In the span of a few decades, HIV went from an uncontrolled, terrifying illness that led to death in a matter of months or a couple of years to a treatable condition with effective medications. Today, people with HIV can live full, active lives for decades, even though the disease is still incurable.
“It’s a manageable chronic illness now, similar to diabetes,” says UNC Health infectious diseases specialist Christopher Hurt, MD. “You need to tend to it and stay on top of your medications, but if you do, you can be healthy.”
But even though today’s medicines can make blood levels of the virus undetectable in most people with HIV—the virus that causes AIDS—it’s still worth trying to avoid it in the first place. And in this area, there’s also medicine: PrEP (preexposure prophylaxis) is about 99 percent effective at preventing infection when taken as prescribed, according to the Centers for Disease Control and Prevention.
People on PrEP generally take one pill a day. An injection, which lasts for two months, also is available.
“HIV still has a spiritual and psychological toll on people,” Dr. Hurt says. “Taking steps to prevent infection just makes sense.”
Know Your HIV Risk
If you are sexually active, you could be at risk of HIV infection, Dr. Hurt says.
“Society has added stigmas to this condition, making it seem like only gay men or people who are promiscuous get HIV,” he says. “People don’t want to think about their own sexual health and wellness, but it’s important.”
You are not at risk, he says, if:
- You are in a sexual relationship with only one partner, and you are certain that partner is not having sex with anyone else.
- You are in a monogamous relationship with a partner who is living with HIV, is regularly taking medication and is regularly tested to confirm their viral load is undetectable.
- You are not having sex.
Doctors don’t always recognize that patients are at risk because doctors and patients don’t always talk about sex.
“It’s often hard for providers to initiate those discussions,” Dr. Hurt says. “And patients are skittish about bringing it up since they’re afraid their provider might judge them.”
If you are in a relationship with a partner who has HIV that is well-controlled, your risk of becoming infected is low, but you still may choose to take PrEP.
“It’s added protection,” Dr. Hurt says. “People who take PrEP are controlling their risk of HIV rather than relying on their partner. Sometimes things happen—someone travels without their medicine, or they don’t get to the drugstore on time,” so their viral load may increase. PrEP gives the partner who is not infected more control.
How to Get PrEP
You can only get PrEP through a prescription from your healthcare provider. If you don’t have a provider, you can use the PrEP Locator website to help find a clinic near you. Several startup companies offer PrEP online as well, Dr. Hurt says.
PrEP is available as a pill or a shot. Two medications are available for PrEP in a pill form. Another medicine is available as an intramuscular injection, given in the side of the buttock in the hip area. You must get the shot in a clinic.
“The shot is good for people who have trouble adhering to a daily pill,” Dr. Hurt says. “Sometimes people don’t have stable housing or a place to safely keep their belongings. Some people don’t have a private place to keep medications.”
How to Take PrEP
Most people on PrEP take it on a continual basis, Dr. Hurt says, but it can be effective if taken “on demand.” This dosing is not approved by the U.S. Food and Drug Administration, but it has been shown to be effective for men having anal sex with men. On-demand has not been studied for heterosexual men and women or for people who inject drugs.
On-demand dosing typically means that a person takes two pills between two and 24 hours before sex, another pill 24 hours after the first dose and another pill 24 hours after the second dose.
“Maybe you’re not in a stable relationship, or you’re planning a trip where you may encounter risks,” Dr. Hurt says. “It doesn’t hurt to stop and restart PrEP. You just need to avoid exposures that could place you at risk for HIV if you’re off of your PrEP.”
PrEP for Injection Drug Users
Sharing needles and other equipment to inject drugs poses a high risk for acquiring HIV and other bloodborne infections. People who inject drugs make up about 1 in 10 HIV diagnoses in the United States, according to the CDC.
PrEP and injection drug use is less studied than PrEP and sexual transmission of HIV, but the medication is considered effective for people at risk of HIV from injection drug use.
“In the injection drug use study, people who took PrEP were less likely to acquire HIV,” Dr. Hurt says. “It just was hard to tell if the HIV exposure was from a needle or sex.”
You Still Need Condoms if You Take PrEP
It’s true that taking PrEP as prescribed will protect you from HIV infection, even without condoms, Dr. Hurt says.
“But for sexual wellness, I’d say yes, wear a condom,” he says. “Remember that PrEP only prevents HIV. Condoms help protect you from other infections, like syphilis, gonorrhea and chlamydia.”
Dr. Hurt says that since the FDA approved PrEP for HIV prevention in 2012, many healthcare providers and patients have become more aware of the treatments, undoubtedly reducing the number of HIV infections throughout the country.
“It is still easier to get PrEP as well as testing and treatment for HIV in urban areas than in some rural communities,” he says. “We will keep working to disseminate information and services to locations that don’t already have a strong infrastructure to support sexual health.”
If you are concerned about your risk of HIV or another sexually transmitted infection, talk to your doctor or find a doctor near you.