HIV Prevention: PrEP and Other Options
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 22, 2019.
How Can HIV/AIDS Be Prevented?
If you are sexually active, there are many things you can do to lower your risk of HIV infection, including:
- Know your partner’s HIV status and avoid multiple sexual partners.
- Use condoms correctly and each time you have vaginal, oral, or anal sex.
- Do not have sex with people whose HIV status you do not know.
- Do not have sex with people who use intravenous (IV) drugs.
- Do not engage in unprotected sex unless you know your partner is not infected with HIV.
Not having sex (abstinence) is the only 100% effective way to prevent HIV and other sexually transmitted diseases (STDs). There is not a vaccine yet to prevent human immunodeficiency virus (HIV) and there is no cure; however, HIV/AIDS can be prevented in most cases with action on your part. You can remain HIV negative by educating yourself and using safe sex practices, learning how the virus is transmitted, and understanding ways to lower your risk using preventive measures.
The only way to know if you have HIV is to get tested. HIV screening is recommended by the CDC for patients aged 13 to 64 years of age in all healthcare settings at least once in their lifetime.
Get tested immediately if you know or think that you have had contact with someone who has HIV. Seek medical treatment quickly if the result is positive because early treatment is best to prevent complications and lengthen your life.
Many effective HIV treatments, known as antiretroviral therapy or ART, are available today. ART can help you maintain a low viral load and live a near normal lifespan. If you have been exposed to HIV, and it is less than 72 hours since the exposure, immediately contact a health care provider as you may be eligible to start post-exposure prophylaxis (PEP) treatment.
Latex condoms are highly effective in lowering the risk of HIV transmission if used correctly. Use a new latex condom each time you have sex. If you are allergic to latex, use a polyurethane condom. Do not use lambskin condoms. Use only water-based lubricants and never petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to break.
Female condoms are also effective for HIV prevention when used correctly. Do not use a male and female condom at the same time.
Avoid IV Drug Use
Your risk for acquiring HIV may be greater if you inject drugs. Do not use intravenous (IV) drugs and share needles or syringes. The HIV virus can live in a used needle up to 42 days depending on the temperature and other factors, according to the CDC. If you do inject drugs, take advantage of needle exchange programs in your community and strongly consider seeking help for your drug use.
PrEP: Prevention for HIV
The use of an antiretroviral medication to help to prevent HIV infection is known as Pre-exposure Prophylaxis (PrEP). HIV treatment guidelines recommend that PrEP be used for people who are HIV-negative and at substantial risk for HIV infection, including high-risk men who have sex with men; high-risk heterosexual men and women; and high-risk injection drug users. Talk with your healthcare provider about other uses, benefits and risks of PrEP - otherwise known as HIV prevention drugs.
According to the CDC, to be clinically eligible to receive PrEP you must have:
- A documented negative HIV test before PrEP is prescribed.
- No signs/symptoms of acute HIV infection
- Normal kidney function
- Not taking any medications that you cannot take with PrEP
- Documented hepatitis B virus infection and vaccination status
How Quickly Does PrEP Work?
For PrEP to be effective, you must commit to taking the medicine every day and following up with your doctor on a regular schedule for HIV tests (usually every 3 months), prescription refills, and other medical tests and counseling, as needed.
Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily.
- The CDC states that PrEP reaches a maximum protection from HIV for receptive anal sex at about 7 days of daily use.
- For receptive vaginal sex and injection drug use, PrEP reaches maximum protection at about 21 days of daily use.
- No data are yet available about how long it takes to reach maximum protection for insertive anal or insertive vaginal sex.
PrEP should be used with counseling on other risk reduction methods, such as correct condom use and safe needle practices for the best effect.
PrEP: HIV Prevention with Truvada or Descovy
In July 2012 the U.S. Food and Drug Administration (FDA) approved the use of Truvada, an antiretroviral medication to prevent HIV infection in certain high-risk individuals. Truvada is a combination of two drugs (tenofovir disoproxil fumarate plus emtricitabine) and can be used in high-risk HIV-negative persons to lower their risk of infection. The medication works by preventing the virus from making copies of itself. Truvada is expected to become generically available in September 2020.
In October 2019, the FDA approved Descovy (emtricitabine and tenofovir alafenamide) as the second drug for PrEP. Descovy is used in at-risk, HIV-1 negative adults and adolescents weighing at least 35 kg to reduce the risk of sexually acquired HIV-1 infection, excluding individuals at risk from receptive vaginal sex. In studies, Descovy was as effective as Truvada in HIV-1 prevention, but advantages were observed with regard to renal (kidney) and bone laboratory secondary endpoints.
