Frequently Asked Questions
So, what’s the deal with PrEP?
PrEP stands for Pre-Exposure Prophylaxis. It’s an anti-HIV pill you can take if you are HIV-negative, and the person you’re having sex with is HIV+ and does not have an undetectable* viral load.
*Undetectable viral load means that the HIV virus level in the body is low enough that it can’t be detected by a viral load test. At this point, folks cannot pass on HIV to someone else. That’s where the U=U slogan comes from; it simply means that treatment is actually a form of prevention.
So, how does PrEP really work?
Remember how we mentioned that PrEP is a pill that prevents folks from getting HIV? Well, it works by blocking the HIV virus from multiplying and taking over your immune system. This way you don’t get infected and you stay HIV-negative.
Taking a daily PrEP pill will prevent you from getting HIV. So you can keep it sexy and stay safe at the same time! Sounds great, right? Research studies have shown that PrEP is 99% effective. So we know that when used properly, PrEP really works. A PrEP schedule will be different for everyone depending on your situation and needs.
Is PrEP really safe?
How will PrEP affect me?
Some folks have had upset stomach, diarrhea, headaches and/or felt tired while taking PrEP. These symptoms usually go away on their own after a couple of days or weeks. Most times your body is adjusting to the medication. In rare cases, people might end up with kidney, bone or liver problems.
Talk to your doctor or nurse practitioner if you’re not feeling well after taking PrEP. They should monitor how your body is reacting to the medication, especially your kidneys.
If I’m on PrEP, do I still have to use condoms?
PrEP does NOT protect against other STIs, such as syphilis, chlamydia and gonorrhea. The only way to prevent STIs is to use condoms. If you have an STI, know that you are not alone and that this is not something to be embarrassed or ashamed of. The stigma, shame, and fear associated with STIs are real and affect many people. This can make it hard to talk about STIs and discourage folks from getting tested and using prevention measures. The silence around STIs makes them seem less common and more severe than they are.
Here are the facts: Anyone who is sexually active can get an STI and pass it on. Many of us will have one or more in our lifetime. Practicing safer sex, getting tested regularly, and getting treated significantly decreases the risk of getting an STI or passing it on.
PrEP Squad TO is a judgment-free zone. If you decide to not use protection or just slip up in the heat of the moment, we want you to have all the right info and know the risks that come with unprotected sex. It’s important that you and your sex partner(s) get tested for STIs regularly.
Can I take PrEP right before sex and be OK?
No, you have to plan ahead to make sure everything is in order. You need to take the pill every day for at least 1 week before having anal sex without a condom, and if you’re having front hole sex, you will need to take the pill for 20 days beforehand.
After having sex that might have exposed you to HIV, you should keep taking the pill daily for a month. If you take PrEP regularly/as prescribed, you will get the full protection of the medication. Inconsistent use will decrease the prevention power of PrEP.
There are a couple of different ways you can take PrEP, including options where you don’t always need to take the pill every day.
We'll discuss these in detail (see below), in the section When should I take PrEP and for how long?
How long does it take for PrEP to start working?
Okay, so here’s what we know: for guys having anal sex, you need to take PrEP pills daily for 7 days in order to be fully protected. Full protection means that your body has the right amount of PrEP in order to fight off any HIV virus that you might come in contact with. If you don’t take the pill for the full 7 days, the medication will not be as effective.
Remember: You must take the pill for the full 7 days in order for it to work. 7 days of PrEP to prep for unprotected (anal) sex. If you are using an on-demand (one-off) schedule, be sure to take 2 pills at least two hours before you have unprotected sex, and follow up with another (1) pill 24 hours after sex and one (1) more pill 24 hours after that.
If you’re a trans guy that has front hole sex, you need to take PrEP pills daily for 20 days to get full protection. Why does it take more time for you to get full protection if you’re having this type of sex? Well, the medication can thin and dry up the walls of your front hole, making it more likely to get microtears. Microtears are openings that HIV and other viruses and bacteria can use to get into your body and potentially cause infections.
When should I take PrEP and for how long?
Well, that depends on your situation, what kind of sex you are having and how much notice you have. Here are your options:
Taking 1 pill every day. That’s it!
- This option is easy to remember and works for both anal and front hole sex.
- It’s great for folks who have condomless sex regularly.
- Remember: 7 days of PrEP to prep for unprotected (anal) sex and 20 days of PrEP to prep for unprotected (front hole) sex.
B. On-Demand: The 2-1-1
If you’re most likely going to have anal sex without a condom, and you know at least 24 hours in advance, go for the 2-1-1 which means:
- Take 2 pills 2 to 24 hours BEFORE sex.
- Take 1 pill 24 hours AFTER sex.
- Take 1 more pill in 24 hours.
No more sex for awhile? No need to take another pill.
Expecting to have more sex? Keep taking 1 PrEP pill daily for up to 2 days (48 hours) after your last sexual encounter.
- On-demand (2-1-1) only works for anal sex and NOT front hole sex.
- If you don’t have condomless sex more than once or twice a week and you plan ahead, this could be the right regimen for you.
- Guys can get the same protection as they would on The Daily AND spend less on their meds (if they are paying out of pocket).
- It may be trickier to get the hang of the on-demand schedule. The risks from missing a day are higher than if you were on The Daily so it is very important to follow the schedule.
Remember: You must continue taking PrEP for up to 48 hours after your last sexual encounter.
Can I still get HIV if I’m on PrEP?
