An ob-gyn explains why prevention is the best medicine.
Your ob-gyn’s office is a place to discuss countless topics related to your sexual and reproductive health. But some conversations don’t happen as often as they should—including how you can prevent HIV with medication.
HIV stands for human immunodeficiency virus. It’s a virus that attacks your immune system and increases your risk of getting other diseases and infections. Without treatment, HIV can lead to AIDS (that’s acquired immunodeficiency syndrome).
If you get HIV, it’s a lifelong condition: The virus can be treated but not cured. The good news is that HIV is now highly preventable, thanks to safer sex practices and a medication called pre-exposure prophylaxis (PrEP).
Here are seven things I want everyone to know about PrEP.
PrEP combines two medications that stop the HIV virus from taking hold and spreading in your body. When taken correctly, PrEP lowers the risk of getting HIV from sex by about 99 percent. And it lowers the risk of getting HIV from injected drugs by at least 74 percent.
Anyone can get HIV, no matter your age, gender, sexual orientation, or who you have sex with. PrEP is for anyone who could be at increased risk for getting HIV, which spreads through contact with semen, vaginal fluids, rectal fluids, blood, and breast milk.
If you are sexually active and do not have HIV, talk with your doctor about whether PrEP is right for you. It’s now recommended that doctors discuss PrEP with all their sexually active patients.
Your doctor may recommend PrEP if:
You have had anal or vaginal sex in the past 6 months and you
have a sex partner who has HIV
do not use condoms each time you have sex
have had a sexually transmitted infection (STI) in the past 6 months
You inject drugs and you
have an injection partner with HIV
share needles, syringes, or other drug injection equipment
You have been prescribed post-exposure prophylaxis (PEP, an emergency medication taken to prevent HIV after possible exposure) and
any of the above situations apply to you
have taken PEP more than once
PrEP was first introduced in 2012 as a pill you take once a day. Then in 2021, the U.S. Food and Drug Administration (FDA) approved a form of PrEP that is injected every 2 months.
Both versions of PrEP are effective at preventing HIV. So the choice comes down to what works best for you and your lifestyle. If you don’t mind taking medicine once a day, then the pills could be the right option for you. If you’d rather not think about PrEP every day, the injections could be the better fit.
It’s important to know that PrEP doesn’t work right away. You must take the pills every day for at least 7 days for it to reach full effectiveness against HIV exposure from anal sex. For vaginal sex and injection drug use, it takes at least 20 days to build up full protection.
Also, PrEP doesn’t prevent against other STIs or unwanted pregnancy. While taking PrEP you should continue to use condoms and birth control, if needed.
It’s possible to take PrEP at more than one point in your life, as your circumstances change. You should be on PrEP for as long as you’re at risk for HIV—and as long as you remain HIV-negative. Talk to your doctor if you’re considering stopping or restarting PrEP.
While you’re taking PrEP, plan to visit the doctor every 3 months or so. Your doctor should do blood work to test you for HIV and other STIs and to make sure you’re still healthy overall (kidney function and bone health are two main concerns).
Those follow-up visits are also a good time to reassess whether you still need to take PrEP. If you decide to stop taking PrEP, wait until it has been at least one month since your last possible exposure to HIV.
If you’re pregnant or breastfeeding, you’re right to wonder whether a medication might harm you or your baby. Fortunately, research has shown that PrEP pills are safe to take during these times. (The injection is not currently recommended while pregnant or breastfeeding.)
If you’re taking PrEP and get pregnant, talk with your ob-gyn about whether you’re still at risk for HIV. They can help determine whether you should keep taking PrEP during your pregnancy and after you deliver.
PrEP doesn’t appear to affect hormone therapy. This is true whether you’re taking hormone therapy to treat menopausal symptoms or as part of gender-affirming care.
For years, the high cost of PrEP prevented many people from being able to benefit from it. Thankfully, most health insurance and Medicaid plans are now required to cover PrEP. This is a big step toward improving access to this important medicine.
If you are uninsured or underinsured, you can look into programs that help with the cost of PrEP and related health care services.
We’ve come a long way with HIV treatment, but we still want to prevent infection whenever we possibly can. That’s why HIV prevention deserves to be a routine conversation among ob-gyns and patients—right up there with birth control, breast exams, and vaccines.
If you’re thinking about taking PrEP, ask your ob-gyn. Yes, this may involve talking about some intimate aspects of your life. But we doctors only have your health and safety in mind, and everything you tell us is confidential. We only ask questions about sex and drug use to get a full sense of what’s going on in your life.
By being as open as possible, you help your doctor give you the best advice to stay healthy. Your health is that important, and prevention truly is the best medicine.
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