Difference Between PrEP vs. PEP for HIV Prevention

Difference Between PrEP and PEP for HIV Prevention

You’ve likely heard about both PrEP and PEP for HIV prevention. These treatments are proven effective in preventing HIV transmission, but with one very important distinction: one is for pre-exposure, while the other is for post-exposure to HIV.

In turn, while both have similar objectives, the differences in PrEP vs. PEP for HIV prevention depend on the individual and whether or not they’ve already been exposed. Below we share more information about both options, what you need to know about each treatment, and how you can access them through your health provider.

What is PrEP?

The acronym PrEP might help you remember the main difference between PrEP and PEP, which is that PrEP is a medication designed to prevent an individual from getting HIV before they’ve even been exposed to the virus.

PrEP stands for preexposure prophylaxis. This medication is designed to help prevent individuals from getting HIV if they take it before being exposed.

PrEP Medications

We use two different medicines for PrEP: Truvada and Descovy.

Both of these medications require patients to take one tablet, once a day and have been shown to be up to 98% effective at preventing HIV when taken daily, as prescribed.

It is important to note that Descovy is not approved for use among cisgendered women.

PrEP Side Effects

Common side effects from taking the PrEP medication Truvada include a slight increase in bowel movements, an upset stomach, headaches, and dry mouth.

However, those side effects usually subside within two to four weeks. If side effects continue any longer, we will have a conversation with a patient and decide if we want to try Descovy.

Though the side effects are similar with both medications, some patients notice negative side effects when they take one but not the other. So we will work with patients to find out which works best for them.

How well does PrEP work?

Both Truvada and Descovy offer a high rate of effectiveness. If patients take Truvada daily, as prescribed, they should experience a 98% to 99% of effectiveness in preventing HIV transmission. Keep in mind, the rate of effectiveness drops to about 74% when you’re sharing IV needles.

Patients should also use a backup form of contraceptives and protection for at least the first seven days using PrEP if engaging in anal sex and about 21 days if engaging in vaginal sex.

Also, PrEP does not prevent other forms of sexually transmitted diseases and infections, so patients should still use some form of barrier protection whenever possible even when taking PrEP.

Finally, patients should know that even with a high rate of efficacy, PrEP does not eliminate all risk. Consider PrEP like wearing a seatbelt, which protects you during an accident, but does not guarantee you will be 100% safe when driving or riding in a car.

Who should take PrEP?

1. Receptive Partners in Penetrative Intercourse

PrEP is recommended for individuals engaging in penetrative sex who receive penetration. HIV is a fragile virus, so it doesn’t live outside the body or in contact with oxygen for long. That means when it comes to sexual activity, anyone who receives, or gets penetrated either anally or vaginally, during intercourse is more likely to contract the virus.

2. Individuals Using Intravenous Drugs and Sharing Needles

Anyone who injects IV drugs or shares needles is also recommended to take PrEP. The bevel or tip of a needle protects the HIV virus in the blood, so if someone has HIV and uses a needle, the tip of the needle maintains a portion of that person’s blood that can be shared to the next person who uses it.

3. Individuals with Multiple Sexual Partners

Those who engage in sex with multiple different partners are also recommended to take PrEP. Essentially, anytime you increase the number of individuals you have sexual intercourse with, you are also increasing your risk of contracting HIV.

Have an honest conversation about PrEP with your provider.

It’s important to have an open and honest conversation with your provider about your sexual activities and whether you use intravenous needles and might be at risk of contracting HIV.

Even if you are worried that you won’t be able to afford PrEP without insurance, you should still talk to your healthcare provider, because there are now programs and options available to help individuals without insurance take PrEP for HIV prevention.

Follow up with your provider every three months.

You should also be making follow-up appointments with your provider every three months. There are a few reasons for this.

