What You Should Know About PrEP

Whether you’re engaging in high-risk sexual activity or simply want peace of mind, pre-exposure prophylaxis, most commonly known as PrEP, may be prescribed to prevent HIV (human immunodeficiency virus), which is the cause of AIDS (acquired immunodeficiency syndrome). This medication, taken as a pill often prescribed in the form of brands like Truvada, Descovy, Apretude, and Yeztugo, works by blocking the virus’s life cycle by protecting your immune system’s T-cells (white blood cells that defend and protect the body). It essentially forms a protective shield and, when taken daily, can reduce transmission risk by a whopping 99%. While the breakthrough drug has become a constant in the lives of those who identify as gay or bisexual, there is still much that can be learned by the general public and those who may be interested in PrEP’s benefits and efficacy. We chatted with two experts in their respective fields, PA and sexual health expert, Jonathan Baker, as well as Tristan Schukraft, CEO and founder of telemedicine provider and PrEP distributor MISTR, for a complete breakdown. Who Should Take PrEP? While the medication is primarily prescribed and marketed towards gay and bisexual men (due to anal sex being the easiest way to transmit HIV — almost 20 times more likely while bottoming than through vaginal sex, according to Baker), anyone who might be exposed, regardless of sex, gender, sexual preference, or relationship status and structure, could benefit from PrEP. “Most people accessing PrEP are sexual minority men (gay and bisexual men) and transgender women and that’s likely stemming from our community awareness and education around HIV,” explains Baker. “Previous public health estimates have suggested, by number, [that] there are actually more heterosexual-identified folks in the U.S. who would benefit from PrEP than sexual minority men and transgender women.” RELATED: Safer Sex Mistakes That Can Lead to STIs “About 30% of heterosexual-identified folks engage in anal sex, so it’s important that we consider the impact PrEP could have in these communities, as well,” he adds. How Accessible Is PrEP? Obtaining a PrEP prescription starts with a doctor’s appointment, followed by a series of blood tests to ensure that your overall health remains in good standing. “Most people get a prescription through their primary care provider after some basic blood work and then repeat that testing every 2-3 months,” says Baker. This is to test for HIV, STIs, as well as kidney and liver function. RELATED: 3 Reasons You Should Get an STI Test (and Where to Do It) Unfortunately, access to PrEP will vary by one’s geographical location. That said, organizations like MISTR have made it a mission to provide easy, safe, and confidential avenues to get the medication into the hands of those who need it most. “Access to PrEP still varies widely depending on where someone lives, but MISTR’s telehealth model has changed what’s possible,” reiterates Schukraft. “In fact, now one in five people on PrEP in the U.S. get their PrEP through MISTR. With MISTR, everything can be done online and through the mail anywhere in the United States. Patients don’t need to find a local specialist, visit a clinic, or navigate a complicated healthcare system.” “This is especially important in smaller communities, where privacy can be a real concern,” he adds. “Many people don’t feel comfortable picking up PrEP at a local pharmacy or visiting the same doctor they might run into socially. MISTR allows patients to access care discreetly, without awkward conversations or fear of being outed, while still receiving high-quality medical care.” RELATED: What to Do When You Have a Sexually Transmitted Infection Additionally, MISTR and similar organizations will also provide remote access to health questionnaires, required testing, and doctor consultations. Lab work can also be completed in-person or via home testing kits. For those in larger cities, PrEP should generally be free or severely discounted. This also includes the associated medical visits and labs. “Nearly every insurance carrier, Medicaid, and Medicare cover at least some version of PrEP,” shares Baker. “Uninsured and underinsured folks can often access PrEP through community organizations. While some of the brand name PrEP options are quite expensive (around $2,000/month), daily generic PrEP medication’s out-of-pocket costs are often around only $30.” How Is PrEP Administered? Thus far, PrEP has primarily been known as a daily pill that people can take. However, while this method can fold into a daily routine, there are some who shy away from the commitment. Luckily, FDA-approved injectables are already on the market and a long-term vaccine continues to be tested and researched among the medical community. “The future