HIV prep – what it is, who should take it and how to get it.

Illustrations by Bryce Chan

By Elizabeth Townsend & Gabriela Cano Uchofen

Oct. 11, 1988, about 1,000 activists surrounded the headquarters of the Food and Drug Administration in Rockville, MD. About half wore white lab coats stained with red handprints. Others were lying down in rows on the concrete, propping makeshift tombstones above their heads painted with epitaphs like “killed by the system” and “dead from lack of drugs.”

The protest, organized by the AIDS Coalition to Unleash Power (ACT UP), was one of the most significant in the first two years of the AIDS activist movement. Days after, the FDA met with protestors; a few months later, it agreed to increase early access to potentially life-saving experimental drugs.

But it would take the FDA nearly a decade to approve the first protease inhibitor, part of highly antiretroviral therapy, which stops the HIV virus from making copies of itself in the body. Research for a cure is still ongoing: In 2012, the FDA approved a drug called Truvada, also known under the generic names emtricitabine (FTC) and tenofovir (TDF). The drug can be taken as part of HIV treatment, but its main purpose is as what’s called “pre-exposure prophylaxis,” or PrEP.

PrEP is a kind of medical prevention for people who are at a high risk for HIV. By taking drugs daily, you can lower your chances of getting infected and, if you come into contact with HIV, prevent it from taking hold and spreading throughout your body. According to the CDC, daily PrEP can lower your risk of getting HIV from both vaginal and anal sex by more than 90 percent and through injecting drugs by more than 70 percent.

Just over 77,000 people in the U.S. are currently taking PrEP, but the CDC estimates that approximately 1.1 million people could benefit from the treatment. But more than thirty years after ACT UP’s FDA protest, access to PrEP is still patchy. Some doctors may not be knowledgeable about PrEP. For those without insurance, the medication can be costly to maintain. According to NPR, Truvada can cost close to $2,000 for a 30-day supply while its manufacturer, Gilead Sciences, annually rakes in billions of dollars off the drug.

The website preplocator.org can help you find nearby health offices that provide PrEP. In Alachua County, the Florida Department of Health (FDHA), Planned Parenthood and Primary Care of Gainesville offer assistance getting on PreP, but the UF Infirmary was not able to provide any information when contacted by The Fine Print.

The FDHA offers assistance no matter if you have insurance. Though the cost of PreP , on the other hand, depends on the
your insurance, copay and medication pay, Gay Koehler-Sides, the Area 3/13 HIV/AIDS Program Coordinator, said not having insurance will not affect whether you receive the medication.

PreP candidates may also have access to Gilead’s PreP Medication Assistance Program (MAP), which purports to make the medication financially accessible, but it depends on your income and you must be 18 years old to receive the assistance. 

Is PrEP for me?

Anyone can take PrEP regardless of their gender expression or sexual orientation. Project Inform, an organization that is dedicated to improving the health of and empowering individuals with HIV and hepatitis C, recommends consulting a medical provider about starting PrEP if your partner is HIV-positive, and if you or your partner has been treated in the past year for non-oral STDs like chlamydia or gonorrhea, been in prison or does sex work. As well, if you feel as though you are at risk of contracting HIV, you should consult a medical provider about the possibility of starting PrEP.

What are the side effects?

PrEP can be 99% effective if you take seven pills per week, but it is not a replacement for contraception or other STI prevention methods. Both the FDHA and Project Inform recommend seeing a doctor at least every three months for routine care and HIV testing. This is important because while the odds of contracting HIV on PrEP are low, the medication cannot be used to treat HIV.

PrEP is generally safe for and well tolerated by most users. The main side effects are nausea, headaches, and weight loss . Most users reported these side effects subsided or went away after the first few weeks of use.

“[PrEP] is a prevention,” Koehler-Sides said. “We want people to know about it and we want people to get on it if they think they are at high risk.” •