  • PrEP is still only 98 to 99% effective, so patients still have a 1 to 2% chance of getting HIV while taking PrEP.
  • Patients who are engaging in behavior that would require them to take PrEP might also contract other STIs or STDs, in which case a follow-up every three months will help your provider treat that infection and help you discover how and where you might have gotten it.
  • Patients need to get bloodwork done to monitor kidney function while taking PrEP. Though kidney function usually goes back to normal when patients stop taking PrEP, the numbers we test for kidney function sometimes show up differently, but this could be due to different factors not related to kidney function. Either way, follow-up appointments help providers make sure you’re healthy and that the PrEP is working for you.

Cost of PrEP

PrEP medications have pretty good commercial coverage, so your insurance should cover the cost. But if it doesn’t cover it, or if your deductible hasn’t been met, we direct patients to the Gilead advancing access program. You can apply by visiting GileadAdvancingAccess.com and filling out a simple application form.

The Gilead copay card helps patients pay for their PrEP treatment. So, make sure your PrEP goes through insurance first, and then whatever copay is leftover should get paid by your Gilead copay card. And, once you meet your deductible, your insurance should cover the entire cost.

What is PEP?

While PrEP helps prevent HIV infection prior to exposure, PEP helps to treat patients who have been exposed to HIV.

PEP stands for post exposure prophylaxis. So, the main difference here is that PEP is for patients who have already been exposed to HIV and need treatment to prevent transmission.

It’s important to note that patients who think they have been exposed to HIV have a 72-hour window from the time of exposure to take PEP for the treatment to be effective.

PEP Medications

PEP is actually a combination of drugs. Truvada, which is used as a form of PrEP, can be a component of PEP as well. We also add another HIV drug, and which one we use depends on the patient, their insurance coverage, and needs.

Usually, at our practice, we prescribe either Truvada and Descovy along with dolutegravir, which is an integrase inhibitor and great for HIV treatment. When these medications are dosed together, patients can reduce their risk of contracting HIV by more than 80%.

You can also take raltegravir, but patients have to take that medication twice a day, whereas they can take the mix of Truvada and dolutegravir only once a day, which is easier to remember. If you think you have been exposed to HIV, you will take these medications for 28 days and then do repeat testing.

PEP Side Effects

PEP side effects are similar to PrEP side effects, as in you might experience gastrointestinal issues, headaches, or changes in your sleep patterns. However, these side effects tend to subside within the first few days of taking the medication and definitely by two weeks.

Since the treatment is only 28 days, mild side effects are usually bearable for patients who are worried about HIV exposure.

How well does PEP work?

PEP can only work when you take it within the 72-hour window of possible exposure to HIV. Then, when patients follow the prescribed dose and take their medications daily for 28 days, they reduce their risk of transmission by 80%.

Follow up with your provider.

If you think you’ve been exposed to HIV, you’ll start taking PEP within that 72-hour window and then take it for 28 days. At your first appointment, you’ll also get tested for syphilis, gonorrhea, hepatitis A, B, and C, as well as HIV. If you’re a cisgendered female, you will take a pregnancy test as well.

After that, you will follow up with your provider to take additional tests for HIV, syphilis, and gonorrhea. If you are a cis female, you’ll likely take another pregnancy test. This follow up appointment is super important, as it will show whether the PEP treatment worked to prevent HIV.

Cost of PEP

The process of getting PEP treatments covered is similar to PrEP. You can still apply for the Gilead Advancing Access Program.

Make sure that when you go to get your PEP treatment, you go to an experienced provider, HIV specialist, or urgent care clinic that understands the urgency of getting this treatment to you. You shouldn’t face barriers to access, as you need to take the treatment within that 72-hour window of exposure.

PrEP and PEP Providers: No Judgment Zone

You deserve to have access to PrEP and PEP to prevent HIV transmission, because you deserve to have an active sex life without any judgment from your medical providers or barriers to health treatments.

That’s why your provider should offer you a judgment-free zone. Contact me if you have any questions about PrEP or PEP for HIV prevention or need help navigating any concern regarding HIV prevention or treatment. I am here to help.

