Why More People Need to Talk Openly About PrEP

Thanks to advancements in detection and treatment, a positive HIV diagnosis is no longer a death sentence.

HIV attacks white blood cells and weakens the immune system so the body is more vulnerable to developing certain infections and cancers. Stage 3 HIV, or AIDS, is the final stage of untreated HIV.

With today's treatments, developing AIDS is rare. And AIDS-related deaths have been reduced by more than 51 percent since their peak in 2004.

A combination of medicines called antiretroviral therapy (ART) can treat HIV. ART makes the virus far more manageable, allowing folks with HIV to live longer, healthier lives.

There's still no cure for HIV or AIDs, but scientists are working to develop a safe and effective vaccine.

Until then, there's PrEP, or pre-exposure prophylaxis. PrEP is a pill taken every day to help protect people who don't have HIV but have a greater risk of being exposed, such as people with an HIV-positive partner.

When taken consistently, the PrEP regimen can reduce a person's risk of getting HIV from sex by 99 percent, according to the Centers for Disease Control and Prevention (CDC).

PrEP is a powerful preventive tool that should be explored by all people who feel like they have a risk of contracting HIV.

With approximately 37 million people worldwide living with HIV or AIDS in 2017, PrEP seems like a wonder drug. However, due to stigma and lack of knowledge — especially among the cisgender, heterosexual community — lack of awareness remains a big problem.

It's important for everyone to know what PrEP is and how it works, and to feel comfortable talking about it openly so more people can get the care they need.

Why haven't I heard more about PrEP?

In the United States, most folks in the LGBTQ community have probably heard about PrEP at some point — whether from a partner, friend, or health professional.

PrEP, also known by its brand name Truvada, has been approved by the Food and Drug Administration for HIV prevention since 2012, but it's not talked about much outside the LGBTQ community for a number of reasons.

Truvada started by marketing to the LGBTQ community, because the rates of HIV and AIDS have historically been much higher in this group since the discovery of the virus in the early 1980s.

HIV is transmitted through certain infected bodily fluids: blood, semen, pre-seminal fluids, vaginal fluids, rectal fluids, and breast milk.

In the United States, HIV is mainly transmitted through unprotected anal or vaginal sex and sharing needles. Men who have sex with men are the most severely affected population, which is why those who identify as gay and bisexual are considered to have a higher risk. Taking PrEP daily can help prevent transmission of the virus during unprotected anal sex.

However, this doesn't mean straight, cisgender people don't have the risk. In fact, according to a recent CDC report, nearly 8,000 people who self-identified as heterosexual received an HIV diagnosis in the United States, which made up for about 20 percent of new HIV diagnoses.

The CDC estimates that about 1 in 200 heterosexual adults should be counseled about the option of using PrEP. Chances are far less people are being educated.

But even the members of the LGBTQ community who are using PrEP have been the target of backlash and 'slut-shaming,' both from within the community and outside. The stigma and shame of taking PrEP, as well as the moralization of the drug, hinder increased uptake.

Misinformation about the drug's safety and side effects may also deter potential PrEP users.

PrEP has been shown to be safe. Although it can cause some side effects, such as nausea or vomiting, these tend to be mild and go away over time.

It's important for everyone, regardless of sexual orientation or lifestyle, to understand what the drug is and how it works, so that those who benefit from taking it can access it. Widespread knowledge and awareness of the drug is crucial for HIV prevention.

What is PrEP, and how does it work?

The PrEP pill (taken daily) contains two HIV medicines: tenofovir and emtricitabine. These work by having different systems in the body store antiretrovirals (ARVs).

When the body is exposed to HIV, these ARVs kick into gear and stop the virus from entering cells in the system. Without the virus being able to enter cells and replicate, the PrEP user stays HIV-negative.

PrEP is an effective way to prevent HIV if you have known risk factors. Like birth control pills, PrEP should be taken daily to make sure it's as effective as it can be. HIV resistance won't disappear if a user misses a daily dose, but users should try their best to make sure they are taking it every day. Protection does decrease when users take less than seven doses a week.

