What is PrEP and who should take it?

Human Immunodeficiency Virus, or HIV, is a virus that attacks the immune system and prevents the body from fighting infections. It also impacts many people, as experts estimate that nearly 1.2 million people in the United States are HIV-positive, 13% of whom don’t even know they have it.

Although anyone can get HIV, the disease devastated the LGBTQ+ community in the 80s and 90s as it became the leading killer of men aged 25-44 at one time in the United States. But while HIV/AIDS continues to have a disproportionate impact on queer people — particularly black and Latino men and trans people — HIV is not exclusive to this demographic. Yet the legacy of the AIDS epidemic and its continued negative association with the queer community still fuels stigma around HIV education and prevention today. So let’s be clear: everyone, regardless of background or sexuality, should educate themselves about the virus and consider their risk of exposure.

One of the best and most effective prevention methods for contracting HIV is to take PrEP (pre-exposure prophylaxis), a prescribed medication that lowers your risk of contracting the virus. The CDC reports that PrEP, when taken as prescribed, reduces the risk of contracting HIV through sex by approximately 99%, and for those who use injection drugs, it reduces the risk by at least 74%. These statistics prove that anyone who is sexually active or who uses intravenous drugs should assess their risk of contracting HIV and consider their options for preventing HIV.

In an editorial statement on HIV testing and PrEP, HIV researchers Hyman Scott, MD, and Paul Volberding, MD, wrote, “Together, the health gains of HIV treatment, the reduction in transmission that result and PrEP provide the tools needed to end the HIV epidemic. »

Ahead, we discuss how HIV works, your risk level, what exactly PrEP does, and how to access it.

What is HIV? What is AIDS?

To understand how to prevent HIV, you also need to understand how the virus works. HIV is transmitted through sexual fluids (including semen, pre-seminal fluid, rectal secretions, and vaginal secretions), blood (via transfusion or shared needles), as well as pregnancy and breast milk, according to the CDC.

HIV weakens the immune system by attacking T cells (the white blood cells that fight infection), which makes HIV-positive people more susceptible to disease. HIV box progress to AIDS, but the two terms are not synonymous. HIV and AIDS mean different things because a person living with HIV is considered to have AIDS when the number of T cells drops to a certain level or if they develop one or more opportunistic infections, i.e. ie infections that occur in people with weakened immune systems. With modern treatment, the Mayo Clinic reports that most people who have HIV will not develop AIDS. However, without treatment, HIV can turn into AIDS in eight to ten years.

Contrary to how it may be described, HIV is not a death sentence, nor does it mean that you cannot have a full and loving life. In fact, many people living with HIV are able to manage the virus through antiretroviral therapy (ART), resulting in what is called an “undetectable viral load”. This means that with daily treatment, HIV can be suppressed to undetectable levels, virtually eliminating the risk of transmission to sexual partners. If you’ve heard the slogan “undetectable = untransmissible” (sometimes referred to as U=U), it refers to this exact scientific research, which means that if your HIV level becomes undetectable, you cannot transmit HIV to a partner. .

What is PrEP?

PrEP is a prescribed drug, and you must be HIV-negative before taking it for it to be effective. Although HIV prevention rates remain high with all three PrEP options, your doctor will look at your lifestyle and other factors (like assigned gender) to help determine which option is right for you. Here are the three FDA-approved options.

  • Truvada is a once-daily pill for people at risk of contracting HIV through sex.
  • Descovy is a once-daily pill for people at risk through sex. However, Descovy is not intended for people designated female at birth (AFAB).
  • Apretude is the only vaccine approved for use as PrEP. It is administered by a health care provider every two months.

The CDC considers PrEP to require a high level of adherence, which means taking PrEP is a serious commitment as part of a larger, more comprehensive HIV prevention plan that you decide with your healthcare provider. health. Deciding on PrEP with your health care provider should “include a discussion about adherence to PrEP, condom use to avoid getting other sexually transmitted infections (STIs), and other methods of reducing risks,” according to the CDC.

Is PrEP safe?

Yes, PrEP is safe, according to the CDC. There are some common side effects such as diarrhea, nausea, headache, fatigue, and stomach pain, but the CDC says they usually go away. However, there are more serious PrEP-related side effects that you should discuss with your doctor.

  • For Truvada and Descovy, serious side effects can include kidney problems, liver problems and lactic acidosis, which occurs when there is too much lactic acid in the blood – a rare but serious medical emergency.
  • For Apretude, side effects may include an allergic reaction, liver problems, depression, or mood changes. You should also avoid Apretude if you have certain allergies to cabotegravir or if you are taking the following medications: carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine.

If you experience any of the above side effects, you should tell your doctor immediately or seek medical attention.

Who should take PrEP?

If you are sexually active or use intravenous drugs, you should talk to a trusted healthcare provider to find out if PrEP is the right option for you. However, HIV.gov lists the following factors that can increase your risk of getting HIV. If any of the situations below apply to you, it could mean you should consider taking PrEP.

  • Live in a community with high rates of HIV. (You can find out by visiting the CDC’s Atlas tool to see maps of HIV rates in your area.)
  • Men who have sex with men.
  • Trans women who have sex with men.
  • People who inject drugs.
  • Black and Latino men, who are disproportionately affected by HIV compared to other racial and ethnic groups.
  • Those who have multiple sexual partners.
  • Those who have sex without using condoms or other safe sex methods.

The CDC has a flowchart to help you assess your HIV risk and whether you should consider PrEP.

Where can I find PrEP?

You can get a prescription for PrEP from your primary care provider, obstetrician, or HIV specialist. Although PrEP coverage is required under the Affordable Care Act and the Department of Labor has said insured patients should not cover the costs associated with PrEP, prices remain high. CNN reports that a monthly supply of generic PrEP costs $60, but brand name drugs like Truvada and Descovy can cost up to $2,000 per month for the uninsured. Even insurance companies, however, have been known to neglect their duty to provide fully covered PrEP medications.

That said, there are several programs that provide people with free or low-cost PrEP, including Ready, Set, PrEP, which helps people without health insurance, and many local health department initiatives for at-risk populations.

Bottom line: everyone should consider their risk of getting HIV and work with a healthcare professional to find out if PrEP is the right option for you. HIV/AIDS is not a “disease of homosexuals” and everyone, whatever their gender, sexuality and origin, must think about protecting themselves and those close to them.

About Bradley J. Bridges

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