PrEP (short for Pre-Exposure Prophylaxis) is a once-a-day pill that prevents HIV. The medication works to prevent HIV from establishing infection inside the body.
HIV PrEP has two main components: emtricitabine and tenofovir-disoproxil-fumarate. These components 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:
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 components to be absorbed by different tissues in the body.
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 2 pills 2-24 hours before HIV-transmissible contact and then 1 pill daily, for two days after (nicknamed the 2-1-1 method). This method is also effective, although less so than everyday PrEP since PrEP’s effectiveness is directly correlated to adherence (taking medication as prescribed). Freddie advocates taking PrEP every day. As they say, safe is better than sorry!
It very well could be! PrEP is recommended for people with the highest risk of acquiring HIV, including (but not limited to):
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. 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?”.
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 and Truvada and generic truvada are all (mostly!) interchangeable! Here is a nifty little breakdown:
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 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.
Thankfully, PrEP is free or low cost for most Canadians! Whether or not you pay for PrEP, and how much you would pay, depends on a couple of factors: the province where you reside, and your clinical eligibility. Here is a summary by province for the provinces Freddie serves:
PrEP is fully covered provincially (i.e. free!) for all Albertans who clinically qualify! That means that if you meet certain criteria (about sexual behaviour, for example), you can access free PrEP with your healthcare card.
The lowest cost option to get PrEP in Nova Scotia is through private insurance. Most insurance plans cover 80% of the cost of PrEP! And with Freddie’s financial assistance programs, we can help lower the cost of your co-pay!
PrEP is also covered by Nova Scotia’s provincial Pharmacare program for those who do not have private insurance, however there are unfortunately very high deductibles and co-pays involved for anyone who earns more than $25,000 per year. You can calculate how much you would pay through this online calculator: https://novascotia.ca/dhw/pharmacare/family-calculator.asp Freddie is working on developing financial assistance programs for our Nova Scotia patients using Pharmacare.
The situation is a bit more complicated here.
Ontario residents under 24 years of age can access free PrEP through the Ontario Health Insurance Plan!
If you’re 25 or older, there’s two main scenarios in the province:
The lowest cost option to get PrEP in Quebec is through private insurance. Most insurance plans cover 80% of the cost of PrEP! And with Freddie’s financial assistance programs, we can help lower the cost of co-pays associated with labs!
PrEP is also covered by RAMQ for those who do not have private insurance, however there are unfortunately co-pays involved. You would pay up to $93 a month for PrEP through RAMQ, although if you are already paying co-pays for other prescription drugs, the amount you’d pay for PrEP is less.
Unfortunately, financial assistance programs to help with the cost of PrEP are not allowed under Quebec law, so Freddie is not able to offer them.
PrEP is covered provincially (i.e. free!) for all Saskatchewanians who clinically qualify! That means that if you meet certain criteria (about sexual behaviour, for example), you can access free PrEP with your healthcare card.
You can see if you qualify for free or low cost PrEP through our one-minute eligibility questionnaire: https://app.gofreddie.com/welcome
Like with any prescribed medication, there are some steps one needs to take before starting on PrEP:
Should you get PrEP in person or online? You can learn more in our article “3 benefits of Accessing PrEP online.” As the title implies, we might be a bit biased :)
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. If , but 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.