PrEP 101: Your Guide to PrEP for Queer and Trans Communities

What is PrEP for HIV?

PrEP stands for pre-exposure prophylaxis. PrEP is medication used by people who are HIV negative to prevent HIV. It is a tool that you can use to help protect yourself, your partners and your community.

Most people who use PrEP take pills, but a long-acting injectable option is also available. 

PrEP is highly effective at preventing HIV when taken as prescribed. 

Who is PrEP for?

PrEP can be for anyone who wants it. 

You might want to use PrEP to stay HIV negative if you:

• don’t always use condoms 
• don’t know the HIV status of one or more of your sex partners
• have a sex partner who is living with HIV and does not have an undetectable viral load 
• inject drugs and sometimes share needles or other injecting equipment

Talk with your healthcare provider to determine if PrEP is right for you.

What PrEP options are available?

PrEP is available as a pill or by injection from a healthcare provider.

There are two ways to take PrEP pills. 

Daily PrEP means taking a pill every day. Anyone can use daily PrEP. On-demand PrEP means following a 2-1-1 dosing schedule: 

• 2 pills between 2 and 24 hours before sex 
• 1 pill 24 hours after the first dose 
• 1 pill another 24 hours later 

If a person has sex several days in a row, they should continue to take a pill every 24 hours until 2 days after the last time they have sex.

On-demand PrEP is an option for cis men and trans women only. 

PrEP is also available as a long-acting injection, given by a healthcare provider on a set schedule. Anyone can use injectable PrEP. 

What should I think about when deciding which PrEP option is right for me?

Choose a PrEP option that you can easily use as prescribed. This is important because if pills or injections are missed, medication levels in your body may decrease and be less effective in preventing HIV.

Many things can affect which PrEP option you choose, such as:

• which PrEP option(s) will be effective for you and fit into your life 
• your preference for pills or injections, which may be influenced by:
  • your ability to store pills and stick to a dosing schedule
  • your ability to visit a healthcare provider regularly for injections
• the insurance coverage available to you

You can find a PrEP option that fits your needs. Talk to a healthcare provider or connect with an HIV organization in your region about which option might be best for you. 

What is involved in PrEP besides taking medication?

Being on PrEP also includes regular healthcare visits for testing and monitoring.

Before starting PrEP, you will need to be tested for HIV to make sure you are HIV negative. Starting PrEP if you are HIV positive (but don’t know it) can create serious problems for future HIV treatment. It is also important to be tested for other sexually transmitted and blood-borne infections (STBBIs; like syphilis, gonorrhea, chlamydia and hepatitis B and C).

Depending on the PrEP option you want, your healthcare provider may do some additional tests to make sure it is right for you. 

After you start PrEP you will need to see a healthcare provider regularly. You will have an initial follow-up visit one month after you start and then ongoing visits every two to three months — the frequency will depend on the PrEP option you’ve chosen. Follow-up visits may include testing for HIV and other STBBIs and monitoring for drug side effects. These are perfect opportunities to ask for support if you need it! 

What are the possible side effects of PrEP?

Most people who take PrEP in pill form report no side effects. When side effects do occur, they are usually very mild and may include nausea, diarrhea, headache or fatigue. Side effects usually go away on their own within a few days or weeks as the body adjusts to the medication. In some people, PrEP pills may affect kidney or bone health, but this is rare and these changes are usually reversed after stopping PrEP. 

For people who get PrEP injections, the most common side effect is tenderness at the injection site, but this also tends to decrease after the first few injections. 

Can I take PrEP if I am taking gender-affirming hormones?

Yes, PrEP is safe and effective for people who take masculinizing or feminizing hormones. Tell your healthcare provider about any medications that you take, including gender-affirming hormones. 

Can I stop taking PrEP or switch to a different PrEP option after I start?

Yes, you can stop taking PrEP entirely or switch to another option, but it’s important to do so safely and in consultation with a healthcare provider. The best approach to stopping or switching depends on the kind of PrEP you’re taking. 

Talk to your healthcare provider if you want to:

• stop taking PrEP 
• restart PrEP after a period of not taking it 
• switch to a different type of PrEP 

How can I get PrEP?

To take PrEP, you’ll need a prescription from a healthcare provider. A doctor or nurse practitioner can prescribe PrEP. In some regions, other healthcare providers such as pharmacists may also be able to prescribe it. 

Some queer and trans people may feel uncomfortable discussing their sexual practices or drug use with a healthcare provider. When possible, try to find a provider you feel safe being open with, so they can properly assess your HIV risk and help you choose the right PrEP option for you. There may be clinics in your area that specialize in supporting queer and trans communities. Online PrEP prescribing services are also available, which can be a good option for people who prefer not to visit a local healthcare provider.

PrEP may be covered by public or private insurance. Talk to your healthcare provider, a pharmacist, a sexual health clinic or a community organization to learn more.

Visit whereto.catie.ca to find PrEP providers near you.

CATIE thanks the Community-Based Research Centre (CBRC) for contributing their expertise as a partner in the development of this resource. 

Production of this resource has been made possible through a financial contribution from the Public Health Agency of Canada.  The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. 

CATIE endeavours to provide up-to-date and accurate information at the time of publication, but it should not be considered medical advice. Decisions about particular medical treatments should always be made in consultation with a qualified medical practitioner. CATIE resources may contain descriptions or depictions of sex, sexuality or drug use, with the goal of promoting public health. Any opinions expressed herein may not reflect the policies or opinions of CATIE or any partners or funders.