of HIV prevention goes well beyond daily pills,” reveals Schukraft. “While human trials for an HIV vaccine are underway, a widely available vaccine is still years away. What is already changing the game is long-acting injectable PrEP.” RELATED: Debunking Common Misconceptions About Gay Men “Injectable PrEP provides full HIV protection with just two shots per year, eliminating the need for daily pills. This is a major breakthrough for people who struggle with remembering to take a daily pill, have limited access to pharmacies, or simply want a more convenient option,” he adds. “There are two injectable PrEP options: Apretude injection every two months and Yeztugo injection every six months,” adds Baker. “I use these most in my patients who don’t take other daily oral medications. One of my patients this afternoon reflected on how freeing it is to not take a pill daily and that they feel much safer knowing they have the shot since they would miss some doses of the daily oral medication prior.” Organizations like MISTR are already preparing for this shift in preference, having built storefronts in gayborhoods such as West Hollywood (Los Angeles), Hell’s Kitchen (NYC), The Castro (San Francisco), North Halstead (Chicago), and Wilton Manors (Fort Lauderdale). RELATED: What Gay Men Could Teach Straight Men About Sexual Health “Patients can receive injections quickly and discreetly. The process is designed to be simpler than a traditional doctor’s visit: Patients complete everything online in advance, arrive for their appointment, scan a QR code, receive their injection, and leave,” explains Schukraft. “Once insurance coverage is finalized, injectable PrEP will be available for free through MISTR.” While injectable PrEP is FDA-approved, access still depends on insurance coverage and state-by-state implementation, which is why the rollout varies across the country. Even so, long-acting injectable PrEP represents the most significant advancement in HIV prevention available today, with the potential to dramatically expand protection for communities that have historically been left behind. What Are Alternatives to PrEP? It is important to note that PrEP’s primary function is the prevention of HIV transmission. For common sexually transmitted infections such as chlamydia, gonorrhea, and syphilis, engaging in safe sex practices or the introduction of antibiotic DoxyPEP (doxycycline post-exposure prophylaxis) are the only proven ways to significantly reduce risk. RELATED: DoxyPEP Is a 'Morning-After Pill' for STIs “Sexual health is not a single-risk issue,” stresses Schukraft. “HIV prevention often sits alongside concerns about other STIs, routine testing, and overall sexual wellness. That is why bundling PrEP with free DoxyPEP matters.” MISTR, as well as other organizations, typically offer DoxyPEP at no additional cost alongside PrEP. DoxyPEP is a single dose of doxycycline taken after sex. When combined with PrEP, it provides broader, proactive protection and gives people more control over their sexual health. Since introducing DoxyPEP, the STI positivity rate among MISTR patients alone has dropped more than 50%. Are There Risks to Taking PrEP? While there is often talk of PrEP’s potentially harmful effects on the liver and kidneys, it is FDA-approved and can be taken safely under the guidance of a medical professional. “PrEP is an extremely safe group of drugs and bloodwork is done in advance to make sure there are no underlying issues,” notes Baker. That said, there are a few risks associated with the injectable versions. “These injectable PrEP options have different side effects and drug interactions, so you can discuss if they are right for you with your healthcare team,” he says. “Although the six-month injection sounds like it might be a better option, the most common side effect is a nodule which can often be seen or felt in the abdomen where it is injected. For some people this is fine, others don't like it. The two-month injection is usually just sore for a few days but doesn’t leave any lasting bumps.” RELATED: What You Should Know About Homophobia As well, while not a risk per se, some may see taking PrEP as somewhat stigmatized thanks to its association with HIV. When it comes to sexual health, taking proactive measures to prevent HIV transmission should never be stigmatized. Instead, it should be praised. If you find yourself in a position where PrEP accessibility is limited and/or considered taboo, consider an organization like MISTR to assist. Nobody should deprive themselves of an active and, most importantly, safe sex life, especially with medical advancements like these to make it all possible. You Might Also Dig: How Easy Is It for Me to Contract HIV If I Have Gay Sex? What Are the Risks of Having Anal Sex? The Best Gay Sex Positions, Illustrated