy if your lifestyle puts you at risk of HIV. Talk to your healthcare provider to learn if PrEP is a good option for you.
PEP is for emergencies — when someone who doesn’t have HIV (or isn’t sure if they do) may have just been exposed. To work well, PEP must be taken within 72 hours (three days) of a possible HIV exposure.
You might need PEP if any of the following situations apply:
If you think there’s a chance you were exposed to HIV, act fast. Go to an emergency room or call your doctor right away. The sooner you start PEP, the better.
PEP isn’t meant to be used on a regular basis. If you often have possible exposures to HIV, PrEP may be a better long-term option. If you take PrEP regularly as prescribed, you don’t need to take PEP.
There are a different types of PrEP:
In some cases, the PrEP medication Truvada can be taken “on demand,” or as needed. On-demand PrEP is only recommended for cisgender men — men assigned male at birth — who have sex with men. On-demand PrEP generally involves taking two doses two to 24 hours before sex, then one pill every 24 hours for two days after. This dosing is sometimes called 2-1-1 PrEP.
Different dosing may be recommended for men who have sex with multiple male partners. Always talk to your doctor before changing how you take PrEP.
If you take PrEP pills, you’ll need an HIV test every 3 months. If you get injectable PrEP, you’ll need to check your HIV status and be screened for other STIs every 2 months.
There are a variety of PEP treatment combinations that often contain some of the same drugs found in PrEP, along with an additional drug. Some PEP medications are taken once a day for four weeks (28 days). Others are taken twice a day. You should have HIV tests while taking PEP and again after completing treatment. If you think you might have been exposed to the virus, start taking PEP as soon as possible. Treatment should start within 72 hours of exposure.
PrEP pills only work well if you take them every day. If you think it will be hard to stick to a daily routine, ask your doctor if PrEP injections every two months may be a better option for you.
During an HIV infection, HIV enters your immune cells and makes many copies of itself. PrEP and PEP are antiretroviral medications that help stop the copying process. These drugs make it harder for HIV to take hold in your body and become a lifelong infection.
The goal of both PrEP and PEP is to prevent new HIV infection. Both PrEP and PEP are highly effective when used correctly.
PrEP can reduce your chance of an HIV infection from sex by up to 99 percent. It also lowers your risk from injection drug use by more than 74 percent.
PrEP works best when taken consistently as prescribed, whether daily or on demand. If you use injectable PrEP, you need to keep getting the shots as scheduled. Missing doses or delaying shots of PrEP as scheduled increases your risk of an HIV infection.
PrEP doesn’t protect against pregnancy or other STIs. Using condoms is still important.
PEP treatment is also very effective. One CDC study found that only 0.5 percent of people who took PEP after a possible HIV exposure got infected. However, PEP is less likely to work if you don’t start taking it right away, if you miss doses, or if you continue to experience potential exposures (for example, unprotected sex or sharing needles) while using the medications.
Yes, PrEP and PEP are generally safe. Most people only have mild side effects, which often go away over time. Side effects of PrEP and PEP medications include:
Side effects of injectable PrEP may include:
If you have any side effects that don’t go away, contact your doctor for follow-up. If you have signs of an allergic reaction, get medical help right away.
People with kidney damage or people over 50 may need to be more careful when using PrEP. Your doctor will help decide which medication is safest for you.
PrEP should also be used with caution if you take other medications that can affect the kidneys, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Always ask your doctor if PrEP is safe to take with your current medications.
PEP can also interfere with other medications. Be sure to tell your doctor about all the medications you are taking so that they can identify any potential problems.
If you think PrEP might be a good option for you or your partner, talk to your doctor to learn more. Your healthcare team can help you learn more about different preventive HIV treatments and guide you through your choices.
If you’re not sure where to find a doctor who offers PrEP, try PrEPlocator.org. This website lists local providers who can prescribe the medications you need. It also offers information on how to access PrEP if you are uninsured or need financial assistance.
On myHIVteam, the social network for people with HIV and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with HIV.
Are you interested in starting PrEP? Have you used PEP treatments? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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