PrEP & PEP

What is PrEP?
 

• PrEP stands for “Pre-Exposure Prophylaxis”, meaning it is a tool to stop infection (“prophylaxis”) that is taken before (a minimum of 7 days) you are exposed to HIV. 
   

• Current clinical guidelines for PrEP recommend daily use of Truvada, Descovy, or generic versions for maximum HIV prevention benefits. 
   

• PrEP is endorsed by the World Health Organization for people who are HIV negative and at risk for becoming positive. 
   

• It has been shown to be as high as 99% effective at reducing the risk for HIV when taken every day (without missing a dose).[i]
   

• PrEP works by disrupting HIV and preventing it from establishing a foothold in the body and causing a systemic infection.
   

• PrEP does not protect against other sexually transmitted infections, and it is not a cure for HIV.
   

• PrEP should be seen not only as a daily pill that prevents HIV, but a comprehensive sexual health plan that links you to ongoing care. 
   

• In addition to getting a prescription from your doctor, PrEP will require ongoing visits with your doctor every three months to screen for HIV, side effects from the medication, and sexually transmitted infections.
  
   

How can I access PrEP?

On September 28, 2017, PrEP became more accessible to people living in Ontario than ever before. PrEP is a highly effective way to prevent HIV that involves taking a pill every day and going for regular checkups with a doctor.
 

• PrEP used to cost $1,000 a month, but now it can be either free or as low as $50 per month, depending on what kind of drug insurance you have. 
   

• Anyone who is registered with ODSP, Ontario Works or Ontario’s Senior drug plan can now have PrEP covered for free. 
   

• Anyone else seeking assistance paying for PrEP can register with the province’s Trillium drug plan for coverage. 
   

• A prescription from an HIV specialist is no longer required to receive coverage, you can get a script from any doctor or nurse practitioner and be covered under Ontario’s plans.
   

• If you have private drug insurance (most likely through your employer), the change won’t make much of a difference. 
   

• But if your private plan was one that didn’t previously cover PrEP, they are more likely to do so now. Check with them about your coverage options. 
  
   

Short and long term side effects to consuming PrEP:

While most people’s bodies tolerate PrEP (pre-exposure prophylaxis) well, like all medications it can have some side effects.

Everyone is different which makes it difficult to know how one’s body will react to a drug regimen until they start using it. It’s usual that everyone will not experience the same side effects when they take the same medication.

Yes, there are some side effects associated to PrEP use but a lot of people don’t experience any of them, and if they do it’s usually for a short period while their body adjusts to the drug.
 

• Short term side effects

  • Nausea

  • Headaches

  • Diarrhea
     

• Long term side effects

  • Liver health

  • Kidney health

  • Loss of bone density

People who won’t have to pay anything for PrEP: 

• Those who have federal health insurance. This includes indigenous people (with status), members of the armed forces, and refugees. 

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• If you are under 25, starting January 1st PrEP will be free through the new OHIP+ program 

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• If you are 65 or over, are on ODSB, or Ontario Works, PrEP is covered through the Ontario Drug Benefit People who will pay a deductible for PrEP: 

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• If you don’t have private insurance or federal insurance and are between the ages of 25 and 64, you can get PrEP through Trillium. This will require you to apply to the program and pay a deductible based on your income. 

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• If your private insurance plan pays only a certain percentage of your prescription (such as 50% or 80%), you will have to pay the rest. If PrEP costs $200 per month, and your insurance pays 75%, you pay $50 per month.

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To get started with accessing PrEP, visit a healthcare provider you are comfortable returning to, as taking PrEP requiring you to return for regular checkups (every three months). Your family doctor is best, although sexual health and community clinics can provide you a prescription to begin PrEP. As can walk-in clinics, though returning to them for check-ups can be tricky.
 

What is PEP?
 

• Post-Exposure Prophylaxis (PEP) is a four-week daily dose of anti-HIV medications (in pill form) that can potentially stop HIV infection after exposure.
   

• PEP must be started within 72 hours of exposure.
   

• The sooner you start taking it the better. 
  
   

When should I get PEP?

You should consider getting PEP to stop HIV as soon as possible if you have:
 

• had a condom break during anal, vaginal, or front hole sex
   

• had anal, vaginal, or front hole sex with no condom, or;
   

• shared syringes for injecting any substance.
   

Accessing PEP is especially important when you know your partner has HIV. It's often appropriate in cases when you don’t know their HIV status as well.

You may also need PEP in a situation where there is a risk to you for HIV because of a sexual assault or because of an accident at work, usually in a medical or EMS work setting. 
 

What do I need to get PEP?
 

1. A prescription (as soon as possible from someone who can write one). As with other medications you can’t walk into a pharmacy or hospital and simply buy PEP. You need a prescription, and in order to get that, the doctor who can give it has to be satisfied that you:
 

• have had an exposure to HIV;

• are not already living with HIV;

• will be able to take the full four weeks of the medication (not start and stop it for whatever reason), and;

• have disclosed all other medical conditions, medications or hormones you may be taking.
   

It is essential to get a prescription as soon as possible, so most people go to their local emergency room for this. It’s important to calmly and clearly explain to emergency staff that you believe PEP needs to be prescribed and started as soon as possible in order to make sure it works well. Some emergency rooms can keep you waiting, but others will be more experienced in dealing with people asking for PEP, rate you as a higher priority and may have the ability to give you a starter kit of medication after your consultation so you start right away until you can get to a pharmacy to fill your entire four weeks worth of medications. In Toronto, the hospital with the most experience with PEP is Women’s College Hospital, although any hospital should be able to handle this issue. If a hospital turns you away or advises you to go elsewhere, consider requesting that they call an infectious diseases specialist for telephone advice on how to handle this situation, since sending you to a different institution result in delays in accessing PEP.
 

2. Quick access: For PEP to work properly you need to get it as soon as possible. After 72 hours from your exposure to HIV has passed, the effectiveness of PEP is so little that the medical professional would hesitate prescribing it to you. 

3. Money: A month’s supply of PEP can cost between $900 - $1300 depending on the medications prescribed. Your private health insurance has to cover it, or you will have to pay for it out of your own pocket in Ontario.x Money should not be a reason not to access medication. If you are unable to afford the medications, you can ask if they can be provided to you free of charge. There is no cost in a sexual assault situation and in many occupational exposure situations.


What else should I know?

• Side Effects: As with all medications, there can be side effects, but newer HIV medications are generally well tolerated by most people.

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• Availability: Not all emergency rooms will automatically offer you PEP if you say that you were exposed to HIV through consensual sex or injection drug use. Emergency rooms vary in their procedures and experience with PEP.

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• Effectiveness: The treatment may not work. But, the sooner you begin PEP following a potential exposure, the more likely it is to be effective.

What if I'm a trans and am thinking about PEP?

• Be aware that having sex without a condom can leave you pregnant, even though you identify as a guy. A potential pregnancy should be one of the things the emergency room staff should consider, but may not be something they realize until you point this out to them.

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• If you think you have been exposed to HIV when you know you are already pregnant, be aware that the emergency room health care practitioners may not realize you are already pregnant. You should consider disclosing your pregnancy to them so that they can look at any protocol necessary to make the delivery safer. A form of PEP can be used to facilitate a safer delivery.

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• If you are taking hormones as either a trans male or a trans female, it would also be good to disclose this to the emergency room staff as some older forms HIV medications can suppress hormones (usually estrogen).