With PrEP, you must take the medication daily. It's important not to miss any doses to help prevent resistance to these medications. It is used in combination with safer sex practices such as use of a condom. It can lower your risk of contracting HIV from sex by up to 99%, if taken correctly. However, you must be HIV-1 negative to start PrEP; everyone is screened for HIV-1 infection before initiating PrEP. Regular tests for HIV status (usually every 3 months) are required with PrEP.
How to Get PrEP for Free
In December 2019 the U.S Department of Health and Human Services launched "Ready, Set, PrEP", a national program to help people without prescription health insurance get PrEP treatment at no cost. You can find out if you qualify by visiting GetYourPrEP.com or by calling toll-free at 855-447-8410.
Most insurance will cover PrEP (Truvada or Descovy) but a Prior Authorization form may need to be completed by your doctor. You may still be a responsible for a copay, which can vary from one insurance company to another based upon their formulary and copay tier of the medication. Contact your local pharmacist with your prescription to determine your copay and if prior authorization is required.
Gilead, the manufacturer of Truvada and Descovy also offers a program to help offset copay costs for PrEP, which may bring your cost to zero. If your insurance is with Medicare, Medicaid, or other government programs this copay card is not valid. In addition, Gilead may also cover the full cost of your PrEP medication if you do not have prescription insurance coverage. You can contact them at 1-800-226-2056. Lab work or doctor's office visits may result in copays, too.
In May 2019, Gilead also announced they would donate 2.4 million bottles of Truvada and Descovy each year to the CDC to help support efforts to end the HIV epidemic in the U.S. These donations are intended for uninsured Americans at risk for HIV. The donation extends up to the year 2030.
More about Prior Authorization: Specialty Pharmacy and Specialty Medicines
HIV Post-Exposure Prophylaxis (PEP)
If you have been exposed to HIV, and it is less than 72 hours since your exposure, immediately seek medical care as you may be eligible to start post-exposure prophylaxis (PEP) treatment to lower your risk of becoming HIV-positive. The sooner you get medical care, the better. PEP has limited effect in preventing HIV infection if you do not start treatment within 72 hours after HIV exposure.
You may be eligible for PEP:
- If you were exposed to HIV during sex (for example, a condom broke)
- If you were exposed to HIV by sharing needles, syringes or other IV drug use materials.
- If you’ve been sexually assaulted.
- If you're a healthcare worker exposed to HIV.
You can seek PEP antiretroviral medicines (ART) treatment at your doctor's office, emergency room, urgent care clinic, or a local HIV clinic. PEP should be used only in emergency situations and is not a regular substitute for proven HIV prevention measures, such as PrEP, condom use, or safe needle practices.
A PEP regimen is taken once or twice a day for 28 days. PEP is effective in preventing HIV when administered correctly, but it is not always 100% effective.
As with nonoccupational exposure to HIV, an occupational exposure to HIV, for example, a healthcare worker with a needle stick or splash of body fluids, should be evaluated for PEP. The CDC recommends immediate PEP treatment using a 3-drug antiretroviral regimen for personnel to help prevent infection. Health care providers should always follow Standard Precautions at all times. Assume that blood and other body fluids are potentially infectious.
Dolutegravir Warning for PEP
CDC currently recommends that prior to starting PEP all women of childbearing potential should have a pregnancy test performed.
The use of dolutegravir (DTG) may pose risks for neural tube defects in pregnancy. Health care providers prescribing PEP should avoid use of DTG for:
- Non-pregnant women of childbearing potential who are sexually active or have been sexually assaulted and who are not using an effective birth control method; and,
- Pregnant women early in pregnancy since the risk of an unborn infant developing a neural tube defect is during the first 28 days.
The preferred PEP regimen for these women is raltegravir, tenofovir, and emtricitabine. However, individual circumstances may dictate consideration of alternatives (e.g., raltegravir is not available). If the PEP regimen for a non-pregnant woman of childbearing potential must include DTG, she should use an effective birth control method until the PEP regimen is completed.
How Can HIV Transmission Be Reduced or Prevented?
If you have been diagnosed with HIV/AIDS, the following preventive measures can help you protect others:
- Avoid practices that expose others to infected body fluids. Always use a new latex or polyurethane condom for any sexual activity.
- If you are pregnant, seek medical treatment immediately. HIV infection can be passed on to your baby, but treatment during pregnancy can greatly reduce the risk.
- Tell previous or current partners that you are HIV positive so that they can be tested. Many states have laws that require you to tell your sexual partners if you’re HIV-positive.
- If you use intravenous drugs, never share your needles and syringes with anyone else as they may contain traces of HIV infected blood.
- Do not donate blood or organs.
- Do not share personal items such as razor blades or toothbrushes.
Can HIV Live Outside the Body?
