Human Immunodeficiency Virus, or HIV, is a virus that attacks the immune system and makes it harder for the body to fight infections. It also affects many, as experts estimate that nearly 1.2 million people in the United States are infected with HIV, with 13 percent not even knowing they have it.
While anyone can contract HIV, the condition devastated the LGBTQ+ community in the 80s and 90s as it became the leading cause of death for men aged 25-44 in the United States at some point. But while HIV/AIDS continues to have a disproportionate impact on queer people, especially black and Hispanic men and transgender people, HIV is not exclusive to this demographic. However, the legacy of the AIDS epidemic and its ongoing negative association with the queer community continues to fuel stigma around HIV education and prevention to this day. So, let’s be clear: everyone, regardless of origin or sexual orientation, should be aware of the virus and be aware of the risk of infection.
One of the best and most effective ways to prevent HIV infection is to take PrEP (pre-exposure prophylaxis), a prescription drug that reduces the chance of contracting the virus. The U.S. Centers for Disease Control and Prevention reports that taking PrEP as prescribed reduces the risk of contracting HIV sexually by about 99 percent, and for those who inject drugs, the risk is reduced by at least 74 percent. These statistics prove that anyone who is sexually active or uses intravenous drugs should assess their risk of contracting HIV and consider HIV prevention options.
In an editorial statement on HIV screening and PrEP, HIV researchers Hyman Scott, MD, and Paul Volberding, MD, wrote: “Together, the improved health of HIV treatment, the resulting reduction in transmission, and PrEP provide essential tools to end the HIV epidemic.” .
Ahead, we’ll discuss how HIV works, your level of risk, what exactly PrEP does, and how to access it.
What is HIV? What is AIDS?
To understand how to prevent HIV, you also need to understand how the virus works. HIV is spread through sexual fluids (including semen, pre-semen, rectal fluids, and vaginal fluids), blood (through transfusion or needle sharing), and through pregnancy and breast milk, according to the CDC.
HIV weakens the immune system by attacking T cells (white blood cells that fight infection), making people with HIV more susceptible to the disease. HIV Can develop into AIDS, but the two terms are not synonymous. HIV and AIDS mean different things because a person with HIV is considered to have AIDS when their T-cell count drops to a certain level or if they develop one or more opportunistic infections, that is, infections that occur in people with weakened immune systems. The Mayo Clinic reports that with current treatment, most people infected with HIV do not develop AIDS. However, without treatment, HIV can develop into AIDS in eight to ten years.
Contrary to how it may be presented, HIV is not a death sentence and does not mean that you cannot live life to the fullest, full of love. In fact, many people with HIV can manage the virus with antiretroviral treatment (ART), resulting in what is called an “undetectable viral load.” This means that with daily treatment, HIV can be suppressed to undetectable levels, virtually eliminating the risk of transmission to sexual partners. If you’ve heard the slogan “undetectable = intransmissible” (sometimes abbreviated as N=N), it refers to precise scientific testing, which means that if your HIV level becomes undetectable, you cannot pass HIV on to your partner.
What is DCP?
PrEP is a prescription drug and you must be HIV negative before taking it for it to be effective. While HIV prevention rates remain high with all three PrEP options, your doctor will consider your lifestyle and other factors (such as assigned sex) to determine which option is right for you. Here are three FDA-approved options.
- Truvada is a once-daily pill for people who are at risk of contracting HIV sexually.
- Descovy is a once-daily pill for people at risk because of sex. However, Descovy is not intended for people assigned female (AFAB) at birth.
- Apretude is the only injection approved for use as PrEP. It is administered by a health care provider every two months.
The CDC believes that PrEP requires a high level of adherence, which means that taking PrEP is an important part of a larger, comprehensive HIV prevention plan that you and your healthcare provider decide. According to the CDC, a decision about PrEP with your healthcare provider should “include discussions about adherence to the PrEP regimen, use of condoms to prevent contracting other sexually transmitted infections (STIs), and other risk reduction methods.”
Is PrEP safe?
Yes, according to the CDC, PrEP is safe. There are some common side effects, such as diarrhea, nausea, headache, fatigue, and stomach pain, but the CDC says they usually go away. However, taking PrEP may cause more serious side effects that you should discuss with your doctor.
- For Truvada and Descovy, serious side effects can include kidney problems, liver problems, and lactic acidosis, which happens when there is too much lactic acid in the blood—a rare but serious medical emergency.
- Side effects of Apretude may include an allergic reaction, liver problems, depression, or mood changes. You should also avoid Apretude if you have certain allergies to cabotegravir or are taking the following medicines: carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine.
If you experience any of the above side effects, you should tell your doctor immediately or seek medical attention.
Who Should Take PrEP?
If you are sexually active or use intravenous drugs, you should talk to a trusted doctor about whether PrEP is right for you. However, the HIV.gov website lists the following several factors that can increase the risk of contracting HIV. If any of the following apply to you, it may mean you should consider taking PrEP.
- Living in a community with high levels of HIV. (You can find out by visiting the Centers for Disease Control and Prevention (CDC) Atlas tool to view maps of HIV prevalence rates in your area.)
- Men who have sex with men.
- Transgender women who have sex with men.
- People who inject drugs.
- Black and Hispanic men who are disproportionately affected by HIV compared to other racial and ethnic groups.
- Those who have multiple sexual partners.
- Those who have sex without using condoms or other safer sex methods.
The US Centers for Disease Control and Prevention (CDC) has flow charts to help you assess your risk of getting HIV and decide if you should take PrEP.
Where can I find PrEP?
You can get a prescription for PrEP from your PCP, OB/GYN or HIV specialist. While PrEP coverage is required under the Affordable Care Act and the Department of Labor has said that insured patients do not have to cover any PrEP-related costs, prices remain high. CNN reports that a monthly supply of generic PrEP costs $60, but brand-name drugs like Truvada and Descovy can cost up to $2,000 a month for the uninsured. However, even insurance companies are known to neglect their obligation to provide fully covered PrEP drugs.
However, there are several programs that provide people with free or low-cost PrEP, including Ready, Set, PrEP, which helps people without health insurance, and many local health department initiatives for at-risk groups.
Bottom line: everyone should consider their own risk of contracting HIV and consult with their healthcare provider to find out if PrEP is right for you. HIV/AIDS is not a “gay disease” and everyone, regardless of gender, gender and origin, should think about protecting themselves and their loved ones.