What Is PrEP and How Does It Work?

PrEP stands for Pre-Exposure Prophylaxis, a medication strategy designed to prevent HIV infection in people who are HIV-negative but at substantial risk of contracting the virus. The medication works by establishing a protective level of antiretroviral drugs in the bloodstream before a person is exposed to HIV.

When taken as prescribed, PrEP can reduce the risk of HIV infection from sexual contact by about 99% and from injection drug use by at least 74%. The medication contains antiretroviral drugs—the same type used to treat HIV—which block the pathways that HIV uses to establish infection in the body. Currently, the FDA has approved two medications for use as PrEP: Truvada (a combination of tenofovir disoproxil fumarate and emtricitabine) and Descovy (a combination of tenofovir alafenamide and emtricitabine).

PrEP Dosing Schedules and Administration Methods

There are two primary ways to take PrEP, depending on your healthcare provider's recommendation and your specific needs: daily dosing and event-driven dosing (also known as 2-1-1 dosing).

Daily Dosing: This is the most common and recommended method for most people. It involves taking one PrEP pill at approximately the same time every day. Consistency is crucial for maintaining protective drug levels in your bloodstream. For people assigned female at birth, daily dosing is the only recommended approach, as studies have shown that protective drug concentrations take longer to develop in vaginal tissues compared to rectal tissues.

Event-Driven Dosing (2-1-1): This approach is sometimes recommended for cisgender men who have sex with men. It involves taking two pills 2-24 hours before anticipated sexual activity, then one pill 24 hours after the first dose, and one final pill 24 hours after that. This method is not recommended for people who have vaginal sex, transgender women, or people who inject drugs.

PrEP Provider Comparison

Several healthcare providers offer PrEP services with varying approaches to care, cost structures, and accessibility options. Below is a comparison of some major PrEP providers:

ProviderService ModelInsurance AcceptanceTelehealth Options
NurxOnline consultation and home deliveryYes, plus self-pay optionsYes
Folx HealthLGBTQ+ focused care, subscription modelLimited, primarily self-payYes
Planned ParenthoodIn-person and telehealth servicesYes, sliding scale availableVaries by location
MistrPrEP-specific telehealth serviceYes, plus assistance programsYes

When selecting a provider, consider factors like consultation methods, lab testing requirements, medication delivery options, and ongoing support services. Some providers offer comprehensive services including regular HIV testing, STI screening, and kidney function monitoring—all essential components of a complete PrEP regimen.

Benefits and Potential Side Effects

Taking PrEP offers several significant benefits beyond HIV prevention:

  • High efficacy when taken as prescribed
  • Increased peace of mind and reduced anxiety about HIV
  • Control over your own HIV prevention
  • No interruption at the time of sexual activity
  • Complementary protection when used with other prevention methods

However, like any medication, PrEP may cause side effects in some individuals. Most side effects are mild and tend to resolve within the first month of use. Common side effects include:

Initial side effects (often temporary):

  • Nausea
  • Headache
  • Fatigue
  • Stomach discomfort

Potential longer-term considerations:

  • Small risk of decreased kidney function
  • Possible mild decrease in bone density

These potential effects are why CDC guidelines recommend regular monitoring while on PrEP, including kidney function tests every 3-6 months. Your healthcare provider from PlushCare or other telehealth services can help monitor these effects and adjust your care plan if needed.

PrEP Accessibility and Cost Considerations

The cost of PrEP varies depending on insurance coverage, location, and assistance programs. Without insurance, the retail price can be substantial, but several options exist to make PrEP more affordable:

Insurance Coverage: Most private insurance plans, Medicaid, and Medicare cover PrEP with little to no cost-sharing, as it's classified as preventive care under the Affordable Care Act. This includes the medication itself and the required lab tests and clinical visits.

Assistance Programs: For those without insurance or with high deductibles, several programs can help:

  • Gilead Advancing Access offers co-pay support for insured individuals and medication assistance for eligible uninsured people
  • Ready, Set, PrEP program through the U.S. Department of Health and Human Services provides free PrEP to those who qualify
  • State-specific PrEP assistance programs in many locations

When considering costs, remember to factor in the expenses beyond just the medication—regular HIV testing, STI screenings, and kidney function monitoring are essential components of PrEP care. Some telehealth providers like Hims offer bundled services that can simplify this process and potentially reduce overall costs.

Conclusion

Taking PrEP effectively requires understanding your dosing options, maintaining consistency, and working closely with healthcare providers for monitoring and support. Whether you choose daily dosing or, for some individuals, event-based dosing, the key to PrEP's effectiveness lies in adherence to the prescribed regimen. Regular testing, open communication with healthcare providers, and awareness of assistance programs can help overcome potential barriers to access. With proper use, PrEP represents one of the most effective tools available for HIV prevention, empowering individuals to take control of their sexual health with confidence.

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This content was written by AI and reviewed by a human for quality and compliance.