The HIV virus does not live for very long outside of the human body. It cannot reproduce outside a human host. HIV is not transmitted by:
- Air or water
- Saliva, sweat, tears or closed-mouth kissing
- Insects or pets
- Sharing toilets
- Sharing food or drinks
- Sexual activities that do not involve the exchange of body fluids
Contact with the following body fluids from an HIV-positive person can lead to HIV in another person:
- Semen or pre-seminal fluid
- Rectal fluids
- Vaginal fluids
- Breast milk
HIV in these fluids must enter the body to cause an infection. Body fluids containing HIV can enter through a mucous membrane (such as the vagina, rectum, penis, mouth), damaged tissue like a cut or scrape, or can be injected into your bloodstream (such as with IV drug use).
Avoid exposure to blood from injuries or nosebleeds where the HIV status of the bleeding person is unknown. Protective clothing, such as gloves, gowns, masks or goggles may be appropriate when caring for people who are injured.
The risk of HIV infection through blood transfusions or blood products is extremely low in the United States. The blood supply is well screened and is considered safe. Unfortunately, this is not always the case in other countries. If an emergency requires that you receive blood or blood products in another country, get tested for HIV as soon as you return home.
Does Circumcision Prevent HIV?
Circumcision has been shown to reduce the risk of men getting HIV from an HIV-positive woman, compared to uncircumcised men. Studies in heterosexuals have shown that male circumcision reduced the risk for HIV in the man by 50% to 60%.
However, circumcision should be used along with other methods of HIV prevention. Additional measures, such as correct condom use with lubricants or preventive medications in high-risk groups are also needed. Male circumcision has not been shown to lower the risk of HIV in women, gay or bisexual men.
What is Life Expectancy with HIV?
You can now live a near normal lifespan with HIV due to advanced medical treatments. In fact, over one million people are living with HIV in the United States. Taking a combination of medications to treat HIV, called antiretroviral therapy (ART), is recommended for all people with HIV. If you have been diagnosed with HIV, you should start medical treatment as soon as possible to maintain a low viral load.
Life expectancy of HIV without treatment, meaning people who do not receive ART and progress to AIDS, typically survive about three years. Without medical treatment, serious and life-threatening opportunistic infections can occur. Once you have an opportunistic illness, life-expectancy without HIV treatment falls to about one year.
Examples of opportunistic infections and other complications common in AIDS patients are:
- Pneumocystis carinii pneumonia
- Mycobacterium avium complex
- Cytomegalovirus retinitis
- Kaposi's sarcoma
- Fungal infections of the respiratory tract (candidiasis)
How to Prevent Mother to Child Transmission of HIV
Women considering pregnancy or pregnant women with HIV should learn about medical advances that may help prevent their baby from becoming infected. Most importantly, pregnant women can safely use many HIV medicines during pregnancy. If you have HIV, taking antiretroviral medications every day to treat HIV starting early in your pregnancy can lower your risk of transmitting the virus to your baby to 1% or less.
Can I Breastfeed If I'm HIV Positive?
Because HIV can spread in breast milk, women with HIV who live in the U.S. should not breastfeed their babies according to the Centers for Disease Control and Prevention (CDC). Infant formula or banked milk is a safe and healthy alternative to one's own breast milk.
Preventing or managing HIV infection is an achievable goal in today’s society. Advances in medical treatments, ease of testing, diagnosis, and manageable drug regimens have made HIV a chronic illness in which patients can live longer with a high quality of life. However, prevention efforts must be adhered to on a regular basis.
For treatment, ART medications must be taken on a daily basis without fail, and monitoring of viral loads is needed. Early treatment is most effective, so a timely diagnosis is imperative. For HIV-negative people at a high-risk for HIV infection, a PrEP regimen, if adhered to, can significantly lower the risk of HIV infection.
- 9 Facts About Current HIV Treatment
- AIDS and HIV Overview
- HIV and AIDS Opportunistic Infections and Symptoms
- HIV and AIDS: Opportunistic Infections, Complications and Treatments
- National HIV Testing Day
- Treatment Options for HIV and AIDS
- Gilead Sciences to Provide Free Truvada for PrEP to Support U.S. Initiative to End the HIV Epidemic. Press Release. Gilead Sciences. Accessed February 26, 2020 at https://www.gilead.com/news-and-press/press-room/press-releases/2019/5/gilead-sciences-to-provide-free-truvada-for-prep-to-support-us-initiative-to-end-the-hiv-epidemic
- HIV and Occupational Exposure. CDC. Accessed Dec. 22, 2019 at https://www.cdc.gov/hiv/workplace/healthcareworkers.html
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- Interim Statement Regarding Potential Fetal Harm from Exposure to Dolutegravir – Implications for HIV Post-exposure Prophylaxis (PEP). CDC. Accessed Dec 22, 2019 at https://www.cdc.gov/hiv/pdf/basics/cdc-hiv-dolutegravir-alert.pdf
- American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129; e827; Accessed February 6, 2019 at https://pediatrics.aappublications.org/content/pediatrics/129/3/e827.full.pdf
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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.