Health Services

HIV stands for human immunodeficiency virus, meaning a virus that attacks the immune system. HIV attacks key parts of your immune system: your T cells or CD4 cells. Your body needs T cells and CD4 cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, then destroys them. Over time, HIV can destroy so many of your CD4 cells that your body becomes incapable of fighting disease and infection. HIV then progresses into AIDS.

AIDS (Acquired Immunodeficiency Syndrome) is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, putting them at risk for opportunistic infections (OIs). You will be diagnosed with AIDS if you have one or more OI, certain cancers, or a very low number of CD4 cells.

HIV can be transmitted through any one of the following fluids:

• Blood
• Semen
• Pre-seminal fluid (pre-cum)
• Breast milk
• Vaginal fluids
• Rectal (anal) mucous

HIV is transmitted through body fluids in very specific ways:

• Sexual contact
• Pregnancy, childbirth, breastfeeding
• Injection drug use
• Occupational exposure i.e. health care workers coming in contact with bodily fluids containing HIV
• Blood transfusions
• Organ transplants

One way HIV can be spread is through unprotected sexual contact with an HIV-positive person. Some of the ways to reduce your risk of getting HIV through sexual contact include:

• Don’t have sex. Sex is the main way that HIV is transmitted. If you aren’t having sexual contact, you are 100% protected from getting HIV in that way.
• Be monogamous. Having only one sex partner reduces your risk of getting HIV.
• Get tested and know your partner's status. Talking about your HIV status can be difficult or uncomfortable - but it's important to start the discussion BEFORE you have sex.
• Use Pre-Exposure Prophylaxis (PrEP). *PrEP* (https://www.aidshelp.org/index.cfm?fuseaction=cms.page&id=1232) is a one-pill-a-day medical intervention that prevents transmission of the virus more than 99% of the time when taken as prescribed.
• Use condoms consistently and correctly. Both male and female condoms will help protect you against HIV and other STIs.
• The best protection for those who are sexually active is to use both PrEP and condoms simultaneously.

If you believe you have been exposed to HIV, see a doctor within 72 hours (the sooner the better) to start on Post-Exposure Prophylaxis (PEP) medication, which may help prevent the virus from taking hold.

PrEP, or pre-exposure prophylaxis, is a daily pill that prevents HIV from taking hold in your body.

• PrEP is not a cure or a vaccine for HIV. But when taken correctly, it helps protect you from acquiring HIV. 
• PrEP does not protect you from getting other STDs like syphilis, gonorrhea, or herpes. 
• PrEP is not a replacement for condoms. PrEP is designed to work with condoms. Unprotected anal, oral, and vaginal sex puts you at risk for HIV and other STIs. PrEP is effective at preventing you from getting HIV when it is combined with condoms for anal, oral, and vaginal sex. 
• PrEP is not injected and does not work the same way as a vaccine. PrEP is a pill you take orally every day. Vaccines provide immunity from diseases by promoting the production of antibodies. PrEP is a combination of two drugs that block HIV from taking hold in your body. While you only need vaccines periodically for them to work, you must take PrEP daily for it to be effective. 
• PrEP is not a pill you pop right before sex. PrEP is an oral pill that must be taken every day. Consistency makes PrEP effective. 
• PrEP cannot give you HIV. There is no virus in the medication.

HIV is still a very real concern in the U.S. In fact, there are 50,000 new infections in this country every year. In Houston, there are approximately 1,200 persons newly infected with HIV annually. PrEP is a viable option for sexually active adults and people who share needles who want to protect themselves against HIV and can commit to consistently taking a pill on a daily basis and having regular doctor visits. It’s important to remember that PrEP should be used in combination with condoms and other prevention tools.

If you are at risk for HIV, you may want to consider talking about PrEP with your doctor or a counselor at a local provider.

The CDC defines those at higher risk as:

• Anyone who is in an ongoing relationship with an HIV-positive partner. 
• Anyone who:
• ...is not in a mutually monogamous relationship with a partner who recently tested HIV-negative, and 
• ...is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or
• Heterosexual men or women who do not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).
• Anyone who injects drugs, including those who have injected illicit drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months.

For couples where one partner has HIV and the other does not, PrEP is one of several options to protect the uninfected partner during conception and pregnancy. People who use PrEP must be able to take the drug every day and to return to their health care provider every three months for a repeat HIV test, prescription refills, and follow-up.

*Mutually monogamous means that you and your partner only have sex with each other and do not have sex outside the relationship.

If you think PrEP might be right for you, there are several clinics in Houston that provide PrEP to eligible patients, including AFH. You can also contact AFH to talk through your questions.

According to the CDC, clinical trials have shown the risk of getting HIV infection is much lower—up to 99% lower—for those who take their pill consistently than for those who did not take PrEP. For more on the research behind PrEP, check out “The Science Behind PrEP."

There are several costs that can be associated with being on PrEP, including fees for office visits, labs, and the cost of the medication itself. There are several programs that can help candidates who are interested in PrEP with financial assistance. And Gilead Science, Inc., the company that makes Truvada, has a patient assistance program for individuals with annual income up to $50,000.

