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Patient Perspective on PrEP Options
Choosing On-Demand PrEP: A Patient’s Perspective

Released: June 06, 2023

Activity Information

Activity

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Key Takeaways
  • I learned about the different PrEP options through participation in PrEP studies and attending conferences.
  • Although I prefer natural remedies and like to avoid pharmaceutical medicines, I choose to use PrEP to protect myself against HIV.
  • For me, on-demand dosing of oral PrEP is preferable to taking it every day to limit my exposure to the medication and its side effects.

My Journey on PrEP
It has been approximately 10 years since I first heard about pre-exposure prophylaxis (PrEP) for HIV prevention. At the time, I didn’t know much about HIV. I was dating a guy and had been using condoms, until at some point we decided to stop using them. Only then did he share his HIV diagnosis with me, a diagnosis he had known about for 3 years.

I was in shock and wished he had told me before we stopped using condoms, but he assured me that the virus was pretty much untransmissible if he was undetectable—mind you, this was before U=U was confirmed in studies.

I went to his next doctor visit with him, and I was introduced to PrEP. I wasn’t interested in taking a pill every day, so I decided against using PrEP at that time, and we went back to using condoms.

Beginning PrEP
Now fast forward to 2017—I moved to New Orleans and started working in HIV prevention. My past experiences drove me to this field. Initially, I began as a volunteer and advocate. [CODER link to: https://clinicaloptions.com/CE-CME-program/hiv/optimal-trt-and-prevention/100003047]

This was the time I started oral daily PrEP. I received it for free with a copay card. Because I was already getting routine HIV testing done and had a PrEP navigator available, it was a fairly easy process.

I was interested in PrEP options that didn’t mean taking a pill every day, so I enrolled in the first study evaluating injectable PrEP. It was a double-blind study, so I took the pill and injectable without knowing which was the placebo. At the end of the trial, I found out I was taking the active pill and was a little bummed.

In 2019, I learned about situational PrEP, or “on-demand” PrEP, at a conference. “On-demand” PrEP is the “2-1-1” dosing strategy where you take 2 pills 2-24 hours before expected sexual activity, then you take 1 pill 24 hours after, and then 1 pill 24 hours after that. Of the 2 methods of oral PrEP, I prefer “on-demand” to daily dosing.

Selecting Between Options
When considering my options for PrEP, I knew I did not want to take a pill every day. But the issue wasn’t remembering to take a pill every day. Rather, I am mindful of chemicals that enter my body and prefer natural remedies. I don’t mind taking vitamins, but I don’t like the idea of taking pharmaceutical medicines.

On top of it, I know these medicines are usually associated with side effects. I remember when I first started taking oral daily PrEP. I had a lot of diarrhea. Luckily, it was temporary, and I don’t have diarrhea anymore. I guess my body was just getting used to it, but I know of other, more subtle side effects of PrEP like the potential impact on bone density from the pill.

In the end, it’s a matter of balancing out the pros and cons and asking yourself which you would rather experience: medication side effects or HIV? For me, I would rather be on PrEP, but preferably on a regimen that is dosed less frequently than daily.

Your Thoughts?
What factors have influenced your patients’ selection of available PrEP options? Join the discussion by posting a comment.