101: PrEP

What is PrEP?

PrEP is a daily medication that lowers your chances of getting HIV (the virus that causes AIDS) from sex or sharing needles.

Taken correctly, PrEP is 99% effective at reducing the likelihood of contracting HIV.

PrEP stands for pre-exposure prophylaxis. Also known by the brand names Truvada and Descovy, PrEP is now available in a generic form, making it more affordable than ever.


Who is PrEP for? 

PrEP is for anyone who is HIV negative and wants to protect themselves from HIV. 

PrEP is recommended for:

  • People who bareback (don’t use condoms during anal and/or vaginal sex)
  • People who have a partner living with HIV with a detectable viral load
  • People who have multiple anonymous sex partners or have partner(s) who have multiple anonymous sex partners
  • People who share needles and other injection equipment 
  • Anyone who wants to reduce their risk of contracting HIV

While PrEP is for anyone that wants protection from HIV, Descovy is not recommended for people with vaginas and those having vaginal sex, because its effectiveness has not been studied for this group.


Why should I protect myself against HIV?

HIV is the virus that causes AIDS. It damages your immune system, making you vulnerable to illnesses; if untreated, HIV/AIDS can be life threatening. 

HIV is most commonly transmitted through sex and sharing needles.

Once you have HIV, the virus stays in your body. There’s no cure for HIV yet, although medicines can help you stay healthy. 

Most people with HIV don’t have any symptoms for many years and may feel totally fine, so they might not know they have it and pass it on. That is why it’s so important to get tested regularly and to protect yourself in advance.

Can I stop using condoms if I’m on PrEP? 

Condoms are still encouraged! 

PrEP only protects against HIV. It will not protect you from contracting other STIs such as herpes, gonorrhea, syphilis, chlamydia, or HPV. 

PrEP is not a birth control method.

Condoms are the only technology that protect you from HIV, most STIs and unwanted pregnancy.

Of course, many people take PrEP so that they can have raw sex. If that’s you, additional birth control methods (such as “the pill”, an IUD, or other contraceptives) are recommended for anyone who can get pregnant and doesn’t want to, while routine sexual health and STI screenings are highly recommended for everyone. Most STIs are easy to treat if diagnosed and medicated quickly.  

Also important to note: Since PrEP only goes into effect after 7-21 days of taking the medication, condoms are recommended until then. PrEP also loses its efficacy when taken less than 5 days a week. Take it every day! If you miss multiple doses, PrEP can take several days to become effective again. Condoms are recommended in the interim. 

What if I’m not on PrEP but my partner(s) say they are? Should I use condoms then?

If your partner(s) take PrEP every day and remain HIV negative, so will you, whether you're on PrEP or not.

The answer to this question comes down to trust and personal preferences. 

Do you trust that your partner(s) are taking PrEP responsibly (every day)? If you’re not sure, you might prefer to use condoms and/or take PrEP yourself. 

Are you concerned about other STIs and/or unwanted pregnancy? If so, condoms are always recommended.

Something we’ve heard at Jems is, “I’m not on PrEP, my partner isn’t on PrEP, but everyone else we are sleeping with is, so we must be fine...” 

Just because PrEP is becoming more common, that doesn’t guarantee your safety or that HIV is necessarily “a thing of the past.”  

Taking PrEP and using condoms are two of the most effective ways of taking your safety into your own hands. 


Does PrEP interact with other medications, like HRT, birth control or antidepressants? 

There are no known interactions between PrEP and:

  • Hormone replacement therapy (HRT)
  • Hormone-based birth control methods, e.g., the pill, patch, ring, shot, implant, or IUD
  • Antidepressants 

It is safe to use PrEP at the same time as any of the above. 

PrEP is also not known to interact with alcohol or recreational drugs. 

Doctors prescribing PrEP will advise you that PrEP can increase the risk for kidney damage if combined with certain medications, including pain medications such as ibuprofen (Advil). As a precaution, people taking PrEP have regular kidney and liver function tests.


Are there side effects to PrEP? 

Serious side effects are very rare! Few people report experiencing:

  • Headaches
  • Loss of appetite
  • Nausea/vomiting
  • Rash

These side effects typically resolve within about two months on PrEP.


Is PrEP the same thing as PEP?

PrEP (pre-exposure prophylaxis) is different from PEP (post-exposure prophylaxis). 

PrEP is an ongoing daily pill for people who may be exposed to HIV in the future. PEP is a short-term treatment for people who’ve already been exposed to HIV within the past 72 hours. 

Another way of thinking about it: PEP is to Plan B what PrEP is to hormonal birth control. PEP is an emergency treatment. PrEP is a prevention method. 


What are some common misconceptions about PrEP?

That it’s “only for gay men.”

PrEP is appropriate for people of any sexual orientation, gender identity, or race.

Over 1.1 million people in the U.S. are living with HIV, and over 63,000 in Canada, with approximately 38,000 new cases appearing every year in the U.S., plus another estimated 2,000 in Canada. 

As Crystal Townsend, the Organizing Program Manager of the Positive Women’s Network, reports: 

“In 2019, cisgender women made up 20% of all new HIV diagnoses in the U.S., a majority of whom were Black women. Although entrenched transphobia means that data on the impact of HIV on women of trans experience is incomplete, many studies have shown that women of trans experience face elevated structural risk for HIV.

This is no coincidence: HIV is merely a symptom of larger issues: inequities in health care access, racism, transphobia, and more. Biomedical tools like PrEP and HIV treatment can help prevent HIV acquisition but we also need universal healthcare, comprehensive sex education, anti-racist policies, and approaches that support full rights and dignity for BIPOC and LGTBQ communities.“


How will I feel on PrEP?

Everyone’s experience will be different! Some people report feeling more confident, open and relaxed in their sex lives on PrEP. Jems loves this video of personal testimonies about PrEP made by FOLX Health.


How can I get PrEP and how much does it cost?

In Canada, the cost of PrEP will depend on your age, location and insurance coverage. In Ontario, PrEP costs about $250 per month, but most insurance plans cover it – including many workplace, university and college plans. If you’re 24 years old or younger and don’t have insurance through school, work, or your parents, you may be able to get PrEP for free under OHIP+ with a valid health card and prescription. If you’re over 25 and don’t have a health insurance plan, you can apply for the Trillium Drug Program, reducing the overall cost for PrEP. In Toronto, The Village Pharmacy offers to help you apply for this and other co-pay assistance programs, to help minimize your deductible. If you’re not in Ontario, check with your doctor, insurance provider, or a sexual health clinic for more information. 

In the United States, most health insurance plans, including Medicaid, cover PrEP. Check with your insurance company to see if PrEP is covered by your plan. You can also ask about State PrEP Assistance Programs. And check out the Ready, Set, PrEP program, which provides free PrEP HIV-prevention medications to thousands of people living in the United States, including tribal lands and territories, who qualify.

People across the United States can also access PrEP through FOLX Health, at a cost of 90 USD per month, with medication delivered right to your door.

Organizations such as Planned Parenthood (in both Canada and the United States) can also help you navigate the process of getting PrEP. 

More resources:

FOLX Health https://www.folxhealth.com/product/prep 

Planned Parenthood https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids + https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids/prep 

Positive Women’s Network https://www.pwn-usa.org/ 

Safer Six, Toronto https://www.safersix.ca/prep 

The Village Pharmacy, Toronto https://www.thevillagepharmacy.ca/prep

Department of Health, New York State https://health.ny.gov/diseases/aids/general/prep/faqs.htm#seven 

Centers for Disease Control and Prevention https://www.cdc.gov/hiv/basics/prep/continuing-prep.html 

Callen Lorde