PrEP
PrEP (pre-exposure prophylaxis) is a highly effective strategy for preventing HIV. PrEP is an anti-HIV medication that an HIV-negative person takes before having sex to reduce the risk of getting an HIV infection. Read on to see whether this could be a good strategy for you!
What is PrEP?
PrEP is a pill made up of two anti-HIV molecules that you take before having sex. It only helps prevent HIV infection; it doesn’t protect against other STBBIs.
To be effective, PrEP needs to be taken correctly. Scientific studies have shown that PrEP is effective in preventing HIV infection only if it’s taken as prescribed by your doctor.
There are two ways to take PrEP:
- Ongoing is the most common way. This means taking a pill at the same time every day for a given period of time.
- Intermittent or “on demand” is when you take PrEP for a few days before and after having sex. You take two pills, two to 24 hours before a high risk of HIV exposure, and one pill per day until 48 hours after exposure.
What’s a high risk of HIV exposure? We refer to a high risk of HIV exposure when you have anal sex without a condom:
- With a partner whose HIV status is unknown; or
- With an HIV-positive partner whose viral load is unknown or high (above 200 copies per millilitre of blood).
If you’re having sex with a person living with HIV whose viral load is undetectable, PrEP is not necessary to protect you from HIV with that person. Check out the viral load section to learn more. If you have other partners, PrEP could be for you. In all cases, if you’re thinking about using PrEP, read the next section and talk with your doctor to assess whether it’s a good fit for you.
Is PrEP a good fit for me?
PrEP may be for you if:
- You’re afraid of contracting HIV.
- You don’t use condoms, or you use them infrequently.
- You use condoms most of the time, but not always.
- You’d like to stay protected even when you’re doing drugs.
- You want to be able to protect yourself no matter who you’re having sex with.
If you’re thinking about it, talk with your doctor. Together, you can evaluate your situation:
- Are you HIV-negative? Your doctor can check by taking a blood sample. This is a standard HIV test. You need to be HIV-negative to take PrEP.
- Have you had anal sex without a condom in the last six months? If so, PrEP might be a good fit for you.
- In addition to having anal sex without a condom in the last six months, is at least one of the following true for you?
- You’ve used post-exposure prophylaxis (PEP) more than once.
- You’ve had an STBBI such as syphilis.
- You’ve had an HIV-positive partner whose viral load is high or unknown.
- You’ve had sex while taking drugs.
- You’ve had two or more sexual partners in the last six months.
If you answered yes to one of these, PrEP is for you. Talk to your doctor to get access. You can use the search tool based on postal code to find a clinic, or contact the community organization in your area to learn about places you can be referred to.
PrEP reduces the risk of HIV infection, but not the risk of other STBBIs. To protect yourself against other STBBIs (such as syphilis and gonorrhea), find out more about other prevention methods.
You can also fill out the online form on the MaPrep.org website (in French only) from the Portail VIH/sida du Québec to evaluate whether this method is a good choice for you.
Where can I get access to PrEP?
You can get access to PrEP through a doctor who agrees to prescribe it to you. You can talk about it with your family doctor if you have one. If not, you can consult the HIV community organization in your area to find out about clinics where you can get PrEP.
The MaPrep.org website (in French only) from the Portail VIH/sida du Québec has information you can print out for health professionals so you come prepared for your appointment.
How much does it cost?
If you don’t have insurance
Without insurance (public or private), the monthly cost of ongoing PrEP (taken every day) varies between $907 and $995 per month.
RAMQ
PrEP is covered by the Régime public d’assurance medicaments (public prescription drug insurance plan) of the Régime de l’assurance maladie du Québec (RAMQ, Québec’s health insurance plan). You’ll need to pay the maximum amount per month, $93.08 (in 2019–2020) unless you’re exempted. Visit the RAMQ site for more details. If you’re currently taking the medication, it won’t cost you more than you’re paying now; after the maximum amount, your medication remains free.
Group insurance
The amounts people pay when they have group insurance at work (private) vary depending on the group insurance policy. You need to find out. Generally, annual coverage starts on January 1. Reimbursements vary depending on your plan, but all insurance plans have a maximum amount you’ll have to pay. In Québec, these amounts are set by the government. Your insurance policy will tell you what this maximum amount is. Remember: PrEP is necessarily covered by your private insurer.
Medical monitoring of PrEP
If you’re HIV-negative and you’re starting PrEP, you need to see your doctor every three months to:
Side effects
PrEP is generally well tolerated. Some people may have unpleasant side effects, which usually disappear after a few days or weeks. These may include:
If you have side effects, talk about them with your doctor. PrEP can also have an impact on your kidneys, your liver or your bones while you’re taking it. Your doctor will do the necessary monitoring to ensure this impact remains low.