WHAT’S PrEP?

Good question. So here's the straight answer: men who have sex with men (gay, bi, DL, trans etc.) are at very high risk of becoming HIV positive during their lifetime.

In the United States, men who have sex with men continue to be the group most affected by the HIV epidemic.

While anyone (straight, gay or bi), can get HIV from unprotected sex, unprotected anal sex is much more likely to result in HIV infection than unprotected vaginal sex. Bottoms are at the highest risk, but tops (especially uncut tops) are still at risk too.

At current infection rates, 1 out of every 6 Gay/Bi men will be diagnosed with HIV in their lifetime; the risk is even greater in minority communities: 1 in 2 African American men who have sex with men and 1 in 4 Latino men who have sex with men, will become HIV positive IF we don't take steps to stop the spread of the HIV virus among us.

If you are at high risk for becoming HIV positive, it makes sense to do whatever you can to lower your risk.

Taking the daily PrEP pill is one big thing you can do to lower your risk of getting HIV; using condoms whenever you fuck is another.

If you're at high risk for HIV infection, taking the PrEP pill makes sense, because it's better to voluntarily take one daily pill now and stay HIV negative, than to become HIV positive and be required to take HIV medication for the rest of your life--and deal with the health consequences of long term HIV infection.

Although our HIV positive brothers who take their daily HIV medications to keep the virus under control (undetectable level), can keep themselves healthy and lead a normal life, it's still best for your overall health to stay HIV negative if you can---even if that means taking a PrEP pill every day to help to keep yourself from becoming infected with HIV virus.

If our HIV + brothers take their meds and keep their virus level undetectable, and those of us at high risk take the daily PrEP pill and use condoms as much as possible, together we can stop the HIV epidemic in its tracks.

Ok---to understand how the daily PrEP pill works to prevent HIV infection, you first have to know a little bit about how the HIV virus harms the human body after it gets inside.

The HIV virus gets into the body by hitching a ride in cum, pre-cum or blood that is shared during unprotected sex with an HIV positive person. Once inside the body, the virus then travels through the bloodstream and invades the cells of a person's immune system.

After the HIV virus gets up inside an immune cell—sometimes called CD4 or T-Cells---HIV hijacks the cell, and starts making thousands of copies of itself. These HIV copies then bust out of the immune cell and the cell eventually dies. After breaking out of the cell, all the new HIV viral copies travel throughout the body and invade even more immune cells, repeating the same destructive process over and over again. This process also causes the death of thousands of “innocent bystander” immune cells, that haven’t even been infected with HIV yet.

When enough immune system cells are killed off by the HIV virus, an HIV positive person's immune system can no longer protect them from infections, and they get Acquired Immune Deficiency Syndrome, or AIDS. Without treatment, a person with AIDS will die from common infections that HIV negative people with healthy immune systems would easily fight off.

The good news is that we now have a combination of medications, that when taken together every day, keeps the HIV virus from multiplying and killing too many immune system cells. This in turn keeps the HIV positive person’s immune system working and stops them from progressing to AIDS . A person living with HIV has to keep taking their medications for the rest of their life in order to keep the HIV virus in check and stay healthy. If they stop their meds, the virus will start multiplying again and destroy their immune system. Before these medications were developed, almost everyone who became infected with HIV, eventually got AIDS and died.

Ok, now here’s where the daily PrEP pill comes in. The daily PrEP pill works by keeping an HIV negative person from becoming HIV positive, if and when they are exposed to the HIV virus.

When someone is exposed to the HIV virus by contact with cum, pre-cum or blood during sex, it takes about 72 hours for the HIV virus to get up inside of the body’s immune system cells and establish a lifelong infection-- making them HIV positive.

For men, after seven days of taking the PrEP pill each and every day, there’s enough of the PrEP medicines inside your immune cells to immediately block the virus from making thousands of copies of itself and spreading all throughout your body destroying your immune system. As a result of the PrEP pill blocking the HIV virus’ ability to make copies of itself, your healthy immune system can knock out the invading HIV virus and you will stay HIV negative.

Remember, it’s very important to take the PrEP pill every day to make sure you always have enough medicine in your body to knock out the HIV virus if you come in contact with it during sex. PrEP won’t work if you don’t take it as prescribed.

The PrEP pill is prescribed to be taken once every day---ideally around the same time every day so that you have a steady amount of medicine in your body at all times available to stop HIV infection. There is now a new PrEP injection, that is given once a month for the first 2 months, and then every 2 months afterwards. This is a good option if you travel frequently or if you have a hard time remembering to take pills, but as there is not yet a generic version, your insurance may not cover it Visit https://apretude.com/ for more information

If you don't take the medicine as prescribed, it's not going to give you the highest level of protection.

If you and your doctor decide PrEP is right for you, you should download a free pill reminder app for your phone to help you remember to take it every day or just set a daily alarm reminder on your smart phone

Keeping the pills on your night stand, so you see them first thing in the morning, or next to your tooth brush, can help you remember too. You should consider gettin yourself a 7 or 30 day pill box like this one, so you can keep track of if you've taken your pill each day. You can get them at any drugstore.

