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What is PrEP?

PrEP, or pre-exposure prophylaxis, is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. PrEP can stop HIV from taking hold and spreading throughout your body.

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Currently, there are two FDA-approved daily oral medications for PrEP. A long-acting injectable form of PrEP has also been approved by the FDA.

Why Take PrEP?

PrEP is highly effective at preventing HIV when taken as indicated.

PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. Among people who inject drugs, it reduces the risk by at least 74% when taken as prescribed. PrEP is much less effective when it isn't taken consistently.

Is PrEP Right for You?

PrEP may benefit you if you test negative for HIV and any of the following apply to you:

• you have had anal or vaginal sex in the past 6 months, and you:
• have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load), or
• have not consistently used a condom, or
• have been diagnosed with an STD in the past 6 months.

Or

• you inject drugs and
• have an injection partner with HIV, or
• share needles, syringes, or other injection equipment.

Or

• you’ve been prescribed PEP (post-exposure prophylaxis) and you
  • report continued risk behavior or
  • have used multiple courses of PEP

You may choose to take PrEP even if the behaviors above don’t apply to you. Talk to your health care provider.

If you have a partner with HIV and are considering getting pregnant, talk to your doctor about PrEP. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.

What Drugs Are Approved for PrEP?

PrEP can be pills or shots.

There are two pills approved for daily use as PrEP. They are combinations of two anti-HIV drugs in a single pill:

• Truvada® (emtricitabine/tenofovir disoproxil fumarate) is for all people at risk for HIV through sex or injection drug use. Exit Disclaimer are also available.

• Descovy® (emtricitabine/tenofovir alafenamide) is for sexually active men at risk of getting HIV. Descovy® is not for women who are at risk for HIV through receptive vaginal sex.

A long-acting injectable form of PrEP has also been approved by the FDA:

• Apretude® (cabotegravir) is for people at risk for HIV through sex who weigh at least 77 pounds (35 kg). It’s an injection given by your health care provider every other month instead of daily oral pills.

Is PrEP Safe?

PrEP is safe. No significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years.

Some people taking PrEP may have side effects, like nausea, diarrhea, headache, fatigue, and stomach pain. These side effects are usually not serious and go away over time. If you are taking PrEP, tell your health care provider if you have any side effect that bothers you or that does not go away.

And be aware: PrEP protects you against HIV but not against other sexually transmitted infections (STIs) or other types of infections. Combining PrEP with condoms will reduce your risk of getting other STIs.

How Do You Get PrEP?

If you think PrEP may be right for you, visit your doctor or health care provider. PrEP is only available by prescription. Any health care provider licensed to write prescriptions can prescribe PrEP; specialization in infectious diseases or HIV medicine is not required.

Because PrEP is for people who are HIV-negative, you’ll have to get an HIV test before starting PrEP and you may need to get other tests to make sure it’s safe for you to use PrEP.

If you take daily oral PrEP, you’ll need to see a health care provider every 3 months for repeat HIV tests, prescription refills, and follow-up. If you use injectable PrEP, you’ll need to see a healthcare provider every two months for an HIV test and the injections.

What If You Don’t Have a Health Care Provider?

If you don’t have a health care provider:

• You can use the HIV Services Locator to find a PrEP provider and other HIV services near you.
• You can visit many community health centers for PrEP services. They have sliding scale fees based on your ability to pay. There are more than 15,000 health centers nationwide. Hundreds of health centers in the 57 jurisdictions prioritized in the Ending the HIV Epidemic initiative are providing PrEP services. Many health centers in other jurisdictions also provide PrEP services.
• Pharmacists can also prescribe PrEP in Arkansas, California, Colorado, Illinois, Maine, Nevada, Oregon, Utah, and Virginia. Exit Disclaimer.

Find Help Paying for PrEP

PrEP remains one of the strongest tools in the HIV prevention toolbox. There are a wide variety of efforts focused on supporting PrEP and other options where you can obtain PrEP medication and/or services. Use this decision tree to find out how to pay for PrEP.

Is PrEP Covered by Insurance?

In most cases, the cost of PrEP medication and services are covered by insurance.

