PrEPared

My name is Alexander. My nickname is Beastly. I write about sex.

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Hello
How are you Alexander?
I am Aaliyah from Uganda Kampala (East Africa)
I just want to ask you something
Does PEP work

**A note to readers: this person sent me a message via my Facebook page. This isn’t my preferred way to receive messages — my inbox is — simply because it’s less anonymous. I know a bit more about this person because I can see their profile.

Yes, PEP works. From the Centers for Disease Control: PEP (post-exposure prophylaxis) “must be started within 72 hours after a recent possible exposure to HIV. If you think you’ve recently been exposed to HIV during sex or through sharing needles…talk to your health care provider or an emergency room doctor about PEP right away.”

HIV specialists bemoan the fact that two relatively new terms, PEP and PrEP, sound so similar, and this has led to widespread confusion. While the terms have only one letter difference between them, they describe two very different things.

PEP is something you take if you’ve been exposed to HIV, either through sex or sharing needles, and it should be taken only in an emergency. It’s the HIV equivalent of a “morning-after” pill.

PrEP (pre-exposure prophylaxis) is a medication that high-risk HIV-negative people (sexually active people with multiple partners, trans women, gay men, and partners of HIV-positive people) take continuously to prevent HIV infection. Both are HIV prevention methods — they are not for HIV-positive people — and both work. But PEP mandates a narrower window — it is shown to be ineffective more than 72 hours (three days) after exposure, so the longer you wait, it’s less likely to be effective. The CDC says that every hour counts.

If you’re prescribed PEP, you’ll have to take it once or twice daily for 28 days. Unlike PEP, PrEP is a pill you take every day by mouth. When you take PrEP diligently, you don’t have to worry about when you are exposed to HIV, as you are constantly protected. If you are sexually active and frequently exposed to HIV, PEP is not the right option for you — PrEP is.

The risk with PEP is that it’s hard to know when you’re exposed. I didn’t know that I had been exposed to HIV when I tested positive — most people don’t. This is why, if you’re a sexually active HIV-negative person, PrEP is the better option.

Both prevention methods work. Both prevent HIV. Both only prevent HIV, not other STIs like gonorrhea and syphilis. There is no need to take both — you should do one or the other. On their own, both are not a complete sexual health strategy; regular STI testing is still necessary if you’re sexually active and the CDC recommends using condoms in addition to both PEP and PrEP.

I have to note that there are currently two medications used for PrEP: Truvada and Descovy. Truvada for PrEP is recommended to prevent HIV for all people at risk through sex or injection drug use. Descovy for PrEP is recommended to prevent HIV for people at risk through sex excluding people at risk through receptive vaginal sex. Descovy has not yet been studied for HIV prevention for receptive vaginal sex, so it may not be effective.

I hope this information was helpful. I’ve never been to Uganda but I’ve been close. I lived in Zambia for many years and traveled nearby to Botswana and Zimbabwe. I’m not a doctor, but I’d recommend PrEP over PEP because it gives you the power to protect yourself — you don’t have to worry about sex partners who don’t stay on top of their sexual health, don’t know how to properly wear a condom, and so on. It takes a major worry — HIV — off the table as long as you take the medication as prescribed.

Go to a sexual health clinic in Kampala and ask a doctor about PrEP as a regular treatment. And if you’ve been exposed to HIV within the last 72 hours, ask about starting PEP right now.

Love, Beastly