PrEP Guidebook for 2024

‍1. What is PrEP?

PrEP (short for Pre-Exposure Prophylaxis) is a medication that prevents HIV. It works to prevent HIV from establishing infection inside the body.

HIV PrEP contains drugs that are also used as treatment by people who have HIV. Although PrEP prevents HIV, it does not prevent other STIs, like syphilis, gonorrhea, chlamydia, etc.

It’s important to understand PrEP is part of what’s called ‘combination prevention’, which is the best method to prevent HIV and STIs. Combination prevention involves the use of multiple strategies that have each been proven to work. These include:

• Pre-Exposure Prophylaxis (PrEP)
• Post-Exposure Prophylaxis (PEP)
• HIV treatment
• Sexual health education
• Needle distribution programs and safe consumption sites
• Anti-poverty work, housing efforts
• Sex work decriminalization and protections
• Condom use

2. How does it work?

Rather than a physical barrier such as condoms, PrEP is a chemical barrier. It prevents the HIV virus from replicating in the body, leading it to die out and not get a hold of a person’s immune system. Essentially, PrEP works by preventing the HIV virus from reproducing, thereby preventing HIV transmission. 

Like any barrier, PrEP needs to be strong enough before it can prevent HIV. Usually that means being on PrEP for 7 days for anal sex and 21 days for vaginal sex. These timelines allow the PrEP medication to be absorbed by different tissues in the body. However, PrEP does not prevent other sexually transmitted infections, so it's important to use it with other prevention methods.

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3. How effective is PrEP?

PrEP is around 99% effective when taken as prescribed. Usually, PrEP is prescribed as a daily pill, to be taken everyday, once a day.

Some choose to take PrEP differently, opting for ‘on-demand’, or ‘event-based’ PrEP. This regimen involves taking two pills between two and 24 hours before condomless sex and then one pill daily, for two days after. This is nicknamed the 2-1-1 method. This method is also effective, but it requires strictly adhering to your pill schedule. It is also only approved for anal sex, not vaginal sex.

4. Is PrEP right for me?

It very well could be! PrEP is recommended for people with the highest risk of acquiring HIV, including (but not limited to):
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• Men who have sex with men
• Trans and non-binary people, if their sex partners were born with a penis (and still have one) and their other sex partners were born with a penis (and still have one)
• People from countries or communities with high HIV rates
• People who inject drugs and their sex partners
• People whose sex partners have detectable HIV
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So all in all, PrEP should be considered by those who are HIV negative and at higher risk for HIV. The decision to be on PrEP is made between patient and healthcare provider. A clinician will assess your HIV risk, and ask questions about your sexual and drug-use behaviour to determine if you’re a suitable PrEP candidate. It’s important to be aware that PrEP may have potential risks, and ongoing medical monitoring is necessary. All kinds of people can be on PrEP, for all kinds of reasons!

Some exams (bloodwork and urine) are required prior to initiating PrEP. These tests are necessary to ensure you remain HIV negative, that your body is tolerating PrEP well, and that you’re being tested and treated for STIs. If you decide to get PrEP through Freddie, your clinician and care coordinator will support you through all of the steps of your PrEP experience through check-ins and reminders

Learn more about whether PrEP is right for you in our article “Is PrEP right for me?”.‍

5. Truvada vs. Generic Truvada

A lot of people know PrEP as Truvada, while many are only familiar with PrEP. So, what’s the difference between Truvada and non-Truvada PrEP? 

"HIV PrEP", "Truvada" and "generic Truvada" are all (mostly!) interchangeable! Here is a nifty little breakdown:

• Truvada: a drug (combination of Tenofovir disproxil fumarate 300 mg/Emtricitabine 200mg) invented by the US pharmaceutical company Gilead Sciences back in 2001. It costs about $2000/month in the US.
• Generic Truvada: After the research, development, and marketing of a new drug like Truvada, companies like Gilead Sciences are given a patent to exclusively sell the drug for a certain period of time. The company can also determine the prices charged for the medication. After that period of time, other manufacturers have the right to create and sell a generic version of the same drug, which include the exact same components. With generics, you get the exact same drug, but at lower costs! Gilead Sciences made a deal with pharmaceutical manufacturer Teva to begin manufacturing generic Truvada for Canadians. This is the exact same drug as Gilead’s Truvada, just a fraction of the cost. It was approved for use in Canada in 2016 by Health Canada. There are now four different generic pharmaceutical companies that offer PrEP in Canada. The price is around $250/month, but it is covered (i.e. free!) for many Canadians through provincial insurance, and is also covered by most private insurance drug plans. You can read more about the cost below.
• HIV PrEP: Technically PrEP is not a drug. It is a type of treatment - the idea of taking a drug before getting a disease to reduce your risk of acquiring it. Right now, Truvada and generic Truvada are the most commonly used drugs for PrEP and so the terms are used interchangeably. That being said, there are a few other drugs used for HIV PrEP. These include Descovy, another pill version of PrEP, and Apretude, an injectable version of PrEP taken every one or two months. Make sure to discuss the best option for you with your healthcare provider, taking into account any potential risks or side effects. Generic Truvada is the only drug covered by provincial plans. 

6. Side Effects 

PrEP may present some short term side effects like nausea, headaches, and stomach aches. In general, less than 10% of PrEP patients experience any side effects, and if they do, they tend to cease after a week.

With regards to long term side effects, PrEP has been shown in some patients to lead to a decrease in bone mineral density, as well as kidney function - however they don’t cause complications unless patients have a pre-existing condition (which would be screened through lab work before PrEP initiation). The risk of these kidney and bone side effects is low. A recent study of 14,000 PrEP patients found 0.9% had these problems. The levels of bone and kidney health also return to normal levels after somebody stops PrEP.

That’s why PrEP requires lab testing every three months - just to make sure your body is tolerating PrEP well. If there are any issues, your clinician will help you manage them to keep you safe.‍

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7. Thinking about PrEP?

If you are thinking about PrEP, why not schedule a free phone call with one of our affirming clinicians? Don’t worry, having a consultation doesn’t mean you automatically have to go on PrEP! We’re here to help you understand if PrEP is for you, because it isn't for everyone. And if you’re on the fence, that’s okay – the best place to get your questions answered is one-on-one with an experienced healthcare professional who knows the ins and outs of life on PrEP. With Freddie, you’ll have your very own dedicated Care Coordinator assigned to you; if you hate calling customer service lines and waiting on hold, this is especially fantastic news for you because you can quite literally just text your Care Coordinator directly with your questions and concerns, and they will figure out exactly what you need behind-the-scenes and get back to you in a timely manner.