Prevent HIV

PrEP

What is Pre-Exposure Prophylaxis (PrEP)?

PrEP stands for pre-exposure prophylaxis:

• Pre = Before
• Exposure = Coming into contact with HIV
• Prophylaxis = Treatment to prevent an infection from happening

PrEP is a once daily pill, a shot every other month, or a shot every six months taken by an HIV negative individual that reduces their risk of HIV infection, it is not a cure for HIV. PrEP can stop HIV from taking hold and spreading throughout your body.

PrEP is highly effective for preventing HIV. When taken daily, PrEP has been shown to reduce the risk of HIV infection through sex by about 99% and by at least 74% among people who share needles. PrEP does not protect against other sexually transmitted infections (STIs) or pregnancy, so using effective birth control methods and condoms are still important for the sexual health of individuals taking PrEP.

There are four approved medicines for PrEP: Truvada®, Descovy®, Apretude®, and Yeztugo®. Truvada® is a daily pill for people at risk of getting HIV from sex or injection drug use. Descovy® is also a daily pill, but it's only recommended for people at risk from sex, not for those at risk from receptive vaginal sex.  Apretude® is a shot prescribed every other month and is recommended for people at risk of HIV from sex. Yeztugo®, is a shot prescribed every six months and is recommended for people at risk of HIV from sex.

PrEP is different from Post-Exposure Prophylaxis (PEP). PEP is a month-long course of medications that an HIV negative individual takes after they may have come into contact with HIV to reduce their risk of becoming infected. The Contra Costa County Public Health Department recommends starting PEP within 36 hours after a possible exposure to HIV. Exposures beyond 36 hours may warrant PEP on a case-by-case basis. If you may have been exposed to HIV and would like more information on PEP, please contact your primary care provider, your closest Planned Parenthood, or ask about PEP at your local emergency room. If you are refused PEP at any Emergency Department or medical clinic, please contact the Contra Costa Public Health Department, HIV/STI Program at prepme@cchealth.org or 925-412-5431 (Monday through Friday 8:30 am to 5:00 pm).

PEP

What is Post-Exposure Prophylaxis (PEP)?

PEP stands for post-exposure prophylaxis. This means taking antiretroviral medicine (ART) to prevent HIV after a possible exposure.

PEP must be started within 72 hours after a recent possible exposure to HIV, but the sooner you start PEP, the better. The Contra Costa County Public Health Department recommends that individuals start PEP within 36 hours after possible exposure to HIV. If you're prescribed PEP, you'll need to take it once or twice daily for 28 days. PEP is highly effective in preventing HIV when administered correctly.

How well does PEP work?

If taken within 72 hours after possible exposure, PEP is highly effective in preventing HIV. To be safe, you should take other actions to protect your partners while you are taking PEP. This includes always using condoms with sexual partners and not sharing needles, syringes, or other equipment to inject drugs.

Is PEP right for me?

Talk to your health care provider, an emergency room doctor, or an urgent care provider right away (within 72 hours) if you think you've recently been exposed to HIV:

1. during sex (for example, if the condom broke)
2. through sharing needles, syringes, or other equipment to inject drugs
3. if you have been sexually assaulted

PEP is for emergency situations

• PEP is given after a possible exposure to HIV.
• PEP is not a substitute for regular use of other HIV prevention methods, including condoms and PrEP.
• PEP is not the right choice for people who may be exposed to HIV frequently.

Talk to your health care provider about PrEP (pre-exposure prophylaxis) if you are at ongoing risk for HIV.

Does PEP have side effects?

• PEP is safe but may cause side effects like nausea in some people.
• These side effects can be treated and aren't life-threatening.

Where can I get PEP?

Your health care provider or an emergency room doctor can prescribe PEP. Talk to them right away (within 72 hours) if you think you've recently been exposed to HIV.

If you are refused PEP at any Emergency Department or medical clinic, please contact the Contra Costa Public Health Department, HIV/STI Program at prepme@cchealth.org or 925-412-5431 (Monday through Friday 8:30 am to 5:00 pm).

Can I take PEP every time I have unprotected sex?

PEP is not the right choice for people who may be frequently exposed to HIV, including people who have sex without a condom with a partner who is HIV-positive or a partner with an unknown HIV status. PEP is given after a potential exposure to HIV, so more medicine is needed to block infection than with PrEP (Pre-Exposure Prophylaxis).

Learn more about PEP from the Centers for Disease Control and Prevention's (CDC) website.

Is PrEP right for you?

PrEP is a safe and highly effective HIV prevention tool to improve your sexual health and wellness. PrEP is for people who are HIV-negative and vulnerable to getting HIV from sex or injection drug use. PrEP can be prescribed for gay and bisexual men, for heterosexual men and women, for transgender individuals, and for genderqueer or nonbinary people.

PrEP may be a good choice for you if you test negative for HIV and any of the following apply to you:

You have had anal or vaginal sex in the past 6 months and:

• have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load)
• have not consistently used condoms
• have been diagnosed with an STI in the past 6 months

You inject drugs and:

• have an injection partner with HIV
• share needles, syringes, or other equipment to inject drugs (for example, cookers)

You have been prescribed PEP (post-exposure prophylaxis) and:

• engage in behaviors that may put you at risk
• have used PEP multiple times

If you are considering getting pregnant and your partner has HIV, talk to your doctor about PrEP. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, and/or while breastfeeding.

Can adolescents take PrEP?

