5 Questions Gay Men Should Ask Before Starting PREP

PREP HIV

Should I Take PREP?

If you are like many gay men, you’ve probably heard about PREP. Just in case you haven’t, PREP is the acronym for pre-exposure prophylaxis and is used to prevent HIV infection and has been around since 2012.

Available in single pill form taken once a day, the use of PREP, which is usually prescribed as Truvada, has become extremely popular among men who have sex with men.

The clinical research suggests that when taken as prescribed, PREP can significantly decrease a person’s chances of contracting HIV, the virus that causes AIDS.

While the data is somewhat scattered, use of PREP is generally thought to reduce HIV infections by as much as 90%, according to the Centers for Disease Control and Prevention. Some academic studies suggest those numbers may be even higher.


FYI: There has been one case where a person claims to have contracted HIV while on PREP. You can read an interview with this person from the POZ website and draw your own conclusions.

With all of that shared, many gay men still wonder if starting PREP is the right choice. Obviously, we are not medical doctors and therefore can’t provide medical advice.

We can, however, offer five questions to ask yourself and reflect upon as part of your own personal journey. Are you ready? Let’s jump right in!

Film countdown. Number 5

1. Why do I want to start PREP?

It all starts with the basic question of motivation. Do you want to take PREP because you are hoping to bareback? If the answer is yes, bear in mind that PREP does not prevent other sexually transmitted infections (STI’s), such as Hepatitis C, syphilis, gonorrhea and others.

With that shared, the CDC suggests you may want to consider PREP if:

  • If you are a gay or bisexual man who has unprotected anal sex within the last six months.
  • If you have been diagnosed with an STI within the past six months.
  • If you are a person who is at substantial risk for HIV infection because you inject drugs with other drug taking partners.

2. If I start using PREP, can I start bare backing?

This is an honest question that many gay men ask themselves as part of contemplating PREP. The official answer to this question is according to CDC is – no.

Here is why:

  • PREP does not stop the spread of other STI’s.
  • HIV prevention is most effective when PREP is combined with condom use.

3. What about the side effects of TRUVADA

Another legitimate question some people have about going on PREP are potential side effects. According to the vast majority of the research, Truvada seems to have few side effects in most people. The Advocate Magazine has an expansive article on this topic you might want to check out.

With that shared, there have been some cases where people experience issues. Some of these apparently subside after being on Truvada for several weeks. Should you decide to go on PREP, your doctor will likely run tests every three months to check bodily functions.

Some side effects include:

  • Decreased kidney function (rare)
  • Gastrointestinal problems
  • Slight headaches
  • Small losses in bone density.

4. Should I go on PREP if I am in a relationship?

There have been issues that have come up for some people who have started PREP related to personal, romantic relationships.

To begin with, the CDC recommends that if you are in a sexual relationship with someone who is HIV+, you should consider PREP, even if they have an undetectable viral load.

But what if you are involved with someone where there is an agreement of monogamy – is PREP something that still should be considered?

Here are some additional questions to think about:

  • Are you 100% confident that your partner is not engaging in sexual behaviors that may expose you to an STI, such as HIV?
  • The length of your relationship and the degree of trust that exists.
  • Your desire to remain HIV free balanced against your relationship experiences connected to monogamy.

5. Will PREP cost me a lot of money?

In many cases, most of the cost of Truvada is picked up by your insurance company. If the cost of the medication is not covered or if you have a large co-pay, there may be programs you can enroll in to help offset out of pocket fees.

GILDEAD, makers of Truvada, offers a coupon program for people who are not enrolled in a government funded prescription drug program. To find out more about options, visit this page on lowering Truvada costs.

Final Thoughts

We’ve included a PREP video below that is published by the CDC for more information. As with anything involving your health, it is important that you educate yourself on PREP as much as possible. Be sure to speak with your doctor if you have questions. If your doctor doesn’t know about PREP, find a physician who does.

You can also visit the CDC’s on HIV Reduction Tool website to learn more about PREP and other forms of HIV prevention.