Do not let the potential cost of PrEP dissuade you from finding out more information. Project Inform has a handy chart that helps explain the process to get PrEP and how to pay for the prescription and lab work, whether you have insurance or not.

In short, no. The names are similar, so it’s understandable that there is often confusion between PEP and PrEP. 

PrEP (pre-exposure prophylaxis) is a daily pill that is taken by HIV negative people to reduce the risk of HIV infection before exposure to the virus.

PEP (post-exposure prophylaxis) is for HIV negative people who have been (accidentally or unknowingly) exposed to the virus. If a person has come into contact with the virus, he/she can take anti-HIV medications prescribed by a doctor up to 72 hours after exposure.

Actually, PrEP is designed to work with condoms. Condoms protect you from HIV on the outside, while PrEP helps protect you from HIV on the inside. Condoms also protect against other STDs such as syphilis, gonorrhea, or herpes

When starting any medication, it is important to consider potential side effects and talk about them with your doctor. Truvada, the brand name for PrEP, has been shown to be safe and well-tolerated in multiple clinical studies. While most people on Truvada report no side effects, there is evidence that some side effects may occur.

According to San Francisco AIDS Foundation, results from one study showed that participants reported the following side effects under four main categories (ordered here as most to least common]: 

Truvada, the brand name for PrEP, is considered safe and well-tolerated. Most people on PrEP report experiencing no side effects; although, some side effects were reported in clinical trials. Participants in the iPrEx study reported side effects that fall into four main categories (ordered here as most to least common):

• Nausea: 9% of those who received Truvada reported nausea in the first month, compared with 5% of those who received placebo. After the first month, there was no difference in reported rates of nausea among those who received Truvada and those who received placebo.
• Headaches: 4.5% of participants who received Truvada reported headaches, compared with 3.3% of those who received placebo.
• Weight loss: 2.2% of those who received Truvada reported unintentional weight loss of more than 5%, compared with 1.1% of placebo users.
• Small increases in serum creatinine: Truvada is known to cause small increases in serum creatinine, a naturally occurring molecule filtered by the kidneys. In this study, 0.3% of those who received Truvada experienced mild increases in serum creatinine that persisted until the next test. Creatinine levels went back down once these participants stopped taking PrEP. Four of the five participants restarted PrEP without recurrence of the creatinine increase. Investigators monitored kidney function throughout the study and found no serious problems.

For most people, these side effects went away on their own after the first few weeks of taking Truvada, or when the medication was stopped.

PrEP is only designed to help protect you from HIV. You should still use protective barriers like condoms to protect yourself from HIV and other STDs.

PrEP is not a vaccine and does not work the same way as a vaccine. A vaccine provides immunity from a disease by producing antibodies against that disease. PrEP is a combination of two drugs that block HIV from taking hold in your body, and it only works while you are taking the medication consistently.

Currently, there is no vaccine to prevent HIV infection.

There are many people who take pills daily to prevent something from happening to their body. One example is women who take birth control pills. Truvada (the drug that is prescribed for PrEP) was originally developed to help people already living with HIV. Research later showed that it could also help HIV negative people from getting infected. 

It doesn’t have to be at the exact same time, but PrEP works best when taken around the same time every day. You can pick morning, lunch, evening – it doesn’t matter; the important thing is to be consistent. A little early or a little late is ok. Just remember to take it every day. It is always important to ask your doctor for exact directions on how to take the prescription.

Not yet. It can vary depending on each person, but generally it takes about seven days for PrEP to reach protection level. Ask your doctor when PrEP will start working for you.

In order to be effective, PrEP must be taken consistently, meaning every single day. Only taking the pills on the weekend will not protect you from HIV.

PrEP is not necessarily designed to be a lifelong program. The decision to take PrEP may be based on specific and individual life circumstances. For example, someone with a HIV positive partner may opt to take PrEP for the duration of that relationship. Someone else may decide that PrEP is right for them as a temporary solution to reduce the risk for a period of time deemed appropriate by him/her and a medical professional.

In order to stay on the program, you must see your doctor every 3 months. If your situation changes between visits, make sure you keep your doctor updated so that you both can decide if PrEP is still right for you.

PrEP is not designed to protect you after you may have been exposed to HIV. If it has been less than 3 days (72 hours) since you were exposed to HIV, you should consider PEP (post-exposure prophylaxis) as an option. PEP is a medical program that you are on for about a month that helps reduce the chance of HIV infection. If it has been less than three days since you were exposed, talk to your doctor right away about PEP, because you must start PEP within 72 hours of possible exposure. Many of the providers on our Resources page can also counsel you on PEP, as well as PrEP. To find out more about PEP, go here: CDC Info on PEP.

It is okay to take PrEP any time before or after you’ve had a drink. Alcohol doesn’t have an effect on PrEP.

There is only one medication currently approved for PrEP: Truvada, which is actually a combination of two HIV medications. There is not a generic version of it available.

However, there are patient assistance programs that can help you pay for the medication. Gilead Science, Inc., the company that makes PrEP, has a patient assistance program. Depending on where you live, there may be other local resources. Check out our Resources page for more information.

It’s okay if your doctor isn’t familiar with PrEP or doesn’t know how to prescribe PrEP for you. You can find information here on how to get PrEP in Houston.