PrEP stands for “Pre-Exposure Prophylaxis” — a medication taken regularly as a way to block any HIV that enters the body from infecting you.

PrEP is currently available as a daily pill in Nova Scotia, although other parts of the country are beginning to introduce an injectable medication taken every 3 months.. The brand you may be most familiar with is Truvada, however there are generic versions you can get from your local pharmacy. Currently, PrEP needs to be prescribed by a doctor, pharmacist, or nurse practitioner, and requires you to check in with them every three months.

PrEP works by stopping the virus’ ability to copy itself. This mainly happens in the small window of time when someone is first exposed, which is 1-3 days. That means that even if you’re exposed to HIV, it is unlikely to copy itself and remain in your body.

PrEP only works if the medication stays in your body all the time, which you can guarantee by the pills every day. This is because the meds need to be in the anus, rectum, or vagina when exposure to HIV occurs, and the drugs need to continue to be there in the days afterwards to make sure the virus can’t make copies of itself and spread throughout the body.

It is recommended to take daily PrEP around the same time each day. Lots of people on PrEP set reminders on their phones or watches to make sure they stay in their routine. You’ll also need to check in with your doctor every three months to get tested for HIV, other STIs, to monitor if there are any reactions or side effects you could possibly be having from this medication, and talk about how your PrEP use is going.

Before using daily PrEP as an HIV prevention strategy for anal sex it needs to be taken everyday for one week for the drugs to reach maximum levels in the anal / rectal tissue. For protection in the front hole or vagina, it takes up to three weeks. While we don’t agree with the gendered language used throughout this article, CATIE has a thorough explanation of how HIV is transmitted in the vagina and why this changes the timeframe someone with a vagina would need to consider when taking PrEP.

Remember, PrEP only works for HIV – it won’t stop you from getting other STIs, which is why it’s recommended to try to combine PrEP with other strategies like condoms as much as possible. It’s also why it’s important for you to get tested for STIs every 3 months while you are on PrEP. One larger effect of taking PrEP is that it makes getting tested for STIs a part of a routine, meaning that it’s easier to diagnose and treat them early, breaking the chain of transmission so other folks don’t get it.

Like any drug, PrEP can have some side effects like stomach aches and nausea, but they usually go away once your body adjusts to the medication. Part of being on PrEP involves getting regular bloodwork done to make sure your body isn’t having any harmful side effects, since it may affect bone density and kidney function. Some people who take PrEP discuss using vitamins and supplements with their doctor as a way of addressing concerns about these side effects. If you’re on PrEP and you are concerned about side effects you are experiencing, it’s a good idea to talk to a doctor right away.

Because it works so well, there are lots of things that might lead you to think about PrEP as a way of staying HIV-negative. Some of these might include

• I’m dating or having sex with someone who is HIV-positive
  
• I don’t always use barrier protection (ex. condoms) during penetrative sex
• I don’t know the HIV status of the person/people I’m having sex with
• I have sex when I’m drunk or high
• I like to hook up with a lot of people
• There are things in my past, or things that I know about my personality, that make it hard for me to make the decisions I want to when it comes to safe sex
• The people I sleep with/have slept with in the past/plan to sleep with pressure me into having sex without condoms.
• I want to take control over my sexual health and PrEP will help me do that
• I am anxious about the sex that I am having and my risk of getting HIV
• I am actively doing sex work that puts me at risk

*This list is not complete, if you have a reason to consider PrEP that isn’t included in this list we still encourage you to discuss it with a doctor so you can determine together if PrEP is right for you.

PrEP Checklist:

A simple checklist to figure out if PrEP might be right for you!

Might PrEP be right for me?

• I only use barrier protection sometimes (or never)
• I am HIV-negative
• One or more of my partners are HIV-positive, or I don’t know their HIV status
• I can remember to take a pill every day and don’t face barriers to taking a medication
• I am able to see a doctor every three months for an HIV & STI test and a prescription refill
• I have insurance that covers PrEP, or I can afford it on my own

If you answered YES to ALL of the above, or if you have questions, talk to your doctor or reach out to us.

If any of these apply to you, PrEP could be a highly effective way of protecting yourself from HIV just like using condoms or, in an emergency, taking PEP. If you want to, there are a few ways to start the conversation about HIV with your partners. But if you think PrEP is right for you, talk to a doctor!

Who to talk to:

If you want to get PrEP, you have to ask a doctor, infectious disease specialist, pharmacist or nurse. If you have a family doctor, and feel comfortable with them, they are a great person to talk to. If not, you can book an appointment at a sexual health clinic, see a nurse practitioner, visit a walk-in clinic (it’s best to call ahead at your local walk-in clinic to ensure they offer this service). A study at Dalhousie University was completed recently carving the way for pharmacists to begin prescribing PrEP – and excitingly, as of July 1, 2024, pharmacists can now prescribe PrEP. The STI Care Now program also offers PrEP assessments with their pharmacist team. They can be found here.

They’ll talk to you about why you might need PrEP. If you both agree that PrEP is right for you, they’ll go ahead and give you an HIV test to make sure you’re negative, give you tests for other STIs, and test to make sure that your kidneys are healthy. If everything looks good, they’ll write you a prescription. While you’re on it, you will be asked to get these tests repeated every 3 months.

You can also talk to a social worker at an AIDS service organization (like us at HEAL NS), sexual health centre, or with the STI Care Now program. They are knowledgeable on PrEP, and while they can’t prescribe it can often help you figure out if it’s worth pursuing and how to access it!

