When you’re at risk for getting an HIV infection, it’s a good idea to think about starting pre-exposure prophylaxis (PrEP) if you aren’t taking it already. These are medicines you take when you’re well to help keep you from getting HIV. PrEP is recommended for people who don’t have HIV but are at higher risk to get it through sex or needles.
If you decide to start PrEP, you’ll have more choices to make. You can choose from one of a few different medicines. You can also decide if you’d rather take a pill every day or get a shot every other month.
The best choice for you might be different from someone else’s. No matter which one you choose, it can help to protect you from HIV. But it may help you to think through the pros and cons of PrEP pills versus shots to decide which you want to try or whether to switch from one to the other. The most important thing is that you take your medicine when you should no matter which type you choose.
What Are My PrEP Options?
You can take PrEP in a pill or a shot. Your PrEP options include:
- Cabotegravir (Apretude)
- Emtricitabine/tenofovir disoproxil fumarate (Truvada)
- Emtricitabine/tenofovir alafenamide (Descovy)
Truvada and Descovy are both pills you take by mouth. Truvada is approved when you’re at risk of HIV from having sex with someone who has the virus or from injecting drugs with needles.
Descovy is for people at risk of HIV from sex. But it’s not for people who could get HIV from vaginal sex. That’s because it hasn’t been tested in people who have this type of sex.
Apretude is the only shot you can get for PrEP. It’s for people who could get HIV from sex. You must weigh at least 77 pounds to get it.
What Are the Advantages of Shots vs. Pills?
You should talk through the pros and cons of each type of PrEP with your doctor to help you decide which one will work best for you. Your answer might be different from someone else. The important thing is that any of the options can help protect you from HIV.
Daily PrEP means you’ll need to take a pill every day. It’s a good option if you want to feel protected from HIV all the time. It works well if you can get into the habit of taking a daily pill. But some people may find it’s hard to remember to take it regularly. Some people also may have other circumstances that make taking a daily pill every day challenging.
Injectable PrEP shots work longer than pills. The first two shots are given 1 month apart, then every 2 months. But you’ll need to go to a regular appointment to get your shots. You can’t take it at home. It’s a good choice if you’re OK with getting shots and can’t or don’t want to take a pill every day.
Can I Take PrEP Pills “on Demand”?
If you’re thinking about taking PrEP pills only around times when you have sex, talk to your doctor. There is some evidence that taking PrEP pills this way can offer some protection for men who have anal sex with men without a condom.
Taking the medication this way isn’t an approved use of PrEP pills. But some health departments and organizations recommend it as an option for some people. The guidelines for PrEP explain how to take the medication this way correctly. You’ll follow a 2-1-1 schedule. That means you’ll take 2 pills between 2-24 hours before you might have sex, 1 pill 24 hours after the first two, and then 1 pill 24 hours later.
This may be an option to think about if you’re a man who identifies as the sex you were assigned at birth (cisgender) who has sex with men and you’re at risk for HIV exposure only occasionally. You’d also need to be able to predict when you’ll need to take PrEP. It’s not recommended for:
- Cisgender women
- Cisgender men who have sex with women
- Transgender people
- People who are at risk of HIV from drug use
What Are the Risks or Side Effects of PrEP Pills vs. Shots?
PrEP is safe even if you take it for years. But it does have some side effects you should know about. Side effects of the pills include:
- Nausea
- Diarrhea
- Headache
- Fatigue
- Stomach pain
- Dizziness
- Depression
- Insomnia
The most common side effects of PrEP shots are:
- Irritation or a reaction where the needle went in
- Headache
- Fever
Side effects with PrEP are more likely at first. They often go away after you get used to taking it. If you have a side effect from PrEP that’s bothering you or isn’t going away, talk to your doctor about it.
Is There a Difference in Cost Between PrEP Methods?
By law, costs for all forms of PrEP must be covered by most insurance plans and by Medicaid. If you’re not covered by one of these, there are assistance programs that can help you get PrEP free of charge or for a lower price.
Can I Switch From Shots to Pills or Vice Versa?
If you’re taking shots but will miss one, you can switch to pills until you can get a shot again. You might need to get two shots 4 weeks apart once you start back depending on how late your shot was.
If you’re taking the daily pill and want to switch to shots, talk to your doctor about it. The shots can be a good choice if you don’t have any allergies to them. You’ll need a doctor to give you your first shots, and you'll need to see them regularly for shots after that.
Questions to Ask Your Doctor About PrEP Pills vs. Shots
- Should I think about starting PrEP?
- Which type of PrEP should I take?
- What are the benefits of PrEP?
- Are there any risks I need to consider?
- How can I pay for PrEP?
- If start with a pill, can I switch to shots?
- If I start with shots, can I switch to pills?
- Can I use PrEP and birth control or other contraception?
- What happens if I am HIV positive and I take PrEP?
- If I take PrEP, can I stop using condoms?
- What’s the difference between PrEP and PEP?
- How long does it take for PrEP to start working?
- What if I miss a dose?
- If I start PrEP, do I have to keep taking it?
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
HIVinfo.NIH.gov: “HIV Prevention.”
CDC: “About PrEP,” “On-Demand PrEP,” “Deciding to Take PrEP,” “PrEP Medication Guide: Reduce Your Risk of Getting HIV,” ”Paying for PrEP.”
San Francisco AIDS Foundation: “PrEP Facts: What are the ways to take PrEP?”
New York State Department of Health: “Preventing HIV by Taking One Pill Once a Day: Pre-exposure Prophylaxis (PrEP).”
HIV.gov: “Pre-Exposure Prophylaxis.”
Prepwatch.org: “Frequently Asked Questions on Pre-Exposure Prophylaxis" (pdf).
