PrEP in a Pandemic: Your Questions Answered

Is temporarily going off the medication a responsible choice?

The coronavirus (COVID-19) pandemic has locked many of us in our homes without the intimate touch of a sexual partner, and we’re all experiencing its effects on our physical and mental health. While an informal poll of mine revealed that just over 20% of respondents are still hooking up outside of their households despite stay-at-home orders (tsk, tsk), most have accepted guidances that you are your own safest sex partner.

For those at risk of contracting HIV, this new way of life has many reconsidering their Pre-exposure prophylaxis (PrEP) regimen. If you’re unfamiliar, PrEP is a prescription medication that, when taken regularly, helps reduce the risk of HIV infection.

With two-thirds of all new HIV infections being men who have sex (MSM), use of PrEP is particularly prevalent within the LGBTQ community. Given the pandemic, though, some have decided to drop the drug entirely for the time being, citing side effects, insurance anxieties, and recent loss of employment. But is temporarily going off the medication a responsible choice? As a wildly neurotic individual, I had to know.

With no solid data to navigate our decision-making, I spoke with infectious disease epidemiologist and assistant professor at Harvard Med, Julia Marcus, PhD, MPH, who researches HIV, PrEP, and sexual health, for some answers. Marcus recently posted her own online poll to gauge how COVID-19 has affected people’s PrEP use.

According to her poll, over half of respondents had stopped taking the drug.

“One of the great things about PrEP is that it can be adapted to what’s happening in people’s lives at any given moment,” Marcus tells NewNowNext. “For most people, there’s less sex happening right now outside of our households, so it makes a lot of sense to put a pause on PrEP.”

In addition to the halt the pandemic has put on our sex lives, this phenomenon could also be the result of reduced access to HIV and sexual health services. With COVID-19 pulling the majority of America's public health resources, organizations have had to reduce or suspend some of their most valuable services, one of the more common being our access to PrEP.

“Individuals who have expressed interest in PrEP will be lost to care or [will] have been exposed to HIV by the time that we are able to provide PrEP services to them,” one local health department said in a recent survey.

Astrid Riecken/Tribune News Service via Getty Images

Truvada, a newly FDA-approved drug to help prevent HIV infection, is among the AIDS drugs that fill the shelves at the pharmacy at the Whitman-Walker Clinic, July 19,2012, a Washington, D.C.-based community health center focusing on HIV/AIDS care and lesbian, gay bisexual and transgender care. (Astrid Riecken/Tribune News Service via Getty Images)

These findings mirror the first published data on how COVID-19 is impacting the health of MSM in the U.S., with respondents expressing that they’re experiencing problems accessing HIV or STI testing. Fearing outbreaks, researchers and professional departments are recommending health-care providers relax follow-up laboratory guidelines, increase prescription refill numbers, and transition to telehealth services to assist patients while in-person efforts are directed elsewhere.

A few individuals responded to Marcus’s poll saying they’ve continued taking PrEP because they believe it could protect them from the coronavirus. This belief is likely tied to headlines expressing that Gilead Sciences, the company that manufactures the PrEP drug Truvada, is testing to see if it could fight against COVID-19.

“There’s a clinical trial happening in Spain to test whether TDF/FTC, or Truvada, can help prevent or treat COVID-19 in health-care workers, but we don’t have any evidence yet about whether it’s actually effective in people,” Marcus says. “There are a number of existing antiviral medications that are being tested for COVID-19, and the hope is that one or more can be repurposed to tackle the current pandemic.”

Marcus’s poll shows there are a small number of people who are still taking PrEP but using fewer pills, suggesting they’ve switched from daily to non-daily use. This routine is known as “event-based dosing” and typically requires four pills: two to be taken 2–24 hours before sex, one pill 24 hours after, and another 24 hours after that.

“This strategy can be particularly appealing for people who are having less frequent sex and can anticipate when it’s going to happen,” Marcus says. “But event-driven PrEP has only been tested in cisgender MSM, and has only been tested for TDF/FTC, or Truvada, not TAF/FTC, or Descovy.”

Getty Images

Open bottle of prescription PrEP Pills for Pre-Exposure Prophylaxis to help protect people from HIV.

Marcus adds that patients should turn to their regular health-care providers for further guidance: "Non-daily PrEP hasn't been recommended yet by the CDC, but there's good evidence that it can be a highly effective strategy for cisgender MSM."

On the fateful day when we are finally able to be intimate with individuals outside of our home, Marcus recommends regular PrEP users take their normal dosage for seven days before sex and continue using it daily. If you’re a cisgender man, you can take two pills 2–24 hours before sex and continue with either daily or event-based dosing after that. But if you’ve had sex since stopping PrEP, it would be wise to check in with your provider, as they may want to test you for HIV before getting back at it.

With partnered sex off the table for many, you have a couple of different options for your PrEP prescription, provided you prioritize your health and safety (read: no “rona raves”). In the meantime, consider investing in some sex toys from a local retailer to stimulate the economy and your body.

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