PrEP is a highly effective HIV prevention tool. It’s great for those who may be at risk of HIV. People who inject drugs, sex workers, and those who frequently hookup with different people are often encouraged to consider PrEP. But PrEP is for ANYONE who thinks they could benefit from it.

PrEP Checklist:

• I only use barrier protection sometimes (or never) especially when having vaginal and/or anal sex
• I am HIV-negative
• One or more of my partners are HIV-positive and not on effective treatment
• I don’t always know the HIV status of the people I have sex with
• I inject drugs and sometimes (or always) share equipment or needles

If any of these apply to you, you might want to consider PrEP! You can always talk to your doctor or reach out to us with any question.

Although PrEP is for anyone (HIV-negative), we don’t all have equal access. Some factors to consider when it comes to deciding if PrEP works with your lifestyle and needs.

• I can remember to take a pill as directed (either every day or following a schedule) 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

Even if these don’t all apply to you, there can be workarounds for some barriers, so reach out if you’re curious!

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.

To get on PrEP, you can go through: 

• • Your primary care provider
  • A sexual health clinic
  • Boyd’s Pharmacy (or any other participating Community Pharmacy Primary Care Clinic*)
  • STI Care Now

• Sometimes walk-ins and Maple virtual care can support getting on PrEP. Due to the need for follow-up care, this  avenue may not always work.

*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. Please note, although pharmacists have prescribing power, training is still required and it is entirely optional. To our knowledge, as of summer 2026 Boyd’s Pharmacy in Halifax is the only pharmacy doing PrEP assessments and prescriptions. 

When you go to your first appointment, your provider will do an assessment. This may look like a more formal questionnaire or a casual conversation about why you might need PrEP. If you both agree that PrEP is right for you, then the next steps will be to test for HIV and other STIs as well as to baseline bloodwork for things such as kidney function. 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 (a social worker) can’t prescribe it, they can often help you figure out if it’s worth pursuing and how to access it!

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. Many sectors of healthcare providers such as pharmacists, physicians, and surgeons as well as social workers have regulatory bodies that you can contact to file a complaint. prideHealth is an organization that supports 2S/LGBTQIA+ people in accessing affirming care and can provide training and resources to providers who may need it.

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 around $200 a month at some pharmacies across Nova Scotia. Generics have been approved by Health Canada and are as effective as Truvada. Note, Descovy is not covered in Nova Scotia.

Coverage looks different in each province and territory. All of them have drug programs that may cover some or all of the costs depending on factors like income, risk, and if you’re a part of a priority population. The Canadian HIV and Viral Hepatitis Pharmacists Network has put together an overview of PrEP coverage across the country that you can check out.

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. Please note that Pharmacare coverage is dependent on your income and can span from complete coverage to co-pays in the thousands.

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 two 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 does not rely on people needing to remember to take a pill at the same time every day.

 As of 2026 there are two long-acting injectable PrEP medications that have now been approved in Canada. Cabotegravir (CAB) –approved in 2024 and available under the brand name Apretude– is injected every two months. Lenacapavir (LEN) –approved in 2026 and available under the brand name YEYTUO– is injected every six months. Prescribing guidelines have yet to be released for LEN but we are seeing some provinces begin to prescribe CAB (at about $2000/2 months).  It is still not available in Nova Scotia. And 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!

Have you heard about on-demand PrEP also known as PrEP 2-1-1? This method involves taking two pills between 2 and 24 hours before having sex, one pill 24 hours after the first dose, and one more pill 24 hours after the second dose.

The 2025 Canadian guideline on HIV pre- and postexposure prophylaxis recommends on-demand PrEP as an HIV prevention option for HIV-negative cisgender men and transgender women who may be at risk of HIV through sex. As more research is done, it has been shown that on-demand PrEP is just as effective as daily PrEP for cisgender Two-Spirit, gay, bisexual, and queer men, AMAB non-binary people and trans women not on feminizing HRT and highly effective for trans women on feminizing HRT. In order for PrEP, both on-demand and daily, to work as best as possible it requires consistently and accurately following the dosing schedule.

Due to a lack of research and how we understand the length of time PrEP needs to build up in the vaginal tissue, on-demand PrEP is not recommended for cisgender women, transgender men and AFAB Two-Spirit and gender diverse people having vaginal sex or people at risk of HIV through injection drug use. That being said, if someone is only using PrEP for anal sex, this method would work since the rectal tissue only needs 7 days to build up enough PrEP in the body.

PrEP on-demand can be beneficial for lots of reasons, a big one being financial. Many instances of on-demand PrEP not working is due to not taking it according to the dosing schedule. Sometimes this happens because we may hear about this method through word of mouth and important information gets lost along the line. That is why it is still important to have this information available. More ways to take PrEP means more people will be able to take it as it can accommodate a broader range of preferences, financial situations, and other access needs.

