It Feels Good to Talk About PrEP

At APLA Health & Wellness, we think it’s good to talk honestly and openly about sex. It’s just one key to establishing a good relationship with your medical provider and with your partner(s). We also believe in talking about the different tools that help protect you against HIV. Pre-Exposure Prophylaxis (PrEP) is one of those tools.

You’ve probably heard about PrEP: It’s a pill you take every day that protects you from HIV. When taken every day as prescribed, it is up to 99% effective.

If you want to know more about PrEP and find out if it’s right for you, talk to us. Call 844.830.PrEP for more information.

You can also call our PrEP navigator at our Gleicher/Chen Health Center in Baldwin Hills at 323.329.9016 or our new Long Beach Health Center at 562.432.7300.

A Q&A About PrEP

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What Is PrEP?

PrEP is a way for people who don’t have HIV to help prevent HIV infection by taking a pill every day. PrEP stands for “pre-exposure prophylaxis,” which means the pill protects you before you get exposed to HIV and keeps the virus from finding a home in your body. Truvada is the medication that is currently used for PrEP, and it has been used, together with other medications, to treat people living with HIV for many years. PrEP is not a cure for HIV and it does not keep you from getting other sexually transmitted diseases (STDs) such as gonorrhea, chlamydia, herpes, warts, and syphilis. Condoms are still the best way to avoid catching other STDs.

There is another treatment you can take after a potential exposure to HIV—such as sex without a condom—called PEP. PEP stands for “post-exposure prophylaxis.” If you think you have been exposed to HIV and you are not on PrEP, call us or come to the health center immediately and ask us about PEP. PEP works best if you take it as soon as possible after the exposure, but definitely within 72 hours of when you think you were exposed and it must be taken for 28 days. At this time, we are unable to offer PEP, but we can tell you where to get it.

Does PrEP Work?

PrEP is up to 99% effective at preventing HIV infection if it is taken every day, 7 days a week. When you start taking Truvada, you need to take it for at least 5 days in a row before you are protected for rectal exposures. (Protection for vaginal exposures may take up to 21 days.) After you start taking Truvada, you should take the pill every day. If you don’t take the pill every day, you will be less protected. We do not recommend only taking Truvada when you plan to have sex.

Is PrEP Right for Me?

PrEP is not for everyone. However, if you’re HIV-negative and at risk of getting HIV, then PrEP might be right for you. Here are some questions to consider:

  • Is your main sex partner HIV-positive?
  • Have you had sex without a condom (bareback sex) recently?
  • Have you had an STD recently, such as gonorrhea, chlamydia, or syphilis?
  • Are you having sex with people whose HIV status you don’t know?
  • Are you having sex with multiple partners?
  • Have you used post-exposure prophylaxis (PEP) in the past year?
  • Do you or your sex partner(s) use alcohol and/or drugs when having sex?
  • Do you or your sex partner(s) exchange sex for money, housing, drugs, alcohol, or other needs?
  • Has anyone ever threatened or forced you to have sex against your will?

If you answered “yes” to any of these, then you are likely a good candidate for PrEP.

How Do I Get PrEP?

If you think PrEP might be right for you, make an appointment with us. We will be able to answer your questions and help you make a decision about whether or not you should start PrEP. Be honest with your medical provider about your current sexual activity and level of HIV risk. Never take Truvada without first talking to a medical provider. If you talk to a doctor in another health center or clinic about PrEP and they won’t prescribe it to you, ask for a referral to an HIV specialist or another doctor who might be able to help you. If you are having problems and need to talk to someone about a referral, call us at the Gleicher/Chen Health Center at 323.329.9016.

What Should I Expect If I Start Taking PrEP?

Before a provider gives you PrEP, you will be required to take an HIV test to make sure you’re HIV-negative. You will also be required to take tests for hepatitis B, kidney function, and other STDs.

After you start taking PrEP, you should take the pill every day. At the Gleicher / Chen Health Center you will see a provider every month for the first 3 months for routine testing. These tests will make sure you continue to be HIV-negative and check for any side effects or STDs. Our providers will also want to continue talking with you about your sexual activity and level of HIV risk. We will not refill your next prescription until your HIV testing is done and it comes back negative, so don’t wait until the last minute to get your blood work done.

PrEP may only make sense for you at different points in your life—for example, when you are in a relationship with a partner who is HIV-positive or when you are having sex without condoms with partners whose HIV status you don’t know. You can stop taking PrEP if your level of risk changes. It’s important to talk with a doctor when stopping or starting PrEP.

Does PrEP Have Side Effects?

Most people who are on PrEP don’t have any side effects. Some people have minor side effects, such as nausea, headaches, or weight loss, but they usually go away after a few weeks. A few people have more serious side effects affecting their bones and kidneys. A provider will do tests while you are on PrEP to find out if you are experiencing these problems.

Do I Need to Use Condoms If I’m Taking PrEP?

PrEP is very effective at preventing HIV transmission and is a great tool to use in your overall approach to your sexual health. But it is not 100% effective and will not protect you from other STDs such as gonorrhea, chlamydia, herpes, warts, and syphilis. People taking PrEP can also do other things to stay HIV- and STD-free. These include:

  • Using condoms consistently and correctly
  • Getting tested for HIV
  • Getting tested for STDs
  • Choosing less risky sexual behaviors (having oral sex only or topping only for anal sex, for example)
  • If you inject drugs, participating in a drug treatment program or using sterile drug injection equipment.