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Under the Affordable Care Act, PrEP is free under almost all health insurance plans. PrEP is a preventive service and should be covered without charging you a co-payment or co-insurance. This is true even if you haven’t met your yearly deductible. That means you can’t be charged for your PrEP medication, the clinic visits to see your health care provider, and lab tests you need to get and maintain your prescription. There are no out-of-pocket costs for you. Exit Disclaimer.

This applies to most private health insurance plans you get through your employer or purchase yourself, individual plans you purchase through HealthCare.gov or state-based Marketplaces, and state Medicaid expansion coverage plans, including the Basic Health Plans. In some states, the traditional Medicaid program also covers PrEP at no charge.[1] This does not automatically apply to Medicare. (Medicare Part D prescription drug plans cover PrEP medication, but there will still be cost sharing.)

To find out whether your health plan covers PrEP medications without charge:

• If you have private health insurance through your employer or have purchased it yourself: Check with your health insurance company about coverage for PrEP medications, or look on their drug formulary (drug list) online to find information about coverage for the drugs approved for PrEP.
• If you purchased your health plan through HealthCare.gov or a state-based Marketplace: This Exit Disclaimer can help you verify whether your plan covers PrEP medications.
• If you are on Medicaid: Check with your benefits counselor.
• If you are on Medicare: Find which plans cover your drugs.
• If you are eligible to receive care through the Indian Health Service (IHS): PrEP services are available with no out-of-pocket costs at IHS health centers most tribal health clinics. For more information, visit IHS.gov.
• If you are eligible to receive care from Veterans Programs: PrEP is available for Veterans who use VA for their health care. For information, visit myhealth.VA.gov.

What If You Don’t Have Health Insurance or Still Can’t Afford PrEP?

If you don’t have insurance or Medicaid coverage, there are resources that may be able to help you pay for PrEP and/or your necessary clinic visits and tests.

• If you have private health insurance that doesn’t cover PrEP or still requires a co-payment but you can’t afford it, you may be eligible to receive co-pay assistance from:
  • Drug Manufacturers Co-payment Assistance Programs: These are drug manufacturer co-payment assistance programs to help people who have insurance to lower or eliminate the amount they owe as a deductible, co-insurance, and/or co-payment for a specific medication.
  • Exit Disclaimer: California, Colorado, District of Columbia, Illinois, Indiana, Iowa, New Mexico, Oklahoma, Virginia, and Washington have state-based programs to help people who have insurance to lower or eliminate the amount they owe as a co-payment for PrEP. These programs also support the costs of clinic visits and lab testing.
  • Co-payment Assistance Programs for Accessing PrEP via Telemedicine: These are co-payment assistance programs to help individuals who have insurance but can’t afford a co-payment to access providers through telemedicine and have PrEP medication delivered to their homes.
  • Exit Disclaimer: The Patient Advocate Foundation helps people who have insurance to lower or eliminate the amount they owe as a co-payment for PrEP.
• If you do not have health insurance, you may be eligible to receive medication for free from:
  • Drug Manufacturers Patient Assistance Programs: These are drug manufacturer patient assistance programs help people who do not have insurance or whose insurance does not cover a specific medication to have access to the medications they need at no or low cost.
  • Exit Disclaimer: California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington have state-based programs to help people who do not have insurance or whose insurance does not cover a specific medication to have access to the medication they need at no cost. These programs also support the costs of clinic visits and lab testing.
  • Patient Assistance Programs for Accessing PrEP via Telemedicine: These are patient assistance programs to help individuals who do not have insurance access providers through telemedicine and have PrEP medication delivered to their homes.
• If you are eligible to receive care through the Indian Health Service (IHS): PrEP services are available with no out-of-pocket costs at IHS health centers and most tribal health clinics. For more information, visit IHS.gov.
• If you are eligible to receive care from Veterans Programs: PrEP is available for Veterans who use VA for their health care. For information, visit myhealth.VA.gov.

Learn More About PrEP

If you think PrEP might be right for you, or you want to learn more, visit CDC’s PrEP Basics.

Also: watch and share KFF’s Greater Than HIV and CDC’s Let's Stop HIV Together Exit Disclaimer videos with PrEP Basics information and Exit Disclaimer. Also, their Exit Disclaimer feature real people sharing why they are taking PrEP to prevent HIV and how it has helped them take charge of their health.

