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Pre-Exposure Prophylaxis (PrEP) is a preventive treatment that reduces the risk of contracting HIV by up to 99% when taken correctly. It consists of taking an antiretroviral medication before a potential exposure to the virus, thereby preventing HIV from infecting the body's cells.
PrEP is a recommended treatment for:
During a consultation, your pharmacist will explain the options and recommendations to help you choose a treatment adapted to your situation. There are two oral intake schedules and one injectable option.
Oral PrEP: daily use vs. on-demand use
Method | How to use | Effectiveness | Why choose this option |
---|---|---|---|
Daily Use | 1 pill per day, at the same time. | Over 99% protection when taken correctly. | Ideal for frequent or unpredictable sex. Maintains a stable blood concentration, offering a small margin of error if a dose is occasionally missed. |
On-Demand (2-1-1) | Two pills 2-24h before sex, one pill 24h after the first dose, then a final pill 24h after the second dose (2-1-1 schedule). If sex continues over several days, continue one pill per day. After the last encounter, continue PrEP for 2 days before stopping. | Very effective, provided the schedule is strictly followed. | Suited for occasional relations. Only recommended with Truvada® and its generics. Indicated for anal sex only. Requires strict planning. |
Oral PrEP: approved medications
Medication | Indications | Advantages | Precautions |
---|---|---|---|
Truvada® & generics (Tenofovir disoproxil + emtricitabine) |
Daily **and** on-demand use | Often the first option covered by insurance plans. Suited for all types of exposure (anal and vaginal). | Can slightly affect kidney function and bone density, which is monitored. |
Descovy® (Tenofovir alafenamide + emtricitabine) |
Daily use only (for cis men and trans women) | Reduced impact on bone and kidney health. | Not validated for protection during vaginal sex. Not for on-demand use. |
The only medication currently approved in Canada is Long-Acting Cabotegravir (Apretude®). Other medications are in development.
Injectable PrEP is an alternative to oral PrEP. Clinical studies have shown it can offer superior protection, notably due to better treatment adherence. It is approved for people of all genders.
Administration method
Step | Description |
---|---|
Oral phase (optional) | Take 1 pill per day for 30 days. This phase is optional and not recommended in most cases. |
Initial phase | Receive 1 injection once a month for 2 consecutive months. This phase effectively starts the treatment. |
Maintenance phase | Receive 1 injection every 2 months to maintain protection against HIV. This rhythm allows for simple and discreet management. |
Injections can be given up to 7 days before or after the scheduled date, offering a 14-day window. If you must be away beyond this period, let us know: a temporary pill treatment will be prescribed to maintain your protection.
Other tests may be suggested depending on your situation to ensure your safety. Our pharmacists will support you throughout your journey, with personalized reminders and advice adapted to your reality.
Only 1% to 10% of people on PrEP experience side effects, which generally disappear after one to two weeks. The most common are nausea, headaches, vomiting, and diarrhea.
In the long term, a slight decrease in bone density or kidney function may occur in a small number of people. These rare effects are reversible upon stopping the treatment. Fear of side effects should not prevent you from trying PrEP.
The newest oral PrEP option, tenofovir alafenamide + emtricitabine (Descovy®), avoids the risks of negative effects on kidney function and bone density. Additionally, people who choose this medication report about half as many side effects compared to tenofovir disoproxil + emtricitabine (Truvada®) and its generics.
Temporary reactions at the injection site, such as pain, tenderness, nodules, or induration, occur in the majority of patients. More rarely, temporary fatigue or headaches may also appear. These effects are generally mild to moderate and well-tolerated by the vast majority of users.
PrEP only protects against HIV, not against other STIs or pregnancy. It is therefore crucial to continue getting screened regularly and to use condoms and/or a contraceptive.
PrEP should be part of a global STI prevention strategy. For optimal protection, it is strongly recommended to use other protection methods in addition to PrEP.
Consult us to discover the protection options adapted to your reality.
The choice between them depends on your lifestyle and what you prioritize.
The choice is yours: the flexibility of the pill or the peace of mind of the injection.
A single, occasional missed dose:
Several consecutive missed doses:
This schedule requires strict adherence. Any deviation can compromise your protection.
If you think your protection was compromised and you had a risky sexual encounter, contact us immediately. We can assess the situation with you and discuss the relevance of PEP (post-exposure prophylaxis), an emergency treatment.
Historically, the first studies and promotional campaigns heavily targeted gay men, bisexual men, and other men who have sex with men (MSM), as they represented (and still represent) one of the populations most affected by the HIV epidemic. This is why the association is so strong in people's minds. But the reality is much broader.
PrEP is for ANYONE who is HIV-negative and at substantial risk of acquiring HIV, regardless of their gender, sexual orientation, origin, or lifestyle. The virus does not discriminate, and neither does prevention.
Risk can apply to many people, including:
We recognize that for many people, accessing preventive healthcare like PrEP can be fraught with obstacles. Stigma, language or cultural barriers, a legitimate mistrust of the healthcare system, or simply a lack of targeted information are realities.
This is particularly true for certain communities, including Indigenous communities, Black communities, racialized people, and migrants, who face systemic health inequalities and therefore sometimes increased risks.