Now Offering Telemedicine Visits During Coronavirus / COVID-19 Pandemic

Telemedicine Atlanta During COVID-19 Coronavirus Pandemic

COVID-19 has really changed the platform for how we deliver and receive care, and as of March 18, 2020, the Georgia Composite Medical Board approved measures to make it easier for medical providers to treat patients via telemedicine.

I am excited to announce that I am now able to offer telemedicine visits to my patients! Druid Hills Primary Care in Atlanta has been discussing offering telemedicine visits for several months now, and with the current COVID-19 / Coronavirus pandemic, it gave us more incentive to offer this service for both new and existing patients!

What We Can Treat with a Telemedicine Visit

Among the health concerns you may have that we are able to schedule Telemedicine visits for include:

During the visit we can discuss any health concerns you may have, refill medications, and advise health screenings.

Perhaps you are wondering, what about my blood work? No problem, we can easily place an order with Labcorp or Quest. Once the order is placed, all you have to do is locate the nearest patient service center to your home and make an appointment.

What You Need for a Telemedicine Visit

Telemedicine is easy for patients to navigate and means that we can continue to provide primary care from the safety of your own home. To have a telemedicine visit, patients will need either a smart phone or a computer equipped with a webcam and microphone.

Below is a quick guide to help you get setup for a Telemedicine visit!

Telemedicine Atlanta
Click for Larger Size

We are all trying to figure out the new normal during this pandemic and there is a lot of uncertainty, but one thing remains the same – you can count on being able to access me, your primary care provider, for your follow ups and sick visits!

To schedule an appointment for Telemedicine in Atlanta, please contact the office at (404) 228-2648 or use the form on the contact page.

Informed Consent HRT: What You Need to Know

Informed Consent HRT Atlanta: What You Need to Know

One of the questions most often asked about receiving hormone replacement therapy is whether or not we offer Informed Consent.

At Druid Hills Primary Care, we are actually one of the few practices in the Atlanta area offering Informed Consent for the purpose of transgender hormone replacement therapy. Below, I provide some greater detail on what Informed Consent HRT means, and what to expect at your first visit to our practice.

What is Informed Consent?

At its most basic level in a healthcare setting, Informed Consent is a legal document that is used to outline a patient’s consent to have a procedure or receive a specific medication or treatment plan. By signing the Informed Consent document, the patient is confirming they are fully aware of all the implications of that procedure or treatment plan, as well as the risks and side effects of the taking of certain medications.

It is common for patients to sign Informed Consent documents before undergoing surgery, or in the case of transgender patients being treated at our practice, signing Informed Consent before receiving hormone replacement therapy (HRT).

Depending on the type of transition a patient is desiring (MtF or FtM) the Informed Consent will be different and will cover the hormones that will be taken during the process. For patients who identify as non-binary, we provide them with the appropriate consent based on the hormone being dosed.

Informed Consent HRT for 18+ Patients

It is critically important to note that I can only offer Informed Consent for patients who are 18-years and older, since patients younger than that do not have rights to sign their own consent, and must have a parent or legal guardian present to sign the Informed Consent for them.

In fact, at Druid Hills Primary Care, we only treat patients over the age of 18, for both primary care and/or hormone replacement therapy, but there are other clinics in Atlanta that do.

Do You need a Therapy Letter before Informed Consent HRT?

It’s not uncommon for some HRT providers to prefer their patients to have a therapy letter, prior to receiving transgender HRT. Some providers prefer to have a mental health care provider document the patient’s readiness for medical transition. Other providers also utilize this approach in order to document the journey/timeline of gender incongruence.

While you are NOT required to have a therapy letter before starting Informed Consent HRT at Druid Hills Primary Care, I do recommend all of my patients see a mental health care provider — especially once they’ve decided to undergo hormone replacement therapy.