Check out this CATIE article for more comprehensive information on PrEP 2-1-1.

PrEP’s effectiveness is directly related to taking the pill consistently  around the same time everyday. If you take it daily and never miss a dose, it works amazingly well. If you miss a few (or more) doses, it works less well. It also takes about a week for people having receptive anal sex, and about 21 days for people having receptive vaginal sex before they’re fully protected. If you’re going off PrEP you need to take it for four weeks after the last time you had sex for that encounter to be protected.

It’s very rare, but some strains of HIV are resistant to PrEP. There have been a few reported cases of people who took PrEP as prescribed becoming infected with these strains of HIV.

It is recommended to use PrEP with condoms/barrier protection, so you can ensure that the chance of HIV transmission while taking PrEP remains extremely low, especially if pills are missed. That being said, PrEP is recommended for people who are not using condoms, so it’s important to know that PrEP still works really well on its own. 

Don’t forget, if you are having sex with someone who is HIV+ and has an undetectable viral load then transmission through sexual contact is NOT possible. Undetectable=Untransmittable 

If you want to decrease the chances of getting STIs like chlamydia, syphilis, or gonorrhea, condoms and medications like Doxy-PEP can be super helpful!

If it happens, take your next pill as soon as you remember. Don’t bother taking two pills at a time to make up for it though. If you don’t generally use condoms during sex, it might be a good idea to use condoms for the days/weeks after a missed pill to keep yourself extra safe.

This could mean a few things and it’s best if you follow up with your doctor right away. If you have flu-like symptoms, like a fever, a headache, joint pain or a sore throat, it could be a sign of possible HIV infection. If you have stomach aches or nausea, these could be side effects of the drug. If they’re really bad, or haven’t gone away after a while, talk to a doctor.

While rare, PrEP can cause bone mineral density and kidney problems for people who have pre-existing related conditions. If this is the case for you, it is a good idea to talk to your doctor to figure out if there are ways to minimize the impact of PrEP. Descovy has been noted to be gentler but it’s not covered in Nova Scotia under Pharmacare and there are no generics.

PrEP can be a complicated issue if the person using it also has a hepatitis B infection. It is especially important that you inform your doctor that you have hep B and talk about what that means.

Don’t forget to also tell your healthcare provider about any meds, including vitamins and supplements, that you take regularly, or any other health stuff they might not know about you to help ensure that PrEP will work well for you.

Taking daily PrEP looks different for everybody. Some people might take it for a couple months when they feel it is appropriate, or others might take it over a longer-term. What’s important to remember is that it takes about a week to build up enough medication in the rectal tissue and 21 days in the vaginal tissue.

If you become HIV-positive, you’ll have to stop taking PrEP immediately and start a new treatment for HIV infection. Check out our HIV treatment section to learn more about what to do after testing positive for HIV.

If the cost of PrEP is a barrier, first make sure you have explored all of your options. As mentioned above, provincial and territorial coverage varies from place to place. Some provinces, like Ontario, even have independent PrEP providers and financial assistance through them. For those located in the central region of Nova Scotia, the Metropolitan Dispensary provides low-cost prescription medications to those who are low-income or unable to afford their medications. A referral by a social worker or 2-1-1 is required.

If you are unable to access PrEP, take some time to learn more about other HIV prevention methods. Barrier protection like condoms, clean drug supplies from harm reduction programs, PEP, learning to talk about STIs and safer sex with partners are all great ways to take control of your sex life without going on PrEP.

There is a lot of confusing information and misinformation online about whether PrEP is effective in trans and gender-diverse people who are either on hormones or have had gender-affirming bottom surgeries. This is largely due to the fact that research often excludes trans individuals, or doesn’t collect information that is specifically relevant to trans and nonbinary people.

Understanding the effectiveness of PrEP is, in some ways, more complicated than it seems. You have to factor in, not only the effectiveness of the drug, but its interactions with other drugs/hormones/medications, the body parts that are or aren’t being exposed to HIV, how regularly someone takes their PrEP prescription, and the social and systemic factors that influence a person’s access to PrEP/ability to take it consistently.

PrEP is highly effective, and the vast majority of research that has been done suggests that taking hormones or undergoing gender-affirming surgery, doesn’t significantly reduce its effectiveness. There was also a myth spread at one point that taking PrEP could reduce the effects of hormone therapy, especially testosterone. This has been disproven!

All of that is to say – if you are trans and in a higher risk demographic you shouldn’t hesitate to reach out to your doctor or a healthcare provider to assess if PrEP might be right for you.

To hear from some trans people on what taking PrEP has been like for them, you can check out this great video by My Genderation.