PrEP is a very good HIV prevention strategy that helps you stay HIV-negative for the times when you do not, or are unable to, use a condom.

Can I Still Get HIV If Take PrEP?

When taken as prescribed, 7 days per week, PrEP is extremely effective at preventing HIV. When you miss a dose, the protection from PrEP is lower. As noted above, there has so far only been documented case of man contracting HIV while on PrEP. No HIV prevention method is perfect and regular HIV testing and using more than one prevention method (such as condoms and PrEP) is always the safest method of protection.

Regular HIV testing is a critical part of taking PrEP. Therefore, it is particularly important to make sure you don’t start or continue to take PrEP if you think you’re already having symptoms that could be your body acquiring HIV such as fatigue, fever, rash, sores in the mouth or genitals, and enlarged lymph glands. Truvada is not enough to treat HIV once it’s in the body, and can lead to virus resistant to the medications in Truvada, making that HIV harder to treat. If you have any questions or concerns, you should speak with our medical providers immediately.

How Much Does PrEP Cost?

Most people can access PrEP at little or no cost. PrEP is covered by all health insurance companies in California, including Medi-Cal. Although you may be required to pay a certain amount (known as a co-pay), you can get help paying for PrEP through a patient assistance program.  If you do not have health insurance, call the Gleicher/Chen Health Center for assistance enrolling in a plan.

Where Can I Get More Information?

For questions and assistance, please call us at the Gleicher/Chen Health Center at 323.329.9016 or set up an appointment and visit us in person!

For more on where to get PrEP in LA, visit getprepla.com.

For additional information from the CDC on PrEP, read more at www.cdc.gov/hiv/prevention/research/prep/.

Post-Exposure Prophylaxis (PEP)

Since prophylaxis means disease prevention, Post-Exposure Prophylaxis, or PEP, is a strategy that involves taking anti-HIV drugs as soon as possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV-positive. To be effective, PEP must begin within 72 hours of exposure, before the virus has time to rapidly replicate in your body. Several HIV medications are indicated for use in PEP and are taken for a period of 28 days to prevent a new HIV infection. Please note that the Gleicher / Chen Health Center cannot currently offer PEP to patients.

What are the different types of Post-Exposure Prophylaxis?

PEP involves taking anti-HIV drugs as soon as possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV-positive. There are two types of PEP: (1) occupational PEP, (sometimes called "oPEP"), and (2) non-occupational PEP, (sometimes called “nPEP”). Workplace exposure (oPEP) is when someone working in a health-care setting is potentially exposed to material infected with HIV. nPEP is when someone is potentially exposed to HIV outside the workplace (e.g., condom breakage, sexual assault, etc.)

To be effective, PEP must begin within 72 hours of exposure, before the virus has time to rapidly replicate in your body. PEP consists of 2-3 antiretroviral medications and should be taken for 28 days. Your doctor will determine what treatment is right for you based on how you were exposed to HIV. The medications have serious side effects that can make it difficult to finish the program. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV.

Who needs PEP?

PEP is usually used for anyone who may have been exposed to HIV. Health care workers have the greatest risk. They can be exposed to HIV by:

  • Needle sticks or cuts
  • Getting blood or other body fluids in their eyes or mouth
  • Getting blood or other body fluids on their skin when it is chapped, scraped, or affected by dermatitis.

The risk of HIV transmission in these ways is extremely low—less than 1% for all exposures. PEP can also be used to treat people who may have been exposed to HIV by accident (e.g., condom breakage) or sexual assault.

When should I take PEP if I’ve been exposed?

PEP is most effective if you take it within 72 hours of possible HIV exposure. The longer you wait to start PEP, the greater the risk of becoming HIV-positive.

Your healthcare provider will consider whether PEP is right for you based on how you might have been exposed and whether you know for sure that the individual who might have exposed you is HIV-positive. You may be asked to return for more HIV testing at four to six weeks, three months, and six months to determine your HIV status.

Where can I get PEP?

At this time, the Gleicher/Chen Health Center does not offer PEP to patients. You can call us at 323.329.9016 and we will refer you to the appropriate facility as quickly as possible. In Los Angeles County, the County of Los Angeles Department of Public Health funds two clinics to provide PEP free of charge to those people at risk for HIV infection who do not have insurance to pay for the medication. Testing and counseling are provided at the Los Angeles LGBT Center (Hollywood area): 1625 N. Schrader Blvd., Los Angeles, CA 90028, phone: 323.860.5855. Information is also available via the LA County PEP Warmline at 213.351.7699.

Additional information on where to get PEP in L.A. is here: getprepla.com

Where can I get information on assistance with co-pays and finding medication?

The Fair Pricing Coalition has created a guide to PrEP and PEP medication and assistance copay programs. It offers details, phone numbers, links, and the process a person has to follow to either obtain free drugs or assistance with out-of-pocket costs. See http://fairpricingcoalition.org/projects/ for more information.