All About PrEP
IS PREP RIGHT FOR ME?
Health is very personal and we feel it’s important to provide information to help you make a well-informed decision about PrEP. It may not be for everyone but it is an important and highly effective HIV prevention option to consider.
PrEP stands for pre-exposure prophylaxis and is a prescription medication typically taken daily to reduce the risk of acquiring HIV. If taken consistently, it can reduce the risk from unprotected sex by up to 99%.
How does it work? How do I take it?
PrEP is a combination of two drugs that fight against HIV known as “antiretrovirals”. They work by preventing HIV from being able to take hold in the body. The medications in PrEP are actually sometimes used as part of HIV treatment regimens as well (but can’t be used alone in treatment, only for prevention).
According to the manufacturer one tablet should be taken every day. Studies have found medication effectiveness depends on how regularly it is taken. Missing doses will make it less effective.
While not officially endorsed by the manufacturer, “On-Demand PrEP” is taken by some. This is taking PrEP just before sexual activity and continued for 2 days after. Studies originally found this may reduce the risk around 80% (although newer studies are suggesting it may potentially be as effective as once daily use). On-Demand use is not currently recommended for trans men and cis women.
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HOW DOES THIS WORK?
Book an appointment with a FREE online prescriber
They’ll chat with you through our app or your web browser and order lab work.
Once your results come back we will send out your medication via FREE shipping
Just before it is time to refill you will get lab work again and have another quick chat with us before shipping.
Who should go on PrEP?
If you have unprotected sex and don’t always know your partner’s status, PrEP may be right for you. 1 in 7 people living with HIV (PLWH) do not know they have the virus.
Anal sex has the highest risk for HIV transmission, with receptive anal sex (“bottoming”) having approximately a 1.38 in 100 chance of acquiring HIV each time if the partner is living with HIV (and not undetectable). However, there is also risk with insertive anal sex (“topping”) or vaginal intercourse. Injection drug use is also a risk factor (PrEP is less effective for prevention for this use).
Situations where PrEP is generally not recommended could include: sex with PLWH who is undetectable and consistently taking their medication, not engaging in sexual intercourse, or monogamous partners who are both negative.
While anyone can acquire HIV, men who have sex with men (MSM) and transgender women (TGW) are overall at highest risk. Some studies have estimated the lifetime risk of acquiring HIV to be 1 in 6 for MSM and 1 in 2 for some TGW.
PrEP is generally well tolerated and side effects can include stomach upset, headache, or feeling tired. These symptoms usually improve or go away with use. The medications in PrEP have now been studied and taken for 20 years.
Rare potential side effects include impact on your kidney function but your prescriber will monitor this during regular bloodwork. Any changes are generally reversible upon stopping the medication. The other possible side effect is changes in bone mineral density (bone strength). This is generally minor and is more of a concern if someone is going to take the medication over 50 years of age or if they are already at risk of osteoporosis and fractures.
PrEP side effects are generally minor and go away for most people.
How Do I Get On PrEP?
PrEP requires a prescription and a family doctor can prescribe it. The PrEP Clinic connects you with free online prescribers if you do not have a family doctor, your doctor will not prescribe it, or you are seeking additional discretion. As you require regular monitoring and follow-up on PrEP many walk-in clinics will not prescribe it.
The prescriber will discuss with you if PrEP is right for you and order lab work. This includes testing for sexually transmitted infections (STIs), including HIV. They can then prescribe the medication and you will get lab work again before your next prescription refill.
An individual will need to test HIV-negative to be on PrEP. If a person does acquire the virus, PrEP alone is not sufficient to treat HIV and could lead to medication resistance.
Why the PrEP Clinic?
We are the first and only online clinic to provide free PrEP prescribing access to all of Ontario combined with free shipping and pharmacy services. Some pharmacies need to regularly special order PrEP but we always have it in-stock. We are also a designated Safer Space where all are welcome, respected, and accommodated.
Pharmacist-Owner Andrew is an expert on PrEP and HIV medication. In fact, he has even developed education programs for other pharmacists and healthcare professionals to teach them about PrEP. As a result, the pharmacy has distinct protocols to support your understanding and care.
FREE online prescribers and pharmacists are here to help.
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How much is it? How do I pay for it?
PrEP is currently covered for some by the public Ontario Drug Benefit Program (ODB) and many private plans.
PrEP is covered for anyone who is under 25 without private insurance, those on ODSP (disability), OW (Ontario Works), social assistance, and people 65+ through ODB. If you have private insurance and are unsure if PrEP is covered contact us or your insurance company to check. Some private plans require a special authorization form to be filled out by the prescriber which we can help take care of.
If you are without coverage or need additional support, the Ontario government has a free program called Trillium that anyone with an Ontario health card can apply to. This program considers your income and sets a deductible (amount you pay) before it will help cover the rest of your medication costs. We recommend applying right away to this if you do not have coverage as it can take a few weeks to become active. If your private insurance does not cover the medication or does not cover it fully you can also apply to Trillium.
More Info On Trillium (including the application):
We can also email, fax, or mail you a copy of the application. More information on drug coverage is available here.
We can help you navigate coverage options for PrEP.
Myth #1: PrEP encourages everyone to higher risk behavior and increases STIs.
FALSE. Earlier studies that looked at PrEP use had found that PrEP did not significantly change sexual behavior. People who were already at risk just got protection. They also were tested more frequently due to regular monitoring being on PrEP. Some newer studies have suggested a potential increase for some.
Myth #2: PrEP is effective so condoms are not needed anymore.
FALSE. Condom use should still be considered as PrEP does not protect against other STIs besides HIV. PrEP plus condom use does further reduce the risk but is something for each person to determine what is right for themselves.
Myth #3: People who are more sexually active go on PrEP.
FALSE. Besides the fact we should not be disparaging people who have more sex, HIV does not discriminate whether someone has sex once or multiple times. Each sexual interaction is it’s own independent risk.
Myth #4: Nothing can interact with PrEP so no need to worry.
FALSE. It’s always important to check with a pharmacist to see if there are any drug interactions or protentional interactions. An example, is anti-inflammatory medications like Advil (ibuprofen). Regular use of these medications while on PrEP may further increase the risk of the rare side effect affecting the kidneys. Hormone medications that may be taken by some transgender individuals can be combined safely with PrEP. We are available for questions 7 days a week.
Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study. SM Jenness, et al. Clinical Infectious Diseases, Volume 65, Issue 5, 1 September 2017, Pages 712–718.
AY Liu, et al. Sexual risk behavior among HIV-uninfected men who have sex with men participating in a tenofovir preexposure prophylaxis randomized trial in the United States. J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):87-94.
There’s a lot of misinformation out there. We’re a fact and evidence-based zone.