Use the HIV Services Locator to find a PrEP provider and other HIV services near you.

[1] California, Colorado, District of Columbia, Delaware, Hawaii, Iowa, Kentucky, Louisiana, Massachusetts, Montana, Nevada, New Hampshire, New Jersey, Oregon, Washington, and Wisconsin. (Exit Disclaimer (PDF, 205 KB))

CAN YOU HAVE SEX WITH SOMEONE LIVING WITH HIV?

Absolutely. Consistently taking HIV medication as prescribed and achieving undetectable levels of the virus for at least six months ensures that a person living with HIV won't transmit it to others.5 This concept is often called "Undetectable = Untransmittable (U=U)”.5

U=U emphasises that when someone with HIV has an undetectable viral load, they cannot transmit the virus. This helps reduce stigma and discrimination, promoting a more inclusive and informed view of intimate relationships involving people living with HIV.

HIV prevention methods for serodiscordant couples/encounters

Serodiscordant refers to couples or encounters where one person is HIV-positive, and the other is HIV-negative. In such situations, partners have different HIV statuses. U=U ensures that this practice is safe. In this scenario, HIV prevention will look slightly different for each individual:

For HIV-positive individuals:

• Practising safe sex, using condoms, and communicating openly with partners are important preventive measures, particularly if the individual has not yet reached an undetectable viral load. For some people living with HIV this may not be possible.
• Taking antiretroviral (ARV) medications as prescribed, utilising the treatment as prevention (TasP) strategy. ARVs are a key component of HIV prevention, helping people living with HIV become undetectable, and therefore untransmittable (U=U).5
• Regular viral load tests inform a person living with HIV whether their viral load is detectable or undetectable. Routine viral load tests not only improve the health of people living with HIV, but also contribute to the prevention of HIV.7
  

For individuals without HIV:

• Just like HIV-positive individuals, practising safe sex, and using condoms is also an important preventative measure against HIV.
• If your partner has a viral load which is not detectable, PrEP can be used as a preventative medication, offering an additional layer of protection.

Being in a sexually exclusive relationship with an HIV-positive individual who remains undetectable would mean preventative measures are not necessary, as per U=U.5

The importance of knowing one’s HIV status

Knowing your status through regular HIV testing is crucial for the prevention of HIV as it enables early diagnosis and timely intervention, reducing the likelihood of transmission to others and improving health outcomes for those affected.

Choosing to share your HIV status helps to prevent transmission by fostering open communication. When individuals disclose their status, it promotes awareness and understanding among partners and encourages safer practices (i.e. condom use). Talking openly about HIV before potential exposure is important. Normalising and destigmatising these conversations breaks the taboo; this, in turn, contributes to effective prevention efforts.

The importance of STI testing

It is not only the responsibility of people living with HIV to get tested for STIs but also anyone having regular sex. STIs such as chlamydia, gonorrhoea, syphilis or genital herpes/ulcers increase the chances of acquiring HIV.6,10 For example, an STI can cause a sore or a break in the skin, making it easier for HIV to enter the body compared to intact skin.6 As a result, regular testing for other STIs is as crucial as testing for HIV. You can get tested in various places, like sexual health clinics, centres run by charities, or alternatives, depending on where you reside.

For more information on where and how to get tested, visit the Your Guide to HIV Testing and Diagnosis page.

POST-EXPOSURE PROPHYLAXIS (PEP): HIV MEDICATIONS TAKEN AFTER EXPOSURE TO PREVENT HIV

Anyone who suspects that they have been exposed to HIV should talk to a healthcare professional as soon as they can. They may recommend an emergency course of post-exposure prophylaxis (PEP), a medicine taken after possible exposure to prevent the individual from acquiring the virus.14 A course of PEP lasts 28 days, and it must be taken daily to be effective.14

Specifically, HIV can be prevented so long as PEP is started within 72 hours after the possible exposure, but ideally within 24 hours.14 PEP may not be effective if it is started after this period. If you think you might be frequently exposed to HIV, PEP may not be the best option for you. Note that other preventative methods should be used along with PEP, such as the correct and consistent use of condoms, not sharing needles and avoiding uninhibited sexual behaviours.14

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