When it comes to wanting to transition, most of my patients have felt this way for a long time, and clearly do have gender dysphoria, but mental health care is so important to help as any patient undergoes hormone replacement therapy. My background and training in psychology allows me to practice more comfortably with certain diagnostic criteria that other providers may not be as well versed in.

What Does the Informed Consent Process Entail?

Informed Consent Review

Before I even meet with a hormone replacement therapy patient for the first time, I go ahead and draft a personalized Informed Consent document to go over with them in person.

During the initial visit, we go through the Informed Consent document together, allowing the patient to ask any questions they may have before signing it. The document lists risks, benefits, the expected time frame, and the expected physical changes of taking hormones. The document also covers the emotional changes that might occur.

Our Informed Consent also includes a schedule of follow-ups and bloodwork, because it’s very important that patients come in for follow-ups to make sure that there are no negative side effects occurring from the hormones.

We can not, in good conscience, refill any hormones if we have not made sure that a patient’s health is in good condition, and that they are not suffering from any negative side-effects from the hormones.

Signing the Informed Consent HRT Document

After I’ve gone through an Informed Consent document with a patient, I go ahead and leave the room and get a support staff member to come in and witness the patient’s signature on the consent.

This witness is simply there to verify that the patient signed the document on their own, that I didn’t make them sign it or force them to sign it in any way.

It’s impossible to witness someone’s level of comprehension of the consent, so I stress to patients that once they’ve signed the consent, they are confirming that they have understood all the information on the consent form and are ready to begin treatment.

Once the patient and the witness sign the document, the Informed Consent demonstrates the patient’s understanding of the treatment and its implications.

Next Steps Following Informed Consent

Once the patient has signed their Informed Consent HRT document, we are ready to begin the medical transition. I am present with my patients along the way and available for any and all follow up questions and concerns.

The transition looks different for different people, depending on their goals. We develop an individualized HRT plan, draw blood work and, in most cases, my patient leaves with a prescription for their medications.

We ensure patients have the necessary training to administer their medications safely, this is a well documented process and by doing this we can make sure the patient is supported every step of the way!

To schedule an appointment to discuss Informed Consent HRT, please contact my office.

Introducing the Exclusively Inclusive Podcast!

Introducing Exclusively Inclusive with Erin Everett, NP-C, AAHIVS

I am BEYOND excited to announce the launching of my brand new podcast, Exclusively Inclusive!

As a life-long Ally of the LGBTQ+ community, and after having the privilege of providing high quality, judgment-free healthcare for this population for the last several years, I wanted to take make a bigger impact.

By launching the Exclusively Inclusive podcast, I hope to provide the most up-to-date information on healthcare issues impacting the community for listeners beyond the metro Atlanta area. It is my personal goal to reach listeners across America and the world who might struggling with access to care and to arm them with the knowledge to help advocate for themselves throughout their healthcare journeys.

The primary topics I will cover on the podcast include healthcare issues surrounding:

  • Transgender Hormone Replacement Therapy (HRT)
  • General Primary Care
  • HIV Prevention & Treatment
  • Gender Dysphoria
  • Transgender Surgeries
  • Cost of Healthcare & Insurance
  • Sexual Health

The podcast will feature not just myself, but also local/national experts in healthcare specialties such as:

Again, I can’t tell you how excited I am to launch this podcast, and I hope you’ll give it a listen. I’d also love to hear your feedback on the show, and any questions you might have that I could potentially answer during a segment.

Follow the Podcast!

Website: https://exclusivelyinclusivepodcast.com

Twitter: https://twitter.com/InclusiveCast

Instagram: https://instagram.com/exclusivelyinclusivepodcast

Facebook: https://www.facebook.com/ExclusivelyInclusive

Alternative Perspectives Interview on Transgender Healthcare

AlternativeTalk.org Podcast on Transgender Healthcare

Recently, Erin Everett, NP-C, AAHIVS, and Dr. Joseph Smiddy of Druid Hills Primary Care were guests on the Gregg Bossen’s Alternative Perspectives podcast.

