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PEP and PrEP

Everyone is talking about preventing HIV with PrEP or PEP. GMHC wants you to know the facts so you can decide what works for you.

 

Quick Facts About PrEP & PEP

PrEP (Pre-Exposure Prophylaxis) PEP (Post-Exposure Prophylaxis)

PrEP is a daily pill for HIV-negative people that can help prevent HIV infection before exposure to the virus.

PEP is an emergency medication for HIV-negative people that can help prevent infection after exposure to HIV.

PrEP is more than 90% effective when taken daily as prescribed.

PEP needs to be started within 36 and ideally no later than 72 hours after exposure to HIV.

According to the CDC, it takes approximately 20 days after starting treatment for PrEP to be optimally effective.

PEP’s effectiveness varies depending on when it is initiated; according to the CDC it can be up to 80% effective. However, it is not effective in all cases.

PrEP is covered by most private insurance. Medicaid covers PrEP in NY State, however coverage varies by state. If you don’t have insurance or need assistance with your co-payments, there are programs that can help pay for PrEP.

PEP is covered by most private insurance. Medicaid covers PEP in NY State, however coverage varies by state. There are also patient assistance programs to help uninsured patients pay for PEP.

PrEP is used by both men and women.

PEP is used by both men and women.

PrEP is safe, with minimal and minor side effects.

PEP is safe, but some people do experience mild to significant side effects.

PrEP is not 100% effective at preventing HIV. It does not prevent the transmission of other STIs like herpes, syphilis, and gonorrhea, nor does it prevent pregnancy. It should be used in combination with condoms and other safer-sex practices. 

PEP should only be used in emergency situations and is not 100% effective at preventing HIV. It does not prevent infection from other STIs like herpes, syphilis, and gonorrhea, nor does it prevent pregnancy.

What can I do if I think I may be regularly exposed to HIV? PrEP!
What is PrEP?
Is PrEP for me?
How effective is PrEP?
How can I get PrEP?
Is PrEP safe?
What are the common side effects of PrEP?
How will I afford PrEP?
Won’t PrEP cause people to stop using condoms?
Why do I need regular HIV tests before I start and while taking PrEP?

What can I do if I think I have already been exposed to HIV? PEP!
What is PEP?
Is PEP for me?
How effective is PEP?
How can I get PEP?
Is PEP safe?
What are the common side effects of PEP?
How will I afford PEP?
Won’t PEP cause people to stop using condoms?

 

What is PrEP?
PrEP stands for pre-exposure prophylaxis. PrEP is a daily pill for HIV-negative people that can help prevent HIV infection before exposure to the virus. Currently, Truvada® is the only medication approved by the FDA for PrEP. It must be taken daily to ensure maximum effectiveness. However, because it is not 100% effective, it should be used in combination with other HIV-prevention methods, including condoms.

Is PrEP for me?
You must be HIV negative to use PrEP. If you are at high risk of contracting HIV, either sexually or through drug use, AND you can commit to taking PrEP daily, then it may be a good option for you. You are at high risk sexually if you are in a relationship with someone who is HIV positive or you have multiple partners, do not know the HIV status of your partners, and/or do not use condoms regularly. Injection drug users are at high risk if needles are shared. While taking PrEP, the CDC recommends HIV testing every three months and regularly scheduled appointments with your doctor to monitor any side effects. PrEP is used by both men and women, and may be especially useful if you feel you cannot ensure you or your partner will use a condom every time you have sex.

How effective is PrEP?
Overall, with strict daily adherence studies have found that Truvada® is over 90 percent effective at preventing HIV infection. However, people often struggle with taking a pill every day, which means in some studies the effectiveness was as low as 44 to 75 percent, or even lower with poor adherence. Therefore, it is vital that you take PrEP every day. The CDC says that it takes approximately 20 days after starting treatment for PrEP to be optimally effective.

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How can I get PrEP?
Your doctor can prescribe PrEP, however he or she may not know about it or may not proactively offer it to you because of taboos about discussing sex and HIV. It is possible your regular doctor will not feel comfortable or is not educated enough to prescribe PrEP. If your doctor cannot or will not provide PrEP, or you do not have a regular doctor, the NYC Department of Health and Mental Hygiene lists  with experience prescribing PrEP. Local Programs also exist throughout the nation in various cities.

Is PrEP safe?
Truvada® has been used since 2004 as part of anti-retroviral therapy (ART) for HIV-positive people. It was approved as PrEP for HIV-negative people by the FDA in 2012. Studies of Truvada® as PrEP have found it to be safe with minimal and minor side effects.

What are the common side effects of PrEP?
Studies have found that the most common side effects are headache, gastrointestinal problems — including abdominal pain and nausea — and weight loss. They tend to fade after a month and are mostly minor. Rarely, more serious side effects have been reported, including a small decrease (1%) in bone density, as well as renal failure and kidney problems. All of these potential side effects should be monitored regularly by your doctor while you are using PrEP, and the side effects have been shown to stop once PrEP is discontinued. Talk with your doctor about potential side effects and how to minimize them.

