Health 101

HIV prevention has advanced significantly, offering highly effective medications that can be categorized into two primary types: Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). These biomedical interventions are crucial tools in reducing HIV transmission and acquisition.

PrEP involves taking specific medicines before potential exposure to HIV to prevent infection.

What is PrEP? PrEP consists of medications taken to prevent contracting HIV through sexual activity or injectable drug use. The goal is to establish protective levels of medication in the body, which significantly reduces the risk of HIV acquisition.

Who is PrEP for? PrEP is recommended for individuals at substantial risk of HIV acquisition. This includes:

• Sexually active adults and adolescents.

• Men who have sex with men (MSM) and transgender women (TW), who experience disproportionately high rates of HIV.

• Heterosexual men and women at risk.

• Persons who inject drugs (PWID).

How Effective is PrEP? PrEP is highly effective when taken consistently and as prescribed.

• For gay, bisexual, and other MSM taking tenofovir disoproxil fumarate (TDF) as PrEP, efficacy was estimated at 99% for four or more doses per week.

• For vaginal tissue, drug levels associated with significant protection against HIV infection required 6-7 doses per week, indicating over 85% adherence.

• The Centers for Disease Control and Prevention (CDC) recommends PrEP for adolescents weighing at least 35 kg and adults who are HIV-negative and at substantial risk.

Types of PrEP: There are two main forms of PrEP:

1. Oral PrEP: This involves taking a pill daily. The recommended daily oral PrEP regimens are emtricitabine (F) in combination with tenofovir disoproxil fumarate (TDF) for men and women, or tenofovir alafenamide (TAF) for men and transgender women. Daily adherence is crucial for its effectiveness.

2. Long-Acting Injectable PrEP: This involves intramuscular injections of cabotegravir (CAB) every two months or lenacapavir (LEN) every six months. This option has been shown to reduce the risk of HIV acquisition among adults and adolescents.

Accessing PrEP: PrEP is designed to be free or low-cost for everyone. To access PrEP, you can:

• Chat with the OSMe Buddy

• Call the Hub at (844) 482-4040

• Visit hivhub.org for more information and local resources for both your health and other needs.

• Talk to your healthcare provider. PrEP can only be prescribed by a healthcare provider.

Important Considerations for PrEP Use:

• Adherence is Key: Consistent use of PrEP is essential to maintain protective drug levels in your body. If you plan to stop PrEP injections, discuss it with your provider, as stopping without another effective prevention method can put you at risk.

• No STI Protection: PrEP prevents HIV but does not protect against other sexually transmitted infections (STIs). It is important to continue using condoms to prevent other STIs and unplanned pregnancies.

• Follow-Up Care: Regular follow-up visits, typically every three months for oral PrEP, are necessary for HIV tests, other required tests, and prescription refills.

PEP is a course of medicine taken after a potential exposure to HIV to prevent the virus from establishing itself in your body.

When to Use PEP: PEP is recommended when a nonoccupational exposure (e.g., sexual, needle) to non-intact skin or mucous membranes has occurred, presenting a substantial risk for HIV transmission, and the source has HIV without sustained viral suppression or their viral status is unknown.

• Urgency: PEP must be started as soon as possible, ideally within 24 hours, and no later than 72 hours after exposure. Delaying the initial dose should not occur due to pending lab results.

• Duration: A full PEP course lasts 28 days.

• Transition to PrEP: If you anticipate repeat or ongoing HIV exposure after completing PEP, your healthcare professional should offer PrEP options and create a transition plan.

Accessing PEP: Healthcare professionals should ensure the first dose of PEP is provided as soon as possible. They may provide a starter pack for 3-7 days, with a prescription for the remainder, or the entire 28-day course, especially if follow-up visits are challenging. Uninsured patients can enroll in patient-assistance programs. 

Vaccinations play a critical role in comprehensive sexual health, protecting against various infections and diseases. Integrating recommended vaccinations into your healthcare routine is a proactive step towards overall well-being.

• Hepatitis A and B Vaccines: These vaccines are recommended for individuals who are sexually active with multiple partners or are being evaluated or treated for an STI. They are also advised for MSM, persons who inject drugs, those with chronic liver disease, and individuals with HIV or hepatitis C infections who have not had previous hepatitis A or B.

• HPV (Human Papillomavirus) Vaccine: The HPV vaccine protects against various cancers, including anal, penile, and oropharyngeal cancers. While knowledge about HPV-related cancers and vaccination is often insufficient among sexual minority men, most are receptive to getting vaccinated. It is crucial for healthcare professionals to openly discuss HPV prevention and detection options with sexual minority male patients. For sexual minority women, potential misconceptions about HPV risk can lead to lower vaccination and screening rates; therefore, proper training for frontline staff and providers is needed to ensure comprehensive care.

• Mpox Vaccine: Administering the mpox vaccine is recommended as indicated. 

Doxy PEP is a medication used after sexual activity to prevent bacterial STIs like syphilis, chlamydia, and gonorrhea.

Who is Doxy PEP for? CDC recommends that providers counsel gay, bisexual, and other MSM, and transgender women (TGW) who have had at least one bacterial STI (syphilis, chlamydia, or gonorrhea) in the past 12 months about the benefits and harms of Doxy PEP. It may also be discussed with MSM and TGW who have not had a recent STI but plan to engage in sexual activities that increase the likelihood of STI exposure.

How to Use Doxy PEP: The recommended dose is doxycycline 200 mg, taken once within 72 hours of oral, vaginal, or anal sex, not exceeding 200 mg per 24 hours.

Important Considerations for Doxy PEP:

• Comprehensive Approach: Doxy PEP should be implemented within a holistic sexual health strategy. This includes risk reduction counseling, STI screening and treatment, recommended vaccinations, and linkage to HIV PrEP or HIV care as appropriate.

• Regular Screening: Persons prescribed Doxy PEP should undergo bacterial STI testing at sites of exposure at baseline and every 3–6 months. HIV screening is also recommended for HIV-negative MSM and TGW.

• Discuss Benefits and Harms: Counseling should include a discussion of potential side effects such as photosensitivity, esophageal discomfort, gastrointestinal issues, and the potential for antimicrobial resistance. The ongoing need for Doxy PEP should be assessed every 3–6 months. 

Your health is your power. We encourage you to:

• Chat: Chat with the OSMe Buddy

• Connect: Call the Hub at (844) 482-4040 to speak with someone about accessing vaccines, HIV/STI testing, PrEP, PEP, and other resources.

• Learn More: Visit hivhub.org for detailed information on vaccines, HIV, STIs, PrEP, PEP and other resources.

• Talk to a Provider: Discuss your sexual health needs, including PrEP, PEP, and recommended vaccinations, with a healthcare professional. Utilize resources like hivhub.org to find a provider.

• Prioritize Screening: Regular HIV and STI testing is a crucial step in maintaining your sexual health.

By actively engaging with these preventive measures and resources, you contribute to a healthier, more empowered Latine LGBTQ+ community.