If you sometimes don't spend the night at home, you can take a PrEP pill with you in a keychain pill case like this, so you're always PrEPared and won't miss a dose!

If you do forget to take your PrEP pill at your usual time, "take it as soon as you remember that day. Do not take more than 1 dose of TRUVADA in a day. Do not take 2 doses at the same time. Call your healthcare provider or pharmacist if you are not sure what to do." (Gilead).

YES. When taken as prescribed (once daily), PrEP is estimated to reduce the risk of getting HIV by 99% in high risk gay/bi men and trans women.

PrEP is less effective if it is not taken every day, although studies suggest that there is still a good level of protection even if you accidentally miss a dose every once in awhile.

However, if you want the highest level of protection, you should do your very best to take PrEP every single day.

Using PrEP with a condom, gives you the highest level of protection from HIV infection because, although it is rare, there are some people who are carrying a type of HIV which is resistant to the medicines in the PrEP pill. In that case, a condom is necessary to give you protection. Right now there are only three reported cases of guys getting a PrEP resistant strain of HIV while using PrEP correctly. Those patients are doing well on HIV meds with undetectable viral loads.

Unfortunately, there haven't been enough studies in trans men yet to see how well it works for "front hole" sex, but it would work the same for anal sex. The reason it might be a little less effective in the front hole is that when you take T it can cause dryness and thinning up in the front hole, which makes small skin tears more likely, which makes it easier for any infection to get into the body--another reason to use plenty of lube!

For (cis) men it takes about seven days of taking daily PrEP pills for the medicine to build up enough in your body to give the highest level of protection during anal sex. So you definitely would not want to have sex without a condom until after at least 7 days of taking daily PrEP pills.

Listen up trans men: for front hole sex, it takes at least twenty days of daily use for the front hole to be protected. Because taking T can cause the walls of the front hole to thin and become drier, you're more likely to get micro tears up in there that can put you at higher risk for all sexually transmitted infections. We're not sure yet if PrEP works as well in front hole sex for trans men as it does with anal sex, so risk reduction estimates don't apply to front hole sex,.

PrEP is safe, and most people have no problem taking it. The combination of medicines in the PrEP pill, has been used as part of a treatment regimen for HIV + people since 2004-- so it's been around long enough to have been proven safe.

In some people PrEP can cause mild side effects, such as upset stomach, headaches, weight loss and tiredness. Those symptoms usually go away after just a few weeks. However, for some folks, it make take a couple months to fully adjust to the medication. If the PrEP pill makes you tired or a little nauseous , you may want to try taking it before bed, instead of in the morning. Rare side effects include kidney or bone problems. Some doctors recommend Vitamin D and Calcium supplements to protect against any bone problems.

Your PrEP provider will go over the possible side effects with you and will help you to monitor your health for medication side effects while you're on PrEP.

Gilead, the makers of the PrEP pills, list these two EXTREMELY RARE side effects:

1) "Too much lactic acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, nausea, vomiting, stomach-area pain, cold or blue hands and feet, feeling dizzy or lightheaded, and/or fast or abnormal heartbeats."

2) "Liver problems. Your liver may become large and tender, and you may develop fat in your liver. Symptoms of liver problems include your skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, and/or stomach-area pain."

Again, these two side effects are VERY rare. Mild nausea is common for the first month or so of treatment, however.

NO! To protect against other STD's you still need to use condoms whenever you can.

Using PrEP along with condoms is the best way to protect against HIV; and using condoms is the ONLY way to protect against common STDs that can infect your penis, butt hole or throat like: Syphilis, Gonorrhea and Chlamydia.

Unfortunately, Syphilis is very common in our community right now. It can be cured with a single shot in most cases, but it's something you need to be aware of, and get tested for, because left untreated syphilis can have serious health consequences.

No,. However, but there is a "non-daily dosing strategy for PrEP that was studied in cis men who have sex with men in France and Canada, and is being used in some clinics in Europe and Canada. This non-daily strategy, also known as “Intermittent”, “Event-Driven,” “Sex-Driven,” “On Demand,” or “2-1-1” PrEP, may be appropriate for some MSM. (see below) for MSM who do not want to use daily emtricitabine/tenofovir disoproxil fumarate (also known as FTC/TDF or Truvada®), which is currently the only FDA-approved dosing strategy for PrEP in the United States The only non-daily dosing strategy for which there are efficacy data is sometimes referred to as “2-1-1.” In the Ipergay and Prevenir studies, which primarily enrolled men who have sex with men (MSM), participants took 2 Truvada® tablets 2-24 hours before sex (closer to 24 hours before sex was preferred), another pill 24 hours after the first 2 pills, and another pill 24 hours after that. Hence the name “2-1-1.” If they continued to have sex on multiple consecutive days, they continued taking one Truvada® per day until 48 hours after their last sexual intercourse. If patients had a gap of less than 7 days between their last pill and their next intercourse, they were allowed to use a loading dose of one Truvada® tablet rather than two. This approach reduced HIV risk by 86% compared to placebo in IPERGAY. Participants took an average of 4 pills per week (a dosing frequency associated with high levels of protection in studies of daily PrEP)." (SF Dept of Health)

NO. With proper medical supervision, you can safely start and stop taking PrEP at different points in your life depending on what your HIV risk is at the time.