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How will I afford PrEP?
While Truvada® as PrEP is expensive, most private insurance covers it. Medicaid covers PrEP in NY State, however coverage varies by state. If you don’t have insurance, Gilead, the pharmaceutical company that makes Truvada®, offers a Medication Assistance Program. For more on this program click here. If you don’t have health insurance, GMHC can assist you with applying for health insurance and then make a referral for PrEP. Please contact Alexandra Remmel at 212.367.1143.

Won’t PrEP cause people to stop using condoms? 
Some activists and health practitioners are concerned that PrEP will decrease the use of condoms. However, a major study of Truvada® as PreP found no evidence that users significantly altered their use of condoms.  In fact, some argue that since being on PrEP requires seeing a doctor four times a year to test for HIV and other STIs and to monitor side effects, PrEP users may be more connected to their health and make safer choices. To learn more click here.

Why do I need regular HIV tests before I start and while taking PrEP?
Truvada® is a combination of two HIV medications, which HIV-positive people also take with other drugs that combat HIV. If you are HIV-positive and only take Truvada® in the dosage used for PrEP, your virus can develop resistance to Truvada®. This is why it’s important to ensure you are HIV negative before starting PrEP, and that you have no flu-like symptoms, which may indicate an early infection that is not yet detectable with an HIV test. Once on PrEP, you should be tested for HIV every three months.

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What is PEP?
PEP stands for post-exposure prophylaxis. It is an emergency medication for HIV-negative people that can help prevent infection after exposure to HIV. If you or your partner believe you have been exposed to HIV, you can obtain PEP as an emergency medication to help avoid HIV infection, preferably within 36 hours, but maximally 72 hours after exposure. PEP is a combination of two or three HIV drugs taken every day for 28 days. PEP should only be used in emergency circumstances.

Is PEP for me?
IIf you think you have been exposed to HIV within the past 72 hours (3 days), you should strongly consider PEP. PEP needs to be started within 36 hours and ideally no later than 72 hours after exposure to HIV. It can prevent HIV from establishing an infection in your body, if you adhere to the regime as prescribed. You will also be given an HIV test before PEP is prescribed to ensure that are not already HIV positive.

How effective is PEP?
PEP is more effective the sooner you take it. If you begin taking it within 36 hours, but no later than 72 hours, of exposure and adhere to the complete regimen for the full 28 days, there is good chance it will prevent infection. There is less information about PEP’s effectiveness than PrEP, but one study found that PEP reduced the rate of infection by 80%.
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How can I get PEP?
PEP is offered at emergency rooms and many clinics. If you are concerned you have been exposed to HIV, do not schedule an appointment with your regular doctor unless he or she can meet with you immediately. You need to start PEP within 36 hours, and ideally no later than 72 hours after exposure to HIV. The NYC Department of Health and Mental Hygiene lists clinics with experience prescribing PEP.  In NYC you may be eligible for e free 3-day starter pack, regardless of insurance status. See: https://www1.nyc.gov/assets/doh/downloads/pdf/std/eligibility-table.pdf .  A fact sheet on PEP from The New York City Health Department is available here. It may be helpful to take this fact sheet with you to your ER or Medical Provider, regardless of where you live.

Is PEP safe?
PEP is safe and has been used for several years, especially by medical providers who are exposed to HIV at work. It may cause side effects, which can be treated and are not life-threatening.

What are the common side effects?
While the side effects of PEP are not long term or damaging to the body in most cases, many people experience nausea, generally not feeling well, fatigue, headaches, vomiting, and diarrhea. However, you can talk to your doctor about other medication to minimize these side effects, as it is important for you to remain on PEP for the full 28 days it is prescribed to avoid HIV infection.

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How will I afford PEP?
While PEP is expensive, most private insurance covers it. Medicaid covers PrEP in NY State, however coverage varies by state. If you do not have insurance, your doctor can help you apply for medication assistance programs. If you don’t have health insurance, GMHC can assist you with applying for health insurance and then make a referral for PEP. Please contact Alexandra Remmel at 212.367.1143. If you are exposed to HIV because of a sexual assault, you may qualify for reimbursement for medications and clinical care costs through the Office for Victims of Crime, funded by the U.S. Department of Justice. If you are exposed to HIV at work and need occupational PEP, your workplace health insurance or worker’s compensation should cover the cost.

Won’t PEP cause people to stop using condoms?
PEP should only be used as an emergency intervention. It is not intended for frequent use and does not replace condoms in any way. If you are worried about regular exposure to HIV, you should consider taking PrEP.

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To learn more about PrEP/PEP and HIV/AIDS:

  • Call GMHC's Hotline at 1-800-243-7692.

    Hours
    Monday through Friday: 2pm–6pm

    Voice messages are returned in 24 business hours.
     

  • Call the New York State HIV/AIDS Information Line:
    1-800-541-AIDS (English) 1-800-233-SIDA (Español)
     
  • The CDC Fact Sheet on PrEP

  • Print this fact sheet and take it with you to the emergency room or your doctor
    The New York City Health Department's fact sheet on PEP
    .

  • Download the PrEP Toolkit from AIDS United, in partnership with the Centers of Disease Control and Prevention (CDC) and Gay Men’s Health Crisis (GMHC).
    G2Zero PrEP Toolkit

 

 

 

 

 

 

 

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