PrEP stands for pre-exposure prophylaxis. PrEP is the act of taking a medicine before exposure to a virus or bacteria to prevent infection- in this case HIV. PrEP is a relatively new tool in HIV prevention and involves those of us who are HIV negative taking anti-HIV medications on a daily basis to reduce our risk of becoming poz. So far, only one prescription medication has been approved for PrEP- Truvada. Truvada is the medicine those of us who are HIV negative take before engaging in activities where there is a risk of HIV infection, making it harder for the HIV virus to establish itself in the body. So, throughout this site, when we say ‘PrEP,’ know that we are referring to the only drug regimen that’s been approved so far- Truvada for PrEP.
Truvada was approved for use among HIV-negative people in 2012 by the US Food and Drug Administration (FDA), and by Health Canada in February, 2016. In approving Truvada as an ‘on label’ medication to prevent HIV, Health Canada joined the World Health Organization as well as the US Centers for Disease Control and Prevention in endorsing and recommending the use of PrEP by individuals who are at high-risk of acquiring HIV, including gay and bi guys and other men who have sex with men. It’s really important that you know that PrEP only works for HIV prevention- it doesn’t do anything to help prevent transmission of other sexually transmitted infections (STIs). Remember that regular testing, treatment, and consistent and correct condom use are the best ways to protect yourself against STIs, and that you still need these tools in your toolkit even if you take PrEP.
Health Canada guidelines recommend taking PrEP every single day, to ensure that medication levels are maintained in the body so that there is effective protection if you’re exposed to HIV. Some of the ways that PrEP work are still being researched, and there are still some questions that we don’t have answers for- like the minimum amount of time you need to take PrEP to get fully protected. Until we know more, guidelines state that you should take PrEP at least one week before engaging in any kinds of sex where HIV can be passed, and that before stopping, you should take PrEP for at least four weeks after you’ve engaged in any kinds of sex where HIV can be passed. We also know that the more regularly you take PrEP, the more protection you have in the event you are exposed to the HIV virus. Missing a dose once in a while isn’t a cause for alarm, but we know from research studies that guys who take PrEP every single day have the highest rates of protection against HIV transmission during types of sex where HIV can be passed.
PrEP has been most researched in cis-gendered men and women, both gay and straight. Trials for trans guys are underway, but results haven’t yet been published. We do know that there are differences in how and when full levels of protection from PrEP develop between different groups of people- including cis guys and trans guys. We also know that until research provides us the evidence we need, these guidelines can only be applied to cis guys, as they are the population who has been most studied for PrEP. This isn’t to say that trans guys can’t benefit from PrEP, it’s just to say that we need more evidence to know how it works, and if there are any precautions or considerations that apply specifically to trans guys.
New PrEP medications and methods are currently being researched, but for now daily use Truvada is the only drug approved for PrEP by Health Canada. One way to think about the state of PrEP is to consider mobile phone technology. If Truvada is PrEP at the car-phone stage, imagine what PrEP will look like at the iPhone X stage! For more information on new drugs and technologies being studied for PrEP, check out Medications Currently Being Studied for PrEP at: http://men.prepfacts.org/the-basics/