PrEP: What It Is, How It Works, and Where to Get It

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What Is PrEP?

Pre-Exposure Prophylaxis (PrEP) is a highly effective medication that reduces the risk of HIV infection in people who are HIV-negative but at high risk of exposure. When taken consistently, PrEP can lower the risk of HIV from sex by 99% and from injection drug use by at least 74%.

Currently, three FDA-approved PrEP medications are available

Who Should Consider PrEP?

PrEP is recommended for anyone who is HIV-negative and at risk of HIV exposure, including:

  • Men who have sex with men (MSM), especially if they have multiple partners or inconsistent condom use.
  • People in serodiscordant relationships (where one partner is HIV-positive and the other is negative).
  • Individuals who have had a recent sexually transmitted infection (STI).
  • People who use injection drugs and share needles.
  • Sex workers and others at high risk of exposure.

If you're unsure whether PrEP is right for you, a healthcare provider can help assess your risk and discuss the best prevention options.

How to Take PrEP: Daily vs. Intermittent Dosing

There are two ways to take PrEP:

1. Daily PrEP (Standard Use)

  • Take one pill every day for consistent protection.
  • Provides the highest level of protection when taken as prescribed.
  • Requires 7 days of daily use to reach full protection for anal sex and 21 days for vaginal sex.
  • Recommended for anyone at ongoing risk of HIV exposure.

2. Intermittent or "On-Demand" PrEP (2-1-1 Dosing)

Also known as event-driven PrEP, this approach is an alternative for cisgender men who have sex with men (MSM) who engage in infrequent condomless sex. It has not been studied or recommended for women, transgender people, or those at risk from injection drug use.

How to use the 2-1-1 method:

  • 2 pills 2-24 hours before sex
  • 1 pill every 24 hours after the first dose (continue daily while sexually active)
  • 1 final pill 24 hours after the last sexual activity

Studies have shown 2-1-1 PrEP is nearly as effective as daily PrEP in MSM when taken correctly. However, it must be taken on schedule to provide adequate protection.

Who is a good candidate for intermittent PrEP?

  • MSM who have sex infrequently (e.g., a few times per month).
  • Those who find daily PrEP difficult to maintain.
  • People who can plan ahead and take medication as prescribed.

Who should avoid intermittent PrEP?

  • Women, transgender individuals, and people at risk from injection drug use (not studied in these groups).
  • Anyone with frequent sexual activity or multiple partners.
  • People who may have difficulty remembering the exact dosing schedule.

3. Injectable PrEP 

For those who prefer not to take a daily pill, there is a long-acting injectable PrEP option that offers protection through periodic injections rather than daily dosing.

How Injectable PrEP Works:

  1. Initiation Phase:

    • First two injections are given one month apart (at 0 and 1 month).
    • These injections are administered intramuscularly (IM) in the buttocks by a healthcare provider.

  2. Ongoing Maintenance:

    • After the initial doses, an injection is required every two months to maintain protection.

Who is a good candidate for injectable PrEP?

  • People who struggle with adherence to daily pills.
  • Those who prefer an option that does not require frequent reminders.
  • People at continuous risk of HIV exposure.

Who should avoid injectable PrEP?

  • Those uncomfortable with receiving intramuscular injections every two months.
  • Anyone unable to commit to returning for scheduled doses (delayed or missed doses may reduce effectiveness).

While an excellent choice for some consistency with injections is crucial. If you miss an injection, you may need to switch to oral PrEP temporarily until the injection schedule can be resumed.How to Get PrEP

Getting on PrEP is a simple process:

  1. Find a PrEP Provider

    • Many primary care providers and sexual health clinics also prescribe PrEP.
    • Organizations like Planned Parenthood and LGBTQ+ health centers provide PrEP services.

  2. HIV & Health Screenings

    • Before starting PrEP, you'll need an HIV test to confirm you are HIV-negative.
    • Additional screenings for kidney function, hepatitis B, and STIs may be required.

  3. Start Taking PrEP

    • Daily Pill Options: Take one pill every day for maximum effectiveness (Truvada or Descovy).
    • On-Demand PrEP: Use the 2-1-1 method for intermittent protection (Truvada only).
    • Injectable Option (Apretude): Receive your first two doses one month apart, then continue every two months.

  4. Follow-Up Appointments

    • Ongoing HIV testing is required every 3 months for daily and intermittent PrEP and every 2 months for injectable PrEP.
    • Routine kidney function and STI screenings are also recommended.

How to Pay for PrEP

  • Insurance Coverage: Most private insurance plans, Medicaid, and Medicare cover PrEP.
  • Patient Assistance Programs:
    • Ready, Set, PrEP (HHS Program): Offers free PrEP for uninsured individuals.
    • Pharmaceutical Companies: may have plans to help with co-pays 
    • State & Local Programs: Many states provide PrEP at no cost through public health programs.

Even if you don’t have insurance, there are resources available to help cover the cost of PrEP.

Does PrEP Have Side Effects?

PrEP is generally well tolerated, but some people may experience mild side effects, including:

  • Nausea
  • Headache
  • Diarrhea
  • Mild fatigue

These symptoms usually go away within a few weeks. Serious side effects, such as kidney or bone issues (more common with Truvada), are rare but can be monitored with routine checkups.

PrEP vs. PEP: What’s the Difference?

  • PrEP is taken before exposure to prevent HIV infection.
  • PEP (Post-Exposure Prophylaxis) is a 28-day emergency treatment taken after a potential HIV exposure (must be started within 72 hours).

If you think you’ve been exposed to HIV, contact a healthcare provider immediately to discuss PEP.


Final Thoughts
PrEP is a game-changer in HIV prevention. Whether you take it daily or use intermittent dosing, it provides nearly complete protection against HIV when used correctly. If you’re at risk, talk to a healthcare provider today and take control of your sexual health.

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