How to have the conversation:

Not every doctor will respond the same way to a conversation about PrEP, so it’s best to be ready for what that conversation might look like. Unfortunately, not all doctors are educated around HIV prevention. The more you know going into your appointment, the better chance you will have of advocating for yourself if the conversation gets tricky. You can always reach out to us if you want to talk through feeling prepared for this conversation.

You may also worry about stigma, homophobia, transphobia, or any intersecting forms of oppression when asking for PrEP. This can be especially true in smaller towns where you may know your healthcare providers in contexts outside of your doctor/patient relationship. If travel outside of your town is an option for you, that may be a way to get around this – however it doesn’t necessarily mean you will receive better treatment than what’s offered near your home.

It is important to have a support system you can talk to before or after your appointment. If you have a friend, family member, or partner who would make this situation feel safer for you you can always bring them into the appointment with you. Be sure to know that it’s not okay to experience stigma on any level. If something happens at an appointment that you don’t feel good about, consider reaching out to a local queer organization, a trusted person in your life, or even sending feedback to the healthcare clinic with a request for your practitioner to get training on the subject.

If you’re thinking of asking your doctor about PrEP, but you’re afraid you won’t know how to ask about it, check out this script from The Sex You Want to give you an idea of how you might want to approach this conversation.

How much will it cost?:

Health Canada has approved the drugs emtricitabine and tenofovir for use in combination with safer sex practices to reduce the possibility of sexually acquired HIV. Typically, Truvada or Descovy – the brand names of PrEP – will cost up to $800-1000 a month. However, generic versions of the drug can cost down to $200 a month at some pharmacies across Nova Scotia. Generics have been approved by Health Canada and are as effective as Truvada.

For certain populations of Nova Scotia residents the Truvada PrEP is covered by Nova Scotia Pharmacare. Nova Scotia

Pharmacare defines these populations as:

• ‘Men Who Have Sex With Men (MSM) and Transgender Women (TGW): For pre-exposure prophylaxis (PrEP), in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 infection in adults at high risk who report condomless anal sex within the last six months and any of the following:
  • Infectious syphilis or rectal bacterial sexually transmitted infection (STI), particularly if diagnosed in the preceding 12 months;
  • Recurrent use of nonoccupational postexposure prophylaxis (nPEP) (more than once);
    Ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200 copies/ mL. (i.e. not on ART or >200 copies/mL); or
  • High-incidence risk index (HIRI)-MSM risk score ≥ 11. Please refer to the BC-CfE PrEP guidelines or the Canadian PrEP Guidelines which include details about how to calculate the HIRI-MSM risk score
• Heterosexual exposure: For pre-exposure prophylaxis (PrEP), in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 infection in heterosexual men and women at high risk of acquiring HIV infection who meet both of the following:
  • Condomless vaginal or anal sex; and
  • Ongoing sexual relationship with an HIV-positive partner who is not receiving stable ART and/or does not have an HIV viral load <200 copies/ mL. (i.e. not on ART or >200 copies/mL).
• People who inject drugs (PWID): For pre-exposure prophylaxis (PrEP) for PWID who are at high risk of acquiring HIV infection and meet both of the following:
  • Report sharing of injection equipment; and
  • Have an HIV-positive injecting partner who is not receiving stable ART and/or does not have an HIV viral load < 200 copies/mL.

If you fit into one of these groups, have your doctor fill out this form to get your PrEP covered by Nova Scotia Pharmacare’

The language defining these categories can be tricky to understand, so if you think PrEP might be right for you we recommend talking to your doctor or giving us a call at HEAL NS to see if you might fall into one of these categories.

If you have private health insurance — including through your work or school — then your plan may cover some or all of the cost of PrEP.

If you have questions about coverage you can reach out to your insurance providers to ask about what drugs / medications are covered under your plan.

Refugees in Canada can access PrEP through the Interim Federal Health Program. You can also access PrEP via your Canadian Forces Health Care Identification Card or Veterans Affairs Canada Health Program. Visitors to Canada who aren’t permanent residents, but who have foreign coverage may be able to import their medications to Canada, check out this link to learn more.

The full cost of Truvada as PrEP is also covered by the Non-Insured Health Benefits (NIHB) Program. NIHB is a federal program that covers costs for certain medications and other health resources for some First Nations and Inuit people. Eligibility to receive NIHB has some restrictions based on a person’s legal recognition as part of First Nations or Inuit communities and their residency status. If you are a First Nations or Inuit person and are not sure if you are eligible for NIHB, you can contact the Atlantic office of NIHB at 1-800-565-3294 or NIHB National Headquarters at 1-866-225-0709.

A new form of PrEP is slowly starting to be made available in Canada; it’s called injectable PrEP! This medication is a long-acting form of PrEP, meaning you go get the injection every 3 months, instead of needing to take a pill every day.

It has been shown to actually be more effective than the daily oral PrEP (the medication described in the rest of this website section), likely because it relies less on people needing to remember to take a pill at the same time every day.

Currently, ViiV Healthcare (the company that makes the approved form of injectable PrEP) is talking with both Canadian insurance companies and Canadian government healthcare bodies about how much the drug will be and how much will be covered.

This means you can’t get it in Nova Scotia yet. Since daily PrEP is still not universally covered by NS Healthcare plans, it is unlikely that this medication will quickly be accessible to most Nova Scotians. However, we can always urge government officials to consider the huge benefit that a medication like this will make to reducing new HIV cases locally!

This section was adapted, with permission, from The Sex You Want Website.
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references

You can learn more about where we got this information from at: CATIE, CBC, Apretude

*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.