Today I’m here with Pivot’s PrEP Coordinators Morgan Jade and Carlos Negrete to talk about some of the frequently asked questions they’re getting about PrEP, and explore what Cascade AIDS Project can do to help you find out whether PrEP is right for you and get connected to a provider.
PrEP stands for Pre-Exposure Prophylaxis, an HIV-prevention strategy that entails taking a daily pill that reduces your risk of becoming infected with HIV. Currently, the only medication approved as PrEP is Truvada, one pill that is a combination of two HIV-fighting drugs.
Morgan and Carlos work full-time at CAP helping people who want to know more about PrEP. They can give you basic information about how it works, help you figure out how to pay for it (they’re able to help many people get it for free) or get connected through a medical provider who is familiar with prescribing PrEP to patients. They can follow up with you after you start PrEP to provide any other support you need.
Matt: If someone is interested in getting on PrEP, what do they need to do?
Carlos: First, if you do have insurance and a medical provider (doctor), talk to your provider and figure out what they require to start the process. If you don’t have insurance or a medical provider, you can contact us at CAP so we can help determine the best way for you to get PrEP.
Morgan: The first thing your provider might do is talk to you about your risk for acquiring HIV to determine whether PrEP is a good option. Then you’ll get a test for HIV and a full STD screening panel. They’ll also test you for Hepatitis B and kidney function to prevent potential complications.
Carlos: Those tests Morgan mentioned are to make sure PrEP is right for you, and your body. Your doctor will assess the results and make the best plan with you.
Matt: How much does PrEP cost?
Morgan: If you were to pay for a month of Truvada yourself, the cost would be between $1,300 and $1,500, but there are a lot of options for getting PrEP at reduced cost or for free. That’s why it’s so important to contact us to talk about your insurance or drug assistance program options.
Matt: How much of the cost does the person have to pay out-of-pocket?
Carlos: It really depends on the person and the insurance plan they have, but depending on income and drug assistance programs, many people can get Truvada fully covered. Gilead, the drug company that makes Truvada, offers a couple of different assistance programs to help you cover the cost of Truvada. They have options for individuals who are insured and uninsured.
Matt: Let’s say I’m interested in PrEP but I’m not sure if I’m at a very high risk for HIV. Am I using up resources that could be going to somebody who needs it more?
Morgan: If you’re eligible for PrEP, it’s definitely not a waste of resources. It’s never a waste to want to take care of your health.
Carlos: Determining if you’re at risk for HIV infection is an important conversation between you and your medical provider. There’s also a website called “is PrEP right for me” (ispreprightforme.com) that can help guide that decision. As PrEP coordinators, we can also talk to you about different things to consider when making the decision.
Matt: When someone contacts Cascade AIDS Project about going on PrEP, what can they expect?
Morgan: We’ll answer your questions over email, phone, Grindr or Facebook, or if you need something more in-depth we’ll schedule an appointment to meet with us 1-on-1.
Carlos: In our appointment, we go over the client’s specific needs—anything from insurance navigation to financial assistance programs to education on PrEP and some of the side-effects.
Morgan: We’ll try to make the process as smooth as possible, and help you find the right provider for you and your specific needs. We’re both PrEP nerds and we always welcome anybody who wants to talk about this topic.
Matt: If someone’s not sure whether they should be on PrEP or not and decides to tell you about their sexual history, will you tell them whether they should be on it or not?
Morgan: We’re happy to talk to you about what makes a person eligible for PrEP, such as things you might do that put you at risk for HIV, but we can’t make the decision for you. Our goal is more to empower you with the information so you can make informed choices going forward.
Matt: Will a health care provider be able to give a definite yes or no answer?
Carlos: First of all, PrEP is a relatively new treatment and some providers still need to catch up. If your provider is not willing to prescribe it, ask for a referral or come talk to us. We have a list of providers who are knowledgeable and comfortable providing PrEP.
Morgan: Educating yourself about PrEP, understanding why you want to consider PrEP and learning to advocate for yourself is so important so you can have a meaningful conversation with your provider.
Matt: Does going on PrEP mean someone no longer has to use condoms?
Morgan: That’s an important decision that only you and your partner or partners can make together. Some people will continue to use condoms when they’re on PrEP, some will stop, and some never used condoms in the first place. With that said, condoms provide an extra layer of protection on top of PrEP.
Carlos: PrEP is very effective at preventing HIV infections, but it doesn’t protect you against other STIs, like chlamydia, syphilis, gonorrhea or herpes, or pregnancy. It’s up to you to decide whether you are only worried about HIV, or you want to reduce your risk of getting any STI or getting pregnant. People who are concerned about things other than HIV may decide to continue using condoms.
Matt: If you still have to use condoms, then why use PrEP?
Carlos: PrEP gives individuals an added layer of protection, and there are many personal reasons why someone chooses PrEP. It can allow you to feel more empowered about your health, your sex life, and your life overall, whether or not you choose to use condoms.
Matt: How easy is it to quit PrEP if someone gets on it and then changes their mind?
Morgan: You can stop PrEP at any time if you feel you don’t need it anymore. However, it’s recommended that you take PrEP for 28 days after your last potential exposure to HIV.
Carlos: Also, if you want to start again, and still have a half a bottle left, don’t just start taking it. Go back to your doctor and get tested again to start PrEP again.
Matt: Will PrEP stop working if someone takes it for a long time, or goes off for a while and gets back on it later?
Carlos: No. It doesn’t make any difference if I stop and start again a year later. But make sure you go through your provider when you do.
Matt: How many days in a row do I have to take PrEP before it starts protecting me?
Carlos: For anal sex, it starts working after seven days. For vaginal sex, 21 days. That’s how long it takes the drug to build up to an effective level in that part of your body.
Matt: If I’m on PrEP is it possible to still get HIV?
Carlos: There hasn’t yet been a known case where someone taking PrEP as prescribed was infected with HIV. That said, there there are still reasons why you’ll get regular HIV tests even while you’re on PrEP to continue receiving the medication. Let’s say I started PrEP today and was exposed to HIV tomorrow. Or, let’s say I skipped several days of the medication and was exposed to HIV during that time, when I didn’t have full protection from PrEP.
Also, if an initial HIV test was done during the window period, there could be a chance that the test did not detect the virus yet even though the person was already infected before starting PrEP. Our test here at CAP is a fourth-generation test; it looks for both HIV antibodies and antigens. Antigens are foreign substances that cause your immune system to activate. The antigen is part of the virus itself and is present during acute HIV infection (the phase of infection right after people are infected but before they develop antibodies to HIV) and they can be detected after 4 weeks of exposure to HIV. So we call those four weeks when the virus cannot be detected the window period.
Morgan: Nothing is 100% guaranteed, but when taken consistently and correctly it can provide up to 99% protection against HIV infection. The more consistently you take it, the less likely it is you’ll contract HIV.
Matt: Thanks Morgan and Carlos, that’s all the questions I have about PrEP. Now how can people get a hold of you if they’re thinking of going on PrEP and want some help?
Morgan: Folks can call, email, or stop by Cascade AIDS Project. We look forward to talking with you!
Contact Morgan at: firstname.lastname@example.org, 503-278-3873 or stop by 208 SW 5th Ave. suite 800.
Contact Carlos at: email@example.com, 503-278-3874 or on the Grindr account “PrEP Questions” or on Facebook.