When PrEP is taken consistently, it can reduce the risk of contracting HIV through sexual transmission by 99 percent and through drug injection by 74 percent, according to the CDC.

The risk of contracting HIV through sex can even be lower for users who combine PrEP and condoms and other protection methods.

Should I try PrEP?

It depends. PrEP is recommended for people who have known risk factors for HIV infection. Some known risk factors include:

• having an HIV-positive partner
• being a man who has unprotected anal sex with men
• using injectable drugs

The CDC also recommends taking PrEP if you're a straight man or woman who doesn't regularly use condoms during sex with people whose HIV status is unknown.

You can also talk to your doctor to find out if you should take PrEP. In the meantime, try the CDC's risk assessment and reduction tool to learn more.

What does it mean when someone is undetectable?

When learning about PrEP, the word 'undetectable' will come up. While LGBTQ folks may be familiar with the term, those outside the community may not know what it means.

'Undetectable' refers to an undetectable viral load, or the amount of the virus in the blood. A simple blood test can measure it. Undetectable doesn't mean there's no virus in a person's blood or that they're cured of HIV. Rather, it means there's a very low level of virus (under 40 copies of the virus per mL).

The virus usually becomes undetectable when ART is working well, usually after six months of consistent treatment.

People who have an undetectable viral load have effectively no risk of transmitting HIV. However, viral load can change quickly, so it's important for people with undetectable viral loads have it monitored every two to four months by a healthcare professional.

Studies have found that 'blips' in viral load can happen. These are spikes in viral load that can occur even in people with undetectable viral loads. After a blip, viral load usually goes back to undetectable levels if the person keeps consistently taking their meds.

If a person has frequent blips, they may not be taking their medicine daily, or it can be a sign that something is wrong.

Blips can also occur when a person's immune system is under stress, like if they get the flu. Because blips increase the risk of HIV transmission, additional protection is needed during this time or until undetectable status returns.

People with undetectable viral loads should be vigilant and make sure they follow their drug regimen.

If your partner is undetectable, you may not need PrEP. But you should still use condoms and check your status. If you worry about your partner's status, it may be helpful to talk with a doctor about PrEP.

How do I get PrEP?

You can't get PrEP over the counter; you need a prescription from a doctor.

Once a doctor prescribes PrEP and you start taking it, you'll have to check in with a doctor every three months to check your HIV status and viral load. This may make it difficult for some people to access the drug, but following up is an essential part of the PrEP regimen.

However, the stigma around HIV and even sex can make talking to a doctor about PrEP daunting — and just because a doctor can prescribe it doesn't always mean they're LGBTQ+ friendly, which may hinder folks in this community.

Talking to a doctor you already know and trust may help if you're nervous about bringing up the subject. You can also ask them for a referral if you'd like to see another doctor with more experience treating LGBTQ+ patients.

Once at the doctor, make sure to be clear and forthcoming. Don't be afraid to ask questions. Tell your doctor you're interested in PrEP, and say you want to discuss its use. Make sure to mention any behaviors or activities that may increase your risk for HIV, such as unprotected sex or sharing needles. Remember, it's a confidential conversation.

If you feel like your doctor doesn't know about PrEP or won't prescribe it, Planned Parenthood and many other community health centers can provide up-to-date, accurate, nonjudgmental information about PrEP and help you get a prescription if you qualify.

Most health insurance plans, including Medicaid, cover PrEP, but for many uninsured Americans, paying for PrEP out-of-pocket can get very expensive. For more information about assistance, click here.

Don't know where to start? Try the Gay and Lesbian Medical Association's provider directory, which lists doctors who are knowledgeable about PrEP, or use this LGBTQ-friendly provider guide.

Takeaway

Knowledge is power. Being educated, as well as talking openly about PrEP, can help normalize a safe, effective drug that can have an enormous positive impact.

Eliminating the stigma surrounding PrEP, both within the LGBTQ+ community and among cisgendered heterosexuals, only helps get the drug to people with known risk factors faster.

HIV affects all types of people. Being able to talk to your partners, friends, and doctor about your risk factors and PrEP can help you and the community as a whole.