I frequently travel to Africa and Latin America. In tropical climates, I am at risk of getting infected by the malaria parasite spread by mosquitoes. Malaria is a deadly disease, so to protect myself, I take medicines used as prophylaxis or prevention.
Taking the prophylaxis keeps medicine in my blood to kill any malaria parasites I get exposed to. This is the same idea behind Pre-Exposure Prophylaxis for HIV disease, abbreviated PrEP. While condoms can protect against HIV infection, condoms aren’t always comfortable or pleasurable.
In many parts of the world, female sex workers are not able to require male partners to use condoms, so they are at risk for HIV infection. Providing a way for women to protect themselves was one of the driving forces behind the development of PrEP. By taking the medicine daily, the virus is destroyed if the person is exposed to it so they don’t get infected.
Currently, the form of PrEP available in the US, Europe, Africa is a combination of two medicines in one pill called Truvada. It contains the medicines tenofovir and emtricitabine. Truvada has been found effective in protecting all types of people no matter what kind of sex they practice.
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Truvada protects serodiscordant couples; partners where one individual is HIV+ and the other is HIV-. The negative partner takes PrEP. The infected partner should
be getting full treatment for HIV [see the previous article]. PrEP protects female sex workers, men-who-have-sex-with-men and people who inject drugs.
- You may want to consider PrEP if:
- Your spouse or partner is HIV positive.
- You trade sex for drugs or money
- You often don’t use condoms and you may have sex with people at risk for HIV infection (e.g. formerly
- incarcerated individuals, people who use drugs, etc.)
- You’re a man who has sex with men (e.g. gay, bisexual/”Down-Low”)
- You use intravenous drugs or share drug paraphernalia
A medical provider must prescribe Truvada. They must confirm you are HIV-negative and that Truvada is safe for you. The pills should be taken every day. PrEP works when you take it! In all studies, study participants who got infected with HIV were not taking their medicine.
PrEP is very effective but there are situations, if a person is infected with HIV virus that is resistant to the medicines in Truvada, their HIV-negative partner may not be protected by Truvada.
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This person may have been prescribed Truvada at one time, but if they didn’t take the drug properly, the drug no longer controls their virus. While this doesn’t seem to happen much, it is possible.
Remember that PrEP only protects against HIV. It DOES NOT protect against any other sexually-transmitted diseases, like syphilis, gonorrhea, Chlamydia, hepatitis C, hepatitis B or human papillomavirus infections. Condoms protect against these infections.
Unfortunately, many medical providers may not be well informed about PrEP and may be reluctant to prescribe it. If you need help finding a prescriber who is knowledgeable about PrEP and could prescribe it visit https://preplocator.org
Dr. Crawford received a B.S degree in Biology from Cornell University and a B.S. in Pharmacy from Temple University. He completed a residency in clinical pharmacy at the National Institutes of Health. He earned a doctorate in Pharmacology from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He completed a post-doctoral fellowship at the National Institutes of Health, studying microbial biochemistry and genetics.
He is currently with the Division of AIDS at the National Institutes of Health. He has over 25 years of experience in HIV treatment and clinical research. This article reflects his personal views and opinions.
