PrEP & PEP

PrEP is a type of medication that people who are not currently living with HIV can take in order to reduce the risk of HIV transmission. PrEP is very effective and has been shown to reduce the risk of acquiring HIV through sex by 99% when taken as prescribed. PrEP is now available either as a pill that must be taken daily, or as an injection given every other month. For the daily pill, PrEP takes approximately 7 days of consistent use to be fully effective with anal sex/tissue, and approximately 21 days for vaginal tissue and other areas of the body.

PrEP works by interrupting the way HIV duplicates within your T cells. If you are exposed to HIV while on PrEP, the medication will prevent HIV from creating the proteins it needs to establish a permanent infection, meaning you will acquire HIV.

Regardless of which medication you are prescribed, it is very important that you follow your provider’s guidance for taking the medication and follow up testing. Missing your daily medication or bimonthly shot can result in decreased protection (similar to the way birth control pills work for preventing pregnancy), putting you at increased risk for acquiring HIV.

It is important to note that PrEP only provides protection against HIV; it will not provide protection against any other STIs or viruses that can be transmitted through sexual contact or injection drug use. It is recommended that PrEP be used in addition to other prevention methods, such as condoms and regular testing.

Currently, the four medications approved for use as PrEP include Truvada, Descovy, generic Truvada (Emtricitabine and Tenofovir Disproxil Fumarate), and Apretude. You can learn more about Truvada specifically through Gilead Sciences, Inc.

Short answer is yes! For people who inject drugs, PrEP is approximately 74% effective in reducing the risk of HIV transmission when taken consistently. Whereas PrEP takes approximately 7 days of consistent use to be fully effective in prevention through anal sex/tissue, it can take approximately 20 days for PrEP to fully activate in other parts of the body which is an important consideration for people who want to use PrEP as a preventative tool with their drug use. Currently, though, PrEP is not FDA approved for preventing HIV transmission for transmission routes outside of sexual behavior.

PrEP has proven to be very safe for most individuals. Some people experience side effects like nausea or dizziness in the beginning, but these side effects subside over time for most people. 

When taking PrEP, the standard of care is to visit your doctor or primary provider every three months. During these routine visits, your provider will run an HIV test to check up on your HIV status as well as run lab work on your liver and kidneys as a preventative measure. Because of these routine visits, people taking PrEP can maintain their health and routinely check in with their provider if they are noticing any changes or severe side effects.

Be sure to tell your provider if you currently have hepatitis, issues with bone density, or existing kidney or liver problems so that your provider can determine which option for PrEP is best for you.

PrEP is for anyone who believes it would be a useful and affirming sexual health and HIV prevention tool for themselves! PrEP can be a great tool for anyone regardless of sexual orientation, gender identity, race and ethnicity, ability, and other identity groups. What you do to take care of your sexual health is a personal choice that you get to decide, regardless of what is seen as “normal.”

It’s important to note that people are able to access PrEP (and associated financial assistance programs, when eligible) regardless of their immigration status. People who are undocumented are able to get on PrEP in Colorado.

Additionally, there is no age limit for PrEP. That said, PrEP is only approved for people who weigh at least 77 pounds. People ages 15 years and older can receive medical services including sexual health services such as PrEP care without the consent of their parents in Colorado.

You have multiple options to get started on PrEP. Most people prefer to connect with a PrEP Navigator, which is a professional staff member who is knowledgeable about PrEP and can help you get enrolled in any eligible financial assistance programs, find a doctor that prescribes PrEP, assist with any barrier navigation, and answer any questions you may have. Colorado Health Network has PrEP Navigators ready to help you across the state of Colorado.

Additionally, you can discuss PrEP with your doctor/primary provider without talking to a PrEP Navigator first. PrEP Navigators are available to you at any point in the process, no matter your situation or how long you’ve been on PrEP.

You can reach out to CHN’s PrEP Navigator, Auston Carlson, using the contact information listed below:

• • Phone: 970-260-9454
  • Email: carlson@coloradohealthnetwork.org

PrEP can be expensive, because of both the price of the medication itself and the associated doctor’s visits. However, there are multiple financial assistance programs available in Colorado that can significantly reduce the financial cost of taking PrEP for those who qualify. If you’re worried about the cost of PrEP, there are “PrEP Navigators” across the state of Colorado who can assist you in finding ways to reduce those barriers. Additionally, some insurance plans may help with reducing the price of PrEP, including Medicaid. 

You do not need insurance to be on PrEP. There are financial assistance programs available for people with private insurance, with Medicaid, and people without insurance, depending on eligibility factors such as annual income. 

A Colorado Health Network PrEP Navigator can answer your questions about finances, assist in the financial assistance program enrollment, and be your support in getting on PrEP.

Yes! It can be difficult navigating sexual health while being on a family member’s insurance plan, but luckily there are programs and tools available to help ensure your privacy in taking PrEP. Your first step will be to connect with a Colorado Health Network PrEP Navigator.

PrEP is a fantastic and really helpful tool for a lot of people, but that doesn’t mean it’s right for everyone. There is no right or wrong answer! If you are still trying to figure out whether PrEP feels like a good choice for you, PrEP Navigators can chat with you for free and help you work through that decision, as well as answer any questions you may have. Learn more about how to connect with a Colorado Health Network PrEP Navigator.

