HIV Treatment and Prevention

Last updated June 2022

HIV is more preventable than ever. A healthy and fulfilling life is possible – no matter your status. Condoms are instrumental in HIV prevention. Screening for and treating sexually transmitted infections (STIs) also reduces the risk of HIV transmission. Regular HIV testing helps to inform safer sex practices, and possibly treatment options.

Let’s talk about some of these HIV prevention and treatment medication options: Open communication, PrEP, PEP and Undetectable (U=U).

Open Communication and Early Detection

Regardless of an individual’s HIV status, open communication with sex partners and health care providers is important. Talking openly can build trust and inform lifestyle decisions. ⁶ Discussing HIV status shows a commitment to personal safety and the safety of others. Sharing HIV status provides individuals with the full picture needed to provide consent and clearly communicate expectations and boundaries around sexual activities. Consent also includes agreements about condom use and other STI and HIV prevention methods. If HIV status is unknown, testing with sex partner(s) can create a sense of support and care for each other. For more information, visit the How to Talk with a Partner page.

PrEP

What is PrEP?

PrEP, or Pre-Exposure Prophylaxis, is a medicine to help maintain HIV-negative status. It is another layer of protection to prevent HIV transmission. PrEP involves taking medication regularly to greatly lower the risk of HIV transmission. ¹ 

PrEP is a low-cost or free safe medication that works for everyone, regardless of gender identities, sexual orientation and drug-use status. ¹   

Unlike condoms, PrEP does not protect from STIs, such as gonorrhea, syphilis, chlamydia or genital herpes. PrEP should be used in addition to using condoms for increased protection against STIs.

Who should take PrEP?

People who are at high risk for acquiring HIV include:

• Those who are in a sexual relationship with someone who is HIV-positive or at increased risk of acquiring HIV
• Men who have sex with other men and have had anal sex without a condom
• Men who have sex with other men and have been diagnosed with a sexually transmitted infection in the past 6 months
• Those who have sex without condoms with people who are at high risk for HIV (for example, IV drug users or men who have sex with other men)
• Those who share needles with others
• Those who have been prescribed PEP (post-exposure prophylaxis) and report continued risk behavior or have used multiple courses of PEP ²

Talk to a medical provider about the risk for HIV transmission and whether PrEP is a good option.

PrEP medications are available to Alaska Tribal Health Beneficiaries at no cost. Others who may need PrEP may eligible to receive the medication at little-to-no-cost through the federal “Ready, Set, PrEP” program. Talk to a medical provider about enrolling or visit https://www.getyourprep.com.

How effective is PrEP?

PrEP can reduce the risk of getting HIV from sex by about 99% when taken as prescribed.³ Honest conversations with a medical provider about sexual activity, frequency and number of partners ensures effective prescription dosages.

However, PrEP does not protect from other STIs, such as gonorrhea, syphilis, chlamydia or genital herpes. For best protection against STIs, condoms should always be used with PrEP. Condoms provide increased protection for persons at increased risk of acquiring HIV.

The effectiveness for PrEP depends on the following lifestyle factors:

Anyone who believes that they may be at high risk for HIV should speak to a medical provider about their risk for HIV and starting PrEP.

PEP

What is PEP?

PEP, or Post-Exposure Prophylaxis, is an emergency-use medication that is protects people from the HIV virus after being exposed. PEP must be started within 72 hours of suspected HIV exposure, although it is most effective the sooner it is started. Once started, PEP is taken daily for 28 days. ⁴ When taken correctly, PEP is very effective in preventing HIV infection.

Like PrEP, PEP works for everyone, regardless of gender identities, sexual orientation and drug-use status. For a possible HIV exposure, visit a local emergency department or talk to a medical provider immediately about the possible exposure and the need to start PEP.

When do I use PEP?

PEP is for emergency situations only, when an HIV exposure has happened. PEP is not recommended for people who may be exposed to HIV frequently, and is not a substitute for other HIV prevention tools, like condoms or PrEP. If there is an ongoing risk for getting HIV, speak to a medical provider about starting PrEP. ⁴

Although there are a few possible ways to acquire HIV, here are some examples:  

• condomless sex, especially with a person whose HIV status is positive or unknown ⁹
•  injection-drug use, especially if sharing any equipment, like needles, syringes & cookers ⁹
• condom breaks during sex ⁹
• sexual assault, including any non-consensual sexual activity ⁹

What is U=U?

The goal of both PrEP and PEP is to keep the HIV virus in the bloodstream at very low levels, to the point where the HIV virus is undetectable in standard blood tests. When the HIV virus is at these ‘undetectable’ levels, the HIV virus cannot be transmitted to another person through sex. This is also known as U=U, short for “Undetectable = Untransmittable.” ¹⁰

Being undetectable does not mean that HIV is cured. There is still HIV within the body, although it has been reduced to very small amounts by these medications. This means that if treatment stops, the viral load will increase – affecting a person’s health and causing HIV to be transmittable again. ¹¹ Regular HIV screening leads to early detection and intervention, which can reduce HIV-related complications, greatly decrease HIV transmission to others and reduce risk of serious non-AIDs-related diseases. ⁸ Again, a rich and fulfilling life is possible through safer sex practices, such as routine use of condoms and preventative medication, as well as HIV treatment, if applicable.