Understanding PrEP: HIV Prevention in the United States

What is PrEP?

PrEP stands for pre-exposure prophylaxis and refers to medication taken by HIV-negative individuals to prevent HIV infection. Unlike post-exposure prophylaxis (PEP), which is taken after potential exposure, PrEP is taken consistently before any potential exposure occurs. When taken as prescribed, PrEP reduces the risk of contracting HIV from sex by about 99% and from injection drug use by at least 74%. The medication works by preventing HIV from establishing a permanent infection in the body if exposure occurs.

Currently, the FDA has approved three medications for use as PrEP in the United States: Truvada, Descovy, and most recently, Apretude (cabotegravir). Truvada and Descovy are daily oral pills containing combinations of antiretroviral drugs, while Apretude is administered as an injection every two months. Each option has specific indications and may be recommended based on individual risk factors and medical considerations.

How Does PrEP Work in the USA?

In the United States, accessing PrEP involves several steps designed to ensure both safety and efficacy. First, individuals must consult with a healthcare provider who will conduct an HIV test to confirm negative status, as PrEP is only for HIV-negative individuals. Additional tests may include kidney function assessment, hepatitis B screening, and tests for other sexually transmitted infections (STIs).

Once prescribed, most patients have follow-up appointments every three months for HIV testing and monitoring of potential side effects. These regular check-ins are crucial components of PrEP care in the US healthcare system. The Centers for Disease Control and Prevention (CDC) has established comprehensive clinical guidelines for PrEP provision that healthcare providers nationwide follow to ensure standardized care.

Importantly, PrEP is part of a comprehensive HIV prevention strategy in the USA that also includes regular testing for HIV and other STIs, condom use, and education about risk reduction behaviors. The medication is not intended to replace these other prevention methods but rather to add another layer of protection.

Who Should Consider PrEP in the US?

PrEP is recommended for several groups at higher risk for HIV exposure. These include:

• Men who have sex with men who engage in condomless anal sex or have had an STI in the past six months

• Transgender individuals with similar risk factors

• Heterosexual men and women who don’t regularly use condoms with partners of unknown HIV status who are at substantial risk

• People who inject drugs or share injection equipment

• People who have partners with HIV, especially if the partner has an unknown or detectable viral load

• Individuals who engage in sex work

Healthcare providers assess individual risk factors to determine if PrEP is appropriate. The decision to start PrEP is personal and should involve an informed discussion about potential benefits, risks, and alternatives with a qualified healthcare provider.

How to Access PrEP in the United States

Access to PrEP has expanded significantly across the United States in recent years. Most primary care providers can prescribe PrEP, as can specialists in infectious diseases, sexual health clinics, and community health centers. Many Federally Qualified Health Centers (FQHCs) offer PrEP services on a sliding fee scale based on income.

The U.S. government has implemented several initiatives to improve PrEP accessibility, including the “Ready, Set, PrEP” program, which provides free PrEP medications to qualified individuals without prescription drug coverage. Additionally, most private insurance plans, Medicaid, and Medicare cover PrEP medication and associated services, as the U.S. Preventive Services Task Force has given PrEP an “A” rating as a preventive service.

For those without insurance or with limited coverage, patient assistance programs from drug manufacturers can help cover medication costs. Organizations like PleasePrEPMe.org and the CDC’s PrEP Locator (preplocator.org) help individuals find nearby PrEP providers and resources for financial assistance.

PrEP Costs and Insurance Coverage in the US

PrEP medication and related services involve several types of costs that can impact accessibility for many Americans. Understanding these costs and available support options is essential for those considering this preventive measure.

Cost Component	Typical Range without Insurance	With Insurance	Assistance Programs
Truvada (generic)	$60-$600/month	Often $0 copay	May cover full cost
Descovy	$1,800-$2,000/month	Often $0-$25 copay	May cover full cost
Apretude (injection)	$3,700 per dose	Variable coverage	Limited programs available
Office visits	$50-$200 per visit	Usually covered	May be available
Lab tests	$100-$500	Usually covered	May be available

Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.

The Affordable Care Act requires most insurance plans to cover PrEP medication and associated services without cost-sharing. However, implementation varies, and some patients still encounter coverage issues or unexpected costs. For uninsured individuals, the Ready, Set, PrEP program and manufacturer assistance programs like Gilead’s Advancing Access can substantially reduce or eliminate medication costs, though related services like doctor visits and laboratory tests may still require payment.

The Future of PrEP in American Healthcare

PrEP continues to evolve with ongoing research focused on developing new delivery methods and formulations. Long-acting injectable PrEP (Apretude), approved in late 2021, represents a significant advance by offering protection through an injection every two months rather than daily pills. Research is also underway on implantable devices, vaginal rings, and other innovative delivery methods that could further improve adherence and accessibility.

Public health experts are working to address disparities in PrEP access and uptake, particularly among Black and Latino communities, women, and people in rural areas. Despite growing awareness, PrEP utilization remains below potential in many communities that could benefit most. Expanding education, reducing stigma, and improving healthcare provider training about PrEP are crucial components of national HIV prevention strategies.

As HIV prevention technology advances, PrEP will likely become an increasingly integral part of comprehensive sexual health services across the United States, contributing significantly to the goal of ending the HIV epidemic.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.