There is a lot of conversation about PrEP, and a lot of different opinions in various communities about PrEP and those who take it which contributes to stigma against people who choose to take PrEP. Often, this stigma comes from misinformation/lack of education about PrEP, fear/anxiety around sex/sexuality/sexual health, and differences in personal values. 

Common stigmas against people who take PrEP often include comments suggesting certain negative ideas about a person’s sexual behavior (such as being called a “Truvada Whore”) or being characterized as more likely to be “sexually reckless or irresponsible.”

However, none of the above are true about any person who chooses to take PrEP and such comments should only be seen for what they are – stigma-based myths and insults. 

Your sexual health and sexuality are up for you to decide and feel empowered in, even if it’s not what others would do. It’s important to know the truth about PrEP (and the stigma associated with it) so that you are able to access the tools you want and deserve to take care of your health.

There are currently four medications approved by the FDA for PrEP:

• • Truvada: Truvada was the first medication approved for use as PrEP in 2012. It has been approved for use in all populations and is a pill taken daily.
  • Descovy: Descovy was approved for use as PrEP in 2018. It is approved for use in cisgender men and transgender women only, and is often prescribed as an alternative to Truvada. Descovy should be taken daily.
  • Emtricitabine and Tenofovir Disproxil Fumarate: This is the generic formulation of Truvada that has been approved since 2021. The generic formulation is as effective as name brand Truvada, and is often preferred by insurance due to being lower cost.
  • Apretude: Apretude is a medication that is given by injection every other month. Approved in December 2021, it is the first option for PrEP available as a long-lasting injection. Due to complexities with insurance coverage, it is not yet widely used or available.

PEP is an acronym for Post Exposure Prophylaxis. PEP is a combination of antiretroviral medicine intended to reduce the risk of HIV infection if taken within 72 hours of an HIV exposure. PEP is an important tool in preventing HIV infection, but it is not a guarantee that someone exposed to HIV will not contract the virus. It is important to start taking PEP as soon as possible after an exposure. While taking PEP, you are advised to use other HIV prevention methods, such as using barriers with sexual partners, such as condoms, and using sterile syringes and other supplies when injecting substances. 

nPEP stands for non-occupational post exposure prophylaxis and is intended to reduce the risk of HIV infection from a non-work related exposure. The preferred medicine for nPEP in adult and adolescent patients 13 and older is Truvada combined with Raltegravir, Dolutegravir, or Isentress. The medication is  is taken 1-2 times daily for 28 days. 

oPEP stands for occupational post exposure prophylaxis and is intended to reduce the risk of infection after a work place (typically in a healthcare setting) related exposure. Workplaces should have safety protocols in place to assist employees in accessing post-exposure care. 

The cost of PEP can vary. Some insurances will cover most of the cost of PEP, including Medicaid. If you are uninsured or pay high copays, there are co-pay programs and self-pay discounts that can reduce or remove the cost.

PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure.

Not necessarily. If you have insurance, call your medical provider and ask to schedule an appointment for testing. If you do not have insurance, visit coenroll.com to get signed up for PHIP. This is a program that helps cover the costs of the labs needed to access the HIV prevention medication known as PrEP. If you test negative for HIV, you can remain on this program if you decide to start using PrEP regularly. If you test positive for HIV, you’ll be able to switch to another program that helps with insurance and medical costs.

Taking PEP is a personal decision and only you know if PEP is a good fit for you. If you have experienced a potential HIV exposure, PEP may be a good tool to utilize in order to reduce risk of contracting the virus.

People may take PEP because they:

• Have engaged in anal or vaginal sex and are unsure if their partner or partners are living with HIV
• Have shared syringes with others. 
• Have engaged in anal or vaginal sex without a condom or other barriers or experienced a condom malfunction during sex.
• Have received a tattoo or piercing with unsterile equipment.
• Have experienced an accidental needle stick.
• Have experienced a sexual assault.

If you have experienced any of the above scenarios, PEP may be a good option for you. 

An HIV infection can only be transmitted through blood, semen, vaginal fluid, and anal fluid. Therefore, in order to contract HIV, HIV must be transmitted through contact between broken skin, wounds, or mucous membranes, such as the vaginal canal and the anus. For more information on how HIV is transmitted, visit the HIV and Me.

Whether or not to seek PEP after a potential exposure is your choice. CHN or other health advocates can help you explore if PEP is the right option for you.

After experiencing a sexual assault, your physical and emotional health and safety are of the utmost importance. Sexual assault is a deeply traumatic experience and you do not have to go through this alone. You are not required to report the assault to authorities or receive a sexual assault forensic exam (rape-kit) if you seek medical care for n-PEP or other STIs. There are resources and support available if you want to pursue either of these options. 

National Sexual Assault hotline: 800.656.HOPE (4673) 

https://www.plannedparenthood.org/learn/sex-and-relationships/sexual-consent/what-should-i-do-if-i-or-someone-i-know-was-sexually-assaulted

https://www.ccasa.org/rape-crisis-services/

https://cdpsdocs.state.co.us/occ/PREA/AgenciesColoradoCounselingSupportServices.pdf