Pre-exposure Prophylaxis (PrEP) – A Fact Sheet for Women
Pre-exposure Prophylaxis is a new HIV prevention strategy that involves the ongoing use of anti-HIV medications by an HIV-negative person in order to reduce their risk of becoming infected with HIV.
The only type of PrEP that has been approved in Canada is a oral pill called Truvada, which contains 2 HIV medications: Tenofovir disoproxil and emtricitabine. It is most effective when taken daily. Research suggests that PrEP can reduce the risk of HIV infection by over 92% if taken every day.
PrEP is recommended as one prevention option for sexually active men and women whose partners are known to be living with HIV, are at substantial risk of HIV acquisition, or for people who inject drug, all of whom are at a higher risk of HIV acquisition.
Truvada is not covered by OHIP (Ontario Health Insurance), but may be covered by some private insurance plans, as well as the Ontario Trillium Drug Program, which anyone living in Ontario with a valid health card can apply for. If you have no private insurance plan, or are not eligible for Trillium coverage, PrEP can cost up to $900-1100 a month.
If you are a woman who is worried about your risk of HIV, whether because you are in a relationship with an HIV-positive partner or worry about condom use, here is some useful information that can help you to make an informed decision about your sexual health. Generally, PrEP has been well accepted by women because it leads to a situation where women have more control over their sexual health.
- 1. Consider PrEP as a package of different options (including risk and harm reduction counselling, as well as STI prevention and treatment). These options could be like using condoms and safer injection gear, and effective HIV treatment for the partner.
2. Be aware that PrEP does not prevent other STIs. Condoms may still be the best strategy to prevent STIs (sexually transmitted infections). Having an STI may increase the risk of being infected by HIV, and can potentially impact the health of people living with HIV then people who are HIV-negative.
3. If you are worried about your risk of HIV, you can feel confident discussing it with your family physician. This does not guarantee that your doctor will mirror that comfort, as many healthcare providers either do not yet know about PrEP or have different opinions on it. For that reason, it's a good idea to have some knowledge around PrEP before going to see your doctor about it.
As the history of your past sexual partners, and your alcohol or drug use may be on the list of discussion with your doctor, it may be helpful to have your partner at this meeting, if possible. Be open about your sexual relationship. Consider the decision to use PrEP is a decision you and your partner can make together. Studies have shown that PrEP, like treatment for the positive partner, can stabilize both physical health and your relationship.
Be aware that HIV doctors are comfortable with Truvada, but they may not see HIV-negative patients. And doctors who do see HIV-negative patients may not be familiar or comfortable with prescribing PrEP. Learning about PrEP before speaking to your doctor is a good place to start.
The Toronto General Hospital Immunodeficiency Clinic has an HIV Prevention Clinic that provides comprehensive assessment and treatment for those requiring PEP, and PrEP. Your family physician can refer you to this service.
- An HIV test.
- Renal function (e.g. a serum creatinine and urine analysis test) should be assessed at baseline and liver function may be tested, too.
- Other health conditions that should be assessed include Hepatitis B & C, and STIs.
- You should provide your doctor with any other health conditions you had in the past, in addition to any kind of medication you are taking (prescription & nonprescription).
6. Most people have few or no side effects from taking PrEP. However, like any new medication, side effects can occur. The most common side effects of Truvada are headache, nausea, vomiting, dizziness and fatigue in the first month. Most side effects will clear up after the first month. In rare cases, it can also cause liver and (reversible) kidney problems. Bone density can also be affected. Your doctor can help you to manage these side effects.
7. Ask for effective contraception services if you do not wish to become pregnant, and repeat pregnancy tests depending on your doctor’s advice.
8. If pregnancy is in your future plans, discuss it with your doctor in advance. An HIV prevention strategy for the baby includes an effective HIV treatment plan for your partner as well. As the risk for perinatal HIV acquisition increases during pregnancy, Truvada can be used for pregnant and breast-feeding women as prevention of prenatal and postpartum to child transmission of HIV.
9. Truvada should not be replaced by other HIV medications. Always be aware of the amount of your pills you have so you can renew your prescription in advance.
10. You being on Truvada is not a substitute for your partner’s HIV treatment. Be aware that you can benefit more effectively on PrEP when your partner is on HIV treatment.
11. At least every 12 months, discuss the need to continue PrEP with your doctor.
12. Counsellors at AIDS Service Organizations (www.HIV411.ca) in Toronto welcome any question or concern you may have regarding your decision on taking Truvada. Find an ASO that you feel convenient with, and be the woman you always want to be.
For more information explore the following resources:
- 1) CATIE News- Uptake of PrEP in the United States, June 2014
2) PrEPared to fight: A Woman- Centered Approach to HIV Prevention, June 2014
3) PrEP for the prevention of HIV infection in the United States- 2014, a clinical practice guideline
4) PrEP for the prevention of HIV infection in the United States- 2014, clinical providers’ supplement