Yes. PrEP is approved for use by adolescents without HIV who weigh at least 77 pounds (35 kg) and who are at risk for getting HIV from sex or injection drug use.

If you identify with any of the above, please talk with your medical provider or the Contra Costa County PrEP Navigator using the form below.

Learn more about PrEP from the Centers for Disease Control and Prevention's (CDC) website.

How do I take PrEP?

• Meet with a health care provider to find out if PrEP is right for you.
• Your health care provider will test you for HIV, sexually transmitted diseases (STDs), and will conduct lab work to make sure PrEP is safe for you.
• PrEP is a single pill taken once daily, taken with or without food, or a shot every other month. In order to benefit from this medication, it should be taken as prescribed.
• You will need to return to your health care provider every two to three months for repeat HIV/STI tests, prescription refills, and follow-up.
• Individuals who only have anal sex may choose a non-daily dosing regimen called 2-1-1 in which they take pills before and after sex. This non-daily dosing regimen can only be done with Truvada®. Ask your PrEP provider if 2-1-1 is safe for you.
• If you need help paying for PrEP or finding a health care provider, contact our PrEP Navigator using the form below.

Is PrEP safe? What are the side effects?

There are four different medications that have been approved for PrEP: Truvada®, Descovy®,Apretude®, and Yeztugo®. Each medication is proven to be safe and most people on PrEP take it with little or no side effects.

Short Term Side Effects

When starting PrEP, about 1 in 10 individuals may experience nausea, diarrhea and/or headaches. These symptoms usually go away in a few weeks. Other side effects are rare (see below).

Rare Side Effects

Truvada®

• Small decrease in kidney function, which will go back to normal if you stop the medication
• Slightly decreased bone density, but no increased risk of fractures

Descovy®

• Small increase in LDL cholesterol, often called the "bad" cholesterol
• Slight increase in body weight

Ask your PrEP provider for more information so you can make the best choice for yourself.

Paying for PrEP

How Do I Pay For PrEP?

Paying for PrEP can be expensive, but we may be able to help! If you need help paying for your PrEP prescription, doctor visits, or labs there are programs that can help lower or eliminate the cost (scroll to the table at the bottom of the page for more information).

Paying For PrEP If You Are Uninsured

The State of California's PrEP Assistance Program (PrEP-AP) may be able to help cover medical costs related to getting on PrEP if you do not have insurance.

What does the PrEP-AP Cover?

1. Certain PrEP-related medical services, such as doctor visits and labs
2. Medications used to treat sexually transmitted infections (the PrEP medication will be covered for free by the drug manufacturer*)
3. If you are a current PrEP-AP client who has stopped PrEP and are worried about a potential exposure to HIV within 72 hours, the PrEP-AP may be able to help pay for nPEP (non-occupational post-exposure prophylaxis), if clinically recommended. Existing PrEP-AP clients will be evaluated by their healthcare provider for PEP

Note: Clients are required to see a provider in the PrEP-AP Provider Network. Search for a provider on our web app.

Qualifications

You may qualify if you are:

1. A California resident, regardless of immigration status
2. An adult age 18 or older or minors between the ages of 12 and 17 who weigh at least 77 lbs.
3. HIV Negative
4. Have an annual Modified Adjusted Gross Income (MAGI) of $62,450 or less for a household of one, or less than $84,550 for a household of two
5. Not fully covered by Medi-Cal or other health insurance plans (if you are eligible, the PrEP navigator can help you enroll in Medi-Cal)

*Please Note: if you are uninsured, you will be enrolled in both PrEP-AP and the Gilead Patient Assistance Program. The PrEP-AP will pay for PrEP-related medical costs and medications to treat sexually transmitted infections and Gilead will cover the cost of the PrEP medication.

Call the Contra Costa County PrEP Navigation team today to see if you qualify or to enroll: 925-412-5431. You can also send an email by filling out our online form below.

Paying for PrEP with Insurance

Most health insurance plans, including Medi-Cal, cover PrEP. We encourage you to check with your insurance provider to see if the medications approved for PrEP, Truvada®,  Descovy®, or Apretude® are covered on your plan. You may have a copay for the medication depending on your coverage plan. There are copay assistance programs available to cover the shared cost of your prescription. Please call our PrEP Navigation team if you need assistance enrolling in one of the copay assistance programs listed below:

Important Announcements

In June 2019, The U.S. Preventative Services Task Force (USPSTF) issued a Grade A recommendation for PrEP.

• A "Grade A" is the highest recommendation that a prevention service can get

What this means for you:

• Most California health plans are now required to cover PrEP without cost sharing, meaning that there should be no out-of-pocket costs for the medication
• This went into effect January 1, 2021

Read the full press release: Commissioner Lara Issues Notice To Take Action in Reducing HIV Transmission and Ensure Health Insurance Companies Cover HIV PrEP Without Patient Cost Sharing

Truvada® for PrEP has gone generic!

What this means for you:

• The generic medication TDF/FTC will be just as effective as the brand name medication Truvada®
• If you have Medi-Cal, there will be no changes for PrEP (Medi-Cal covers PrEP 100%)
• If you have private insurance and are charged a copay for the generic TDF/FTC, you can request to fill brand-name Truvada® (may require an "override") and use the Gilead Co-Pay Card to cover the cost
• Learn more about copay assistance for generic TDF/FTC

When filling your next PrEP prescription at the pharmacy, if you face challenges, or if you are charged more than you've been charged in the past, please contact your PrEP health care provider or the Contra Costa PrEP Navigator!

Read more about Truvada® going generic