Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV. It is taken by people who are HIV-negative, and when used as prescribed, it reduces the risk of getting HIV from sex by about 99%. Many people are able to get PrEP at low or no cost, including those without insurance.

PrEP is used by people of all genders, sexual orientations, and relationship types. It can be a good option for people who want to prevent HIV, including those who are sexually active or use injection drugs, or who want an added layer of protection.

PrEP is available through doctors, sexual health clinics, community health centers, and Planned Parenthood, as well as through telehealth services in many areas. Many programs cover the cost of PrEP, including for people without insurance. This can include the medication, clinic visits, and lab tests. Clinic staff, pharmacists, and community organizations can help connect you to these programs.

Before starting PrEP, you will take an HIV test to confirm that you are HIV-negative. This can be done at a clinic or through at-home testing, depending on the provider. After starting PrEP, you will have routine follow-up visits and testing to make sure it continues to work as expected.

PrEP can be taken as a daily pill or as a long-acting injection. The pill is taken once a day at home. Injectable PrEP is given by a provider: one option begins with two starter injections about a month apart, then continues every two months, and a newer option (lenacapavir) is given as an injection just twice a year. The injection does not require daily medication but does require attending scheduled appointments. You can work with a provider to choose the option that fits your routine, your preferences, and your access to care. You can also change options over time if your needs or priorities shift.

Post-Exposure Prophylaxis (PEP) is an emergency medication you can take after a possible exposure to HIV to prevent infection. PEP is for people who are HIV-negative and may have been exposed within the last 72 hours.

PEP may be appropriate if you have had a possible exposure to HIV, including:

• Sex without a barrier method (condom or internal condom) with a partner who has a detectable viral load or whose HIV status you do not know
• Sex where a condom broke, slipped, or was not used as planned
• Sexual assault
• Sharing needles, syringes, or other injection equipment used to prepare or inject drugs
• A workplace exposure to blood or other bodily fluids, such as a needlestick or contact with an open wound

You can get PEP at most urgent care clinics, emergency rooms, or sexual health clinics. In many states, including California and Nevada, pharmacists can also directly prescribe PEP.

PEP is a series of pills taken for 28 days in response to a potential exposure. A provider will likely examine you and may do an STI test before prescribing PEP. Follow-up HIV testing is recommended after treatment, usually at 4–6 weeks and again at 3 months after exposure.

Sources: CATIE — Seven ways to prevent HIV, SFAF — HIV prevention, Planned Parenthood — How can I prevent HIV?

Safer sex practices are an important way to reduce the risk of HIV and support your health and your partners. They can be part of making choices that feel informed, respectful, and aligned with your needs.

Talking with your partners

Talking with sexual partners about HIV status and testing helps you understand what prevention looks like for both of you before having sex. This can include sharing your own status, asking about testing, and checking in about what each person is doing to prevent HIV. Having this information can help you make decisions about what feels right for you.

These conversations can happen when you’re getting to know someone, before sex, or anytime you want to check in. This can look different depending on the situation, whether it’s a one time partner, someone you see regularly, or multiple partners.

Here are some ways to start the conversation:

• “How would you feel about getting tested before our date next week? I have an appointment on Monday.”
• “Quick check-in? I’m [status] and I was last tested [time frame]. What about you?”
• “I can’t wait to meet you in person. Have you been tested recently? I like to get tested before each new partner.”

Using Barrier Methods

Barrier methods like condoms, internal condoms, and dental dams significantly reduce the risk of contracting HIV. They work by preventing the exchange of fluids during sex and can be used during oral, anal, and vaginal sex. Condoms are available at almost all drug stores, supermarkets, gas stations, online, and for free at most clinics and LGBTQ+ centers. Dental dams and internal condoms may be available at some clinics or online, and providers can help you find options that work for you.

Choose latex or polyurethane condoms and water-based lubricants, since oil-based products can cause condoms to break down.

STIs, STI testing, and HIV risk

Having another sexually transmitted infection (STI) can increase the risk of HIV for a few reasons. Some infections can cause sores, cuts, or small openings in the body, which can make it easier for HIV to enter during sex. STIs can also cause inflammation, which means the body sends more of the cells that HIV infects to that part of the body. When more of these cells are present, HIV has more opportunities to enter the body and start an infection.

Sources: CATIE — Seven ways to prevent HIV, CATIE — HIV transmission

There are ways to reduce the risk of HIV when using injection drugs. Using sterile equipment and accessing services like syringe programs can help prevent HIV transmission.

If you use injection drugs, use new, sterile needles, syringes, and equipment every time. HIV can pass through blood left in used supplies, even in small amounts. Never share needles or supplies, even with people you trust. Using clean equipment each time is one of the most effective ways to reduce risk of HIV transmission and other infections such as hepatitis B and C.

Syringe services programs (also called needle exchange programs) provide free sterile injection supplies and safe disposal for used equipment. They may also offer HIV and STI testing, referrals to care, and other health services. These programs are available in many communities and can help you access what you need to reduce risk.

You can find a program near you here: nasen.org

Sources: CATIE — HIV transmission

HIV can be transmitted through pregnancy (via the placenta), childbirth (via exposure to blood and other fluids), and nursing (through milk). For a birthing parent living with HIV, taking antiretroviral therapy (ART) and maintaining an undetectable viral load is the most effective way to prevent passing HIV to their child.

When ART is started early and viral suppression is maintained throughout pregnancy and delivery, the risk of passing HIV to the baby is reduced to less than 1%. Even when the birthing parent has an undetectable viral load, a small chance of transmission remains through nursing. There is also a small chance of transmission through feeding an infant food that has been pre-chewed by a person living with HIV, if blood from the person’s mouth (such as from bleeding gums) mixes with the food.

Sources: CATIE — HIV transmission

When the amount of HIV in the body is so low that it does not show up on standard tests, the virus is considered “undetectable.” When someone living with HIV is on treatment and has an undetectable viral load, HIV cannot be passed on through sex. This is known as Undetectable = Untransmittable (U=U). U=U is a proven form of HIV prevention for sexual transmission. It does not apply to other types of exposure, such as sharing injection equipment, where other prevention strategies are needed.

Sources: San Francisco AIDS Foundation — U=U