PrEP - Other Frequently Asked Questions

Will PrEP replace condoms?

ACT encourages guys to continue using condoms in addition to taking PrEP. Neither are 100% effective in preventing HIV transmission, but when used together, they provide the most complete reduction in risk of the transmission of HIV as well as other STIs. For guys that don’t use condoms, PrEP is a powerful option.

While PrEP is an exciting new tool in HIV prevention, condoms still have many benefits over PrEP. These include:

    · Condoms provide protection against STIs in addition to HIV, while PrEP only protects against HIV.

    · Condoms are much more affordable. While condoms can be accessed for free from HIV service organizations, sexual health clinics, and through ACT’s Condom Dispensing Network, PrEP has an average monthly cost of $800-$1100.

    · Condoms are easier to access than PrEP. In order to access PrEP, you need to be assessed by your doctor, be screened for any health complications, and then continue to follow-up with your doctor every 3 months for HIV testing and counselling.

    · Condoms are used on an as needed basis, whereas PrEP needs to be taken consistently to be effective.

    · Some guys may experience unpleasant side effects from Truvada, especially when first starting the medication. Others may be concerned about the long-term impacts of taking pharmaceutical drugs. Condoms have no known side effects or long-term negative impacts. For guys with latex allergies, there are latex-free options.

    · Condoms can have some practical benefits. These include helping some guys maintain erections, making fucking easier with less friction, and making clean-up after sex easier. They are also easy to modify so you can use them as a barrier for other activities like rimming.

How effective is PrEP? Do I really need to take it every day?

There have been a variety of studies that looked at how effective PrEP is in preventing HIV. The iPrEx study is the only study that looked at gay men using PrEP. Participants in the iPrEx study were 44% less likely to contract HIV than a control group. While this number may seem low, it includes participants who were not taking the medication as much as recommended or at all.

Further analysis of iPrEx 1 , as well as additional studies conducted since, have demonstrated that there is a direct link between how consistently people take the pill and how much protection PrEP provides. In the iPrEx study, among participants who took the pill daily, as recommended, PrEP was 92% effective at preventing HIV infection.2 Certainly, at this point, studies have demonstrated the more regularly someone takes the pill, the greater their ability to prevent HIV infection.

While there is recent evidence that PrEP may still be effective when taken less than daily,3 research is still being conducted on the efficacy of non-daily PrEP regimens.4 This emerging research is promising, because it could mean that occasionally missing or forgetting a dose may not decrease your protection.
Can I start and stop PrEP whenever I want?

PrEP is not a medication you have to take for the rest of your life, and for many guys, PrEP only makes sense for certain periods of their life based on the type of sex they're having. However, it's important that you discuss with your doctor when you want to begin or stop using PrEP to make sure that the medication is taken effectively.

We don’t yet know how long it takes before PrEP becomes effective once the medication is started. Some studies suggest that it can reach its maximum effectiveness in rectal tissue as early as 7 days after beginning treatment, and in 20 days in the blood and in vaginal tissue.5 Research is exploring this issue more deeply.

Current guidelines recommend you continue using PrEP for one month after your most recent significant exposure before you stop taking PrEP. Stopping the medication prematurely when you have been exposed to HIV could increase your risk of contracting HIV.

If you have stopped PrEP and want to start it again, you should go through your doctor to begin treatment, even if you're very familiar with taking PrEP. It's important that you get tested to make sure that you are still HIV negative, because taking Truvada inconsistently or without other drugs when you are HIV positive makes it possible for the HIV in your body to develop a resistance to the medication.6 If you have become HIV positive and develop drug-resistance to Truvada, it will limit the treatment options for you in the future.

Could PrEP cause a highly drug resistant strain of HIV?

If PrEP is taken consistently, there is no significant risk of the development of a drug resistant strain of HIV.7. This is only a risk for people who are already HIV-positive when they start taking PrEP, or who become HIV-positive while taking PrEP inconsistently, and continue to use it. Part of the recommendations for PrEP involve getting tested for HIV before starting PrEP, and again every 3 months, which limits the amount of time that the HIV can build a resistance to the drug, if someone were to become HIV positive. The issue of drug resistance with HIV medications is not new - anyone who is HIV positive and taking their medications inconsistently runs the risk of having the HIV in their body develop a resistance to those medications. However, cases where drug-resistant HIV has been sexually transmitted are not great enough to limit the use of this important new prevention tool.

What are the long term effects of PrEP?

There is little research to date on the long term effects of using Truvada as PrEP because of how recently it was introduced. However, among people who are living with HIV and taking Truvada to treat HIV, there are concerns about increased kidney function and decreased bone mineral density. Keep in mind that people using PrEP may not take it for the rest of their lives, and these long-term effects need to be weighed against the health effects of managing HIV long-term. These are considerations to discuss with your doctor.

Are there other medications that can be used as PrEP?

To date, Truvada is the only HIV medication that has been approved in the United States and elsewhere for use as PrEP. While clinical trials are being conducted to see if other HIV medications may be effective as PrEP, none have been approved for use as PrEP. Using other HIV medications as PrEP could make you vulnerable to HIV infection or harmful side effects from improper dosing.