For example, if you start a relationship where you and your boyfriend are both HIV negative and both of you are absolutely SURE neither of you are going to have sex with anyone else, you might decide to stop taking PrEP while you're in that relationship. If that relationship ends and you plan on getting out to start dating and hooking up again, you could then start PrEP again.

However, any time you start PrEP, it is important to remember that it takes at least seven days of daily use for PrEP to reach full effectiveness for anal sex. And, if you're planning on stopping PrEP, you need to keep taking it for 4 weeks after the last time you had unprotected sex.

Maybe some people will, but you can't let what some judgmental asshole thinks control how you live your life.

Haters gonna hate, that's life.

When unmarried females first were fighting for the right for to be able to get birth control pills, they were called sluts by a lot of conservative men. But now you wouldn't even think of calling a female a slut for taking daily birth control pills to keep from getting pregnant--you'd say she was being responsible! So, taking daily PrEP to prevent HIV infection doesn't make you a slut either.

PrEP is only crazy expensive if you don't have health insurance or your insurance plan doesn't cover it. The good news is most insurance plans do cover it, as do many Medicaid type programs.

Check out our "Paying 4 PrEP" page to find out more about the resources available to pay for PrEP. Many people are able to get PrEP at low or no cost, using the available resources.

It's possible, to get HIV while taking PrEP, but it's very unlikely. If you are using PrEP correctly (taking it every day), it is highly unlikely that you will become infected with HIV.

In scientific studies, people on PrEP only got HIV if they didn't actually take their PrEP pill as prescribed, OR if they had sex with someone with HIV before they had been taking PrEP for 7 days (anal sex) or 20 days (vaginal sex)-- OR if they were exposed to a type of HIV that is resistant to the medications in the PrEP pill--that last situation is VERY rare--only two case have been reported so far.

If you take PrEP every day your risk of getting HIV will be very low--and it will be almost zero if you combine daily PrEP with consistent condom use.

Even if you're taking daily PrEP, it's still a good idea to know your partner's HIV status, and if they are on HIV medication and have been "undetectable" for 6 months.

HIV positive people who have been undetectable for 6 months and stay that way cannot transmit HIV to their partners. If they're not "undetectable", you should ask if they have a resistant form of HIV. If they have a drug resistant form of HIV, you need to use a condom, even if you're taking PrEP

So you're thinking "I'm on PrEP and that's supposed to keep me from getting HIV, so why the f*ck do I have to keep getting tested?"

Well, it's because you're human-- if you slip up and miss a bunch of days of taking PrEP and then have unprotected sex, you could still get HIV.

If you do become HIV + while you are on PrEP, it's very important to know that as soon as possible because the PrEP pill alone is not strong enough to control the HIV virus once someone becomes HIV positive. To fully treat an established HIV infection, your doctor will need to add another medicine to the PrEP pill or give a a different combo of medicines to keep your HIV in check and keep you healthy.

PEP, or POST exposure prophylaxis, is a combination of HIV medicines that you take for a month if you think you may have been exposed to HIV during sex (condom breaks or sex without a condom with an HIV+ person) or if you have been stuck by a needle from a syringe used by someone else who might have HIV.

You have to start PEP within 72 hours of exposure to HIV, or it won't work. The sooner you take it, the better. If you take PEP in time, usually HIV infection is prevented.

In contrast, PrEP is a single daily pill you take BEFORE you are exposed to HIV, to keep you from becoming HIV positive if you are exposed to the virus during sex.

TasP is short for Treatment As Prevention. Multiple scientific studies looking at couples in which one partner was HIV positive and the other was HIV negative have shown that to date, no positive person has passed HIV on to their partner, so long as the HIV positive partner was on HIV medication AND had an undetectable level of HIV in their blood (undetectable viral load). According to these studies, current scientific consensus is that when an HIV positive person is taking all their medications as prescribed, and has been able to get their HIV viral load to "undetectable" levels for six months AND continues to keep it undetectable, they will not transmit HIV to their partner(s). In other words, their HIV TREATMENT works AS HIV PREVENTION

The goal is to get everyone who has HIV to "undetectable" levels whenever possible, both for the benefits to their own health and for the health of their partners. This is why getting tested and getting treated as early as possible for HIV infection is so important.

The earlier an HIV positive person gets their viral loads under control, the better their long term health--and the lower their viral load, the lower their risk of passing HIV to their partners.

Combining TASP and PrEP together would lower HIV rates dramatically and ultimately put an end to the epidemic.