Our role, as front-line healthcare professionals, is to work to break down these barriers. We are committed to offering a safe, confidential, and non-judgmental space where every person, whatever their reality, can discuss their sexual health and access PrEP if it is the right option for them.
In reality, their combination represents a much more complete and proactive approach to sexual health, with a dual impact: for you, and for the community.
It is essential to understand that Doxy-PEP never replaces PrEP. If your sexual practices warrant the use of Doxy-PEP, it means a risk of HIV exposure exists. For an HIV-negative person, PrEP must therefore absolutely be part of the overall prevention strategy.
A health strategy must be based on solid scientific evidence. Currently, the clinical studies that have demonstrated the greatest benefits of Doxy-PEP have done so within a specific group.
This approach is therefore discussed on a case-by-case basis and is primarily intended for gay men, bisexual men, and other men who have sex with men (MSM). It is in this group that studies have proven that Doxy-PEP can very significantly reduce recurring bacterial infections.
This includes MSM who are:
The idea is that there is no single magic bullet, but rather a set of tools that you can combine to create the strategy that perfectly fits your life and your needs. Here are the main tools at your disposal:
The condom (male or female) remains the only tool that protects against HIV, most other STIs, and unwanted pregnancies all at once.
Pre-Exposure Prophylaxis (PrEP) involves taking a medication continuously to prevent HIV from establishing itself in the body. It is an extremely effective method for HIV-negative people.
Doxycycline Post-Exposure Prophylaxis (Doxy-PEP) involves taking an antibiotic after a risky sexual encounter to reduce the chances of contracting syphilis and chlamydia. It has no effect on HIV.
Post-Exposure Prophylaxis (PEP) is a 28-day course of antiretroviral treatment to be started as soon as possible after a high-risk situation. It is an emergency solution for people who are not on PrEP.
This is the principle that a person living with HIV who is on effective treatment and has an Undetectable viral load cannot transmit the virus (U=U, or I=I in French). It is a major HIV prevention strategy.
Vaccination protects you long-term against several infections. Consider checking if you are up to date for Mpox (monkeypox), hepatitis A and B, and HPV (Gardasil®9).
Getting tested regularly (every 3 months) and communicating openly with your partners are the foundation of a healthy sex life.
In summary, the best strategy is the one you build by choosing the tools that adapt to your life.
Studies show that protection is at its maximum (over 99%) for people who take their treatment rigorously (every day or according to the recommended schedule). Poor adherence, such as frequently missed doses, significantly reduces this effectiveness.
Injectable PrEP is a new option that provides constant protection without having to think about taking pills. An injection every two months protects you at all times.
While highly effective against HIV, PrEP should be part of a comprehensive prevention approach that includes:
Each method has its own protocol for achieving maximum protection.
This is the most studied method. The delay varies depending on the type of sexual intercourse:
This method provides very rapid protection for anal sex only.
This method provides continuous protection for all types of sexual intercourse.
It is essential to respect these timelines and to use additional protection (like a condom) until maximum protection is achieved.
To be protected from an exposure that might have occurred during your last sexual encounter, you must continue taking the pills for a certain period afterward (this is often called the "tail").
After anal sex:
After vaginal sex:
Stopping injectable PrEP is more complex because the medication stays in your body at a slowly decreasing concentration for several months.
Life changes, and so do your prevention needs. If you want to restart PrEP after a break, it's simple: you just need to complete a new round of screening tests and consult a professional. Never resume taking old pills without new medical advice.
Yes, clinical studies demonstrate that injectable PrEP offers superior protection against HIV compared to oral PrEP.
One of the clear advantages of the bimonthly injection is that it completely eliminates the risk of missing a daily pill. Since consistent adherence is the most important factor for ensuring the effectiveness of oral PrEP, the injectable method provides continuous and stable protection. It can therefore be considered one of the most reliable HIV prevention methods available today.
Injectable PrEP, like oral PrEP, is intended for people who are at substantial risk of contracting HIV and who have a negative screening test.
Regarding coverage, injectable PrEP is covered by RAMQ (the public plan) and all private insurance plans in Quebec. As with oral PrEP, the final cost to you depends on your specific coverage, and financial support programs from the manufacturer are available to help reduce or completely eliminate this cost. This is why many people say they receive PrEP "for free."
Despite its effectiveness, injectable PrEP is not automatically suitable for everyone. It is a very personal choice. Here are a few points to consider:
In summary, injectable PrEP is a major advancement that simplifies life for many people. A frank discussion with one of our pharmacists is the best way to weigh the pros and cons and to determine if this option fits your reality.
The effectiveness of PrEP is not a matter of luck, but of science. Maintaining a sufficient concentration of the medication in your body is the only way to achieve the greater than 99% effectiveness demonstrated in studies.
It means following the protocol that was prescribed for you, without compromise.
Maintaining a perfect routine can be challenging. If you frequently forget to take your medication, the important thing is to talk about it.
Your regular follow-up appointments are the ideal time to discuss your adherence to the treatment and adjust the strategy as needed. This is an essential dialogue for your safety.
Prenez-Rendez vous avec notre clinique en ligne et renseignez-vous sur les protections indiquées à votre situation.