Let’s Have a PrEP/PEP Talk!

This month’s topic is PrEP and PEP. These HIV-prevention strategies are for more people than you may realize, maybe even yourself. Northland Cares has been providing services and health care to people living with HIV for more than 20 years, but it’s just in the last two that we’ve been able to offer these important prevention services.

Pre-Exposure Prophylaxis (PrEP) is a safe medication that can be taken daily, and we now offer an injectable version that will prevent HIV transmission if taken as prescribed. PrEP medications do not prevent any other sexually transmitted diseases, but we test our PrEP patients every three months for other STDs to be sure we can provide treatment when it’s needed. All STDs are either treatable or curable, and we offer services for both.

How do we know that PrEP medications are safe and effective? I’m glad you asked! We know this because we have used these medications for years to treat HIV-positive patients and been able to successfully suppress the virus in them with these pills. Some people have concern about PrEP medications because they’ve heard that some people develop kidney problems using a medication called Truvada. The adverse effects of Truvada affect 1-3 percent of those taking it, and once they quit taking it and switched to a different prescription those issues resolved.

A range of medications can be prescribed for PrEP HIV prevention, including a new injectable medication called Apretude (aka cabotegravir), an excellent preventive medication. This does not require taking a daily pill, but it does require regular treatment, so patients can’t miss their appointments.

Our providers are infectious-disease specialists, so all our patients receive a very high level of preventive care. PrEP medications are for everyone. If you enjoy having sex with a variety of people, or occasionally step out on a partner, this is an excellent prevention strategy for you. For those who occasionally have sex with different people in the course of a year, PrEP is a great prevention tool.

I hear people say that we all should just use protection or have a committed monogamous relationship, but what’s real is that those are just not for everyone. There are many reasons why some people don’t use prophylaxis (condoms) and are not in committed relationships, but they still want to enjoy sex and the intimacy of sex.

Did you know that 85% of new cases of HIV in heterosexual women are from unprotected heterosexual encounters? It's true, fact-check me. Still, many people inaccurately think of HIV as a disease that mainly affects the LGBTQ+ community. Well, there are more cases of HIV in the heterosexual community than in the LGBTQ+ community, and those among heterosexuals are on the rise, largely due to this misconception.

I work in outreach, so I hear it all in talking with members of our community. There are many misconceptions circulating with help from well meaning but poorly informed individuals. When we can, we educate.

Did you know that the LGBTQ+ community tends to be more responsible with their unprotected sex than the heterosexual community? It’s true, and we see that daily. I want to invite anyone who is in a swinger group, a party-and-play group, or has sex with anonymous partners or one-night stands to come and get a free rapid HIV and Hepatitis C test from us at Northland Cares. We provide curative services for Hep C, and that's much easier to get than HIV.

Let’s have a PEP talk. Post-Exposure Prophylaxis (PEP) is an Emergency HIV intervention that we carry in our office. A lot of people might need PEP: first-responders, housekeepers, thrift-store employees, janitorial staff, sanitation workers, trailhead, creek or park clean-up volunteers, and anyone who is at risk of or experiences a needle-stick injury.

This medication is also for people who are victims of sexual assault or have had their beverage or food drugged and are victims or possible sexual/exploitative crimes. PEP is an excellent HIV prevention strategy. We only have 72 hours from the time of exposure to get the medications into the person — the closer to the time of exposure, the more effective the medications are. Did you know HIV can survive in a discarded syringe for 42 days? Even a dirty, janky-looking syringe can hold live virus material. It only takes a split second for it to enter your system through a needle-stick injury.

Law-enforcement and rape-crisis workers, you can add our services to yours by simply calling us when you encounter a victim of sexual assault. We’ll come to you, the hospital, urgent-care center, shelter, wherever, with the medications and a new-patient packet. We’re only a phone call away, or just walk into one of our offices in Prescott and Cottonwood. You do not need an appointment to start PEP, you just have to walk in or call us if you live farther away. We can meet you in a mutually safe location to get you started on PEP.

To date we have not had any PEP patient become HIV-positive at Northland Cares. If you are having sex with someone with unknown HIV status and the condom breaks, call us or come in for support. If you hook up with someone, check their medicine cabinet and find HIV medications and are afraid to ask, you can call us. You can also ask the person if they are undetectable. HIV-positive people who are undetectable, meaning their viral load cannot be detected using venipuncture labs, cannot transmit the virus, even with unprotected sex.

The NIAID followed 2,500 couples in which one person was HIV-positive and the other negative for ten years, and they reported all sorts of unprotected sex. The agency found that when the person who was HIV-positive had an undetectable viral load, HIV was not transmitted to the partner. That is some good solid evidence!

This is Hedda Fay reminding you that we’re here for you, with excellent, safe HIV-prevention strategies, in the form of PrEP and PEP, and free prophylaxis! We want you to have enjoyable and safe sex!