The chance of getting HIV if you’re taking PrEP properly is very low. Taking PrEP properly mean that you are taking the pill daily at least 7 days before anal and 20 days before front hole sex. If you are taking PrEP daily and also use condoms on top of that, then you have almost zero chance of getting HIV. Condoms are also another way of protecting you from other STIs.
What should I do if I forget to take PrEP?
Do not panic! If you forgot to take your pill one day, make sure that you take it the next day. Do NOT double up on PrEP to make up for missing day(s). If you think you may have been exposed to HIV, contact your health provider as soon as possible.
When we say that PrEP is 99% effective at protecting folks from getting HIV, we are assuming that they are taking the pill daily. Your level of protection goes down when you aren’t keeping to your PrEP regimen. If you find yourself becoming inconsistent with taking PrEP, it is a good idea to check in with your health provider and support system. It is also important to keep your condoms extra close to protect yourself from HIV and other STIs.
Tips for remembering to take PrEP:
- Put a reminder or alarm in your phone.
- Get a pill reminder app.
- Take it the same time everyday.
- Use a 7-day pill box—you can get these at any pharmacy.
- Make it part of your morning or night time routine.
- Take it at the same time as your other meds and/or supplements.
- Chat with your squad (family, friends, partner, family doctor, nurse practitioner) to get support.
Why should I take a PrEP pill every day if I’m not HIV+?
If you’re HIV-negative, PrEP can help keep it that way. Just because we know the benefits of using condoms, doesn’t mean that we always end up using them. There are so many situations and complications that come up in our sex lives. Maybe you or your partner(s) don’t like the feeling of using condoms. You might not know your partner’s HIV status, either because you don’t feel comfortable asking, they aren’t willing to share that information or they don’t get tested.
PrEP might be a good way for you to protect yourself from HIV (Check out Is PrEP Right 4 Me). And unlike a condom, taking PrEP doesn’t depend on your partner and they don’t even have to know you’re on it. There’s one thing we need to make clear though: PrEP does not prevent you from getting any other STI except HIV.
What’s the difference between PrEP and PEP?
Good question! PrEP and PEP are both medications called prophylaxis which means they work to prevent HIV infection, but the timing and reason for taking them are different. Here’s the breakdown:
I heard PrEP is for bottoms. I’m a top, so I’m safe without it, right?
That's not true! Bottoms (receiving partner) are at a higher risk of getting HIV than tops (penetrating partner) for biological reasons, but either can contract HIV from sex. PrEP can protect you from HIV regardless of your position.
Will I be shamed for using PrEP?
Our society is still holding onto stigma and discrimination based on HIV status, sexuality, race, etc. Some people might make assumptions about your HIV status, sex life, morals, etc. if they know you take PrEP. It isn’t right nor is it fair, but at the end of the day, you need to make decisions to protect your body and stay healthy. The PrEP Squad TO family will always have your back!
PrEP prevents HIV so why aren’t more Black gay, bisexual and trans men taking it?
Black gay, bisexual and trans men hold multiple oppressed identities in terms of race, sexuality and gender identity. We know that anti-Black racism has resulted in Black communities in Toronto experiencing worse socio-economic, educational, employment and health outcomes as compared to other groups. Homophobia is another form of discrimination that can limit the opportunities available to LGBTQ folks and expose them to human rights violations. For those living at the intersection of these groups, there are many structural barriers that can get in the way of them accessing quality health care, including HIV prevention, care and treatment options.
Taking PrEP is highly stigmatized because of who society thinks of as being the primary users of this medication. PrEP use is inaccurately linked to being gay, promiscuous and irresponsible. When it comes to Black men, this stigma is even more intense due to racial prejudice and stereotypes (i.e. hypersexualization).
So, what can we do about all of this? Firstly, resources like this one need to reach Black gay, bisexual and trans men, as well as other men who have sex with men. It is also important to train service providers on culturally informed and anti-oppressive care so that they can better respond to the needs of their clients. Policy and program development should take into account the socio-economic realities of many Black gay, bisexual and trans men who do not have private insurance, experience financial and housing insecurity and live further from downtown where the majority of LGBTQ-friendly clinics and pharmacies are located. On a structural level, work must be done to tackle racism, homophobia and other forms of discrimination that have very real consequences for the health and wellbeing of oppressed people.
If I start PrEP, do I have to keep taking it forever? What if I want to stop taking PrEP?
No, PrEP doesn’t have to be a permanent part of your life. It’s more of a use-as-needed prevention strategy. There may be times when PrEP is right for you and times where it might not be. It’s all good—your family doctor or nurse practitioner can help you get on and off PrEP safely.
Remember: 7 days of PrEP to prep for unprotected (anal). Twenty (20) days of PrEP to prep for unprotected (front hole) sex.
So that is the amount of time you need to take PrEP for it to work properly. What if a guy was taking PrEP daily for almost a year and then takes a break for a few months? To get protection this time around, he would still need to take PrEP for 7 or 20 days before having unprotected sex, and 4 weeks after the sexual encounter.
If PrEP works so well then why would I keep getting tested for HIV?
Ok, so here’s the thing: PrEP is only as good as we allow it to be. If you stick to your pill regimen, you’ll get full protection from HIV. But let’s be real—sometimes you might slip up and miss a day here and there. That means that there is still a chance you might get HIV, especially if you don’t use condoms.
Know your status and the status of your partner(s). This info will help you make the best decisions for your health. PrEP is more than just a pill—it’s an HIV prevention strategy that includes testing every three months and ongoing support from your family, friends, partner and/or health provider.