During the episode, Mr. Bossen asked questions regarding gender dysphoria, transgender rights, access to healthcare, as well as some of the ins-and-outs of hormone replacement therapy.

To listen to the entire episode, visit AlternativeTalk.org.

Sexual Health: The Missing Link in Primary Care

Health promotion and disease prevention are hot topics in primary care these days. With changes in healthcare, employers are being rewarded for keeping their employees low risk for chronic illness. Incentives include discounts for non-tobacco users and deposits into the health savings account for having low cholesterol, A1C, and regular Blood Pressure checks to reduce Hypertension.

Healthcare incentives are a great way to encourage a healthier lifestyle, and hopefully over time statistics will show they work to reduce healthcare costs long term. However, I believe these measures omit an incredibly important aspect of a person’s overall health. Too often people overlook sexual health when discussing health promotion and risk reduction.

With Atlanta having one of the highest rates of new HIV diagnoses and other STI transmissions it is imperative we include sexual health in the overall discussion in primary care.

Promoting HIV Prevention with PrEP

Pre-exposure prophylaxis (PrEP) is a daily oral prescription medication (Truvada) used for the prevention of HIV infection. Commercial healthcare insurance providers cover PrEP, and many state funded programs are available to improve access to PrEP. However, many primary care providers have little information on what PrEP is, or think it is just for men who have sex with men. Arming providers with the information they need to prescribe and manage PrEP will allow patients greater access to HIV prevention.

Having conversations about sexual health with your patient may uncover concerns about HIV prevention and also other potential sexual health risk factors. With the rise of antibiotic resistance, it is important to emphasize all STI prevention along with HIV. PrEP advocates also promote barrier methods of STI prevention. It’s important for patients to know they have options.

Be Open with Your Primary Care Provider

Primary care providers, talk to your patients about their sexual health. Ask who they are sleeping with and what kind of behaviors they are engaging in, because preventing HIV and STIs is as important as reducing the risk of coronary artery disease.

Patients, if your primary care provider is not having these discussions with you then bring it up during your next visit. If you do not feel comfortable having these discussions with your provider, it may be time to seek out a new one, because understanding the whole picture of your health is critically important.

If you know anyone who is interested in starting on PrEP for HIV prevention, or wants to know more, feel free to contact me.

Choose Health, Choose the Right Nurse Practitioner for You

When I talk to patients about what it means to be healthy, the responses I receive are largely varied. For some people it means preventing illness and maintaining their current level of functioning, for others it means avoiding a hospital visit this month, quarter, or year.

Health goals vary greatly depending on the age of the patient as well. Adolescents have a much different view of health versus seniors. In order to truly meet and identify what your health goals are, it is important to meet with a practitioner who you trust and can form a strong relationship with. Finding a practitioner who understands your needs, your current health status, and where you see yourself advancing health wise, is essential to your overall wellness.

Tips for Choosing the Right Nurse Practitioner

  1. Take a moment to write down your health goals. Is is weight loss? Better nutrition? Decreasing medications such as blood pressure pills? Having increased mobility?
  2. Once you have identified your individual needs, start asking friends who they see and what they like about their nurse practitioner. Is it that they take the time to explain options? Do they call after hours with lab results? Think about what is most important for you with your relationship with a healthcare provider.
  3. Decide whether or not you are comfortable with alternative therapies or prefer a more traditional approach, or both. Some nurse practitioners heavily subscribe to alternative therapies, while even more stick with traditional medicine. Sometimes finding the right combination of the two is what a patient really desires. Not quick to prescribe antibiotics or chronic meds, but also wary of letting conditions get out of hand.
  4. Find a primary healthcare provider who you can speak open and honestly with. If you do not feel comfortable sharing everything with your provider then it is time to look for a new one. One of the riskiest health decisions you can make is to withhold health information from your primary care providers.

Remember, we are here to serve you and your healthcare needs, not to pass judgement on you. Make sure you keep looking until you find the right nurse practitioner and primary care provider for you!