Fact Sheet
PrEP and PEP
PrEP is a pill that you take every day that can lower your risk of getting HIV if you are exposed to the virus and don’t already have HIV. PEP is a set of 3 medications you can take if you have recently been exposed to HIV to lower your risk of getting it.
PrEP
What is PrEP?
PrEP stands for “pre-exposure prophylaxis”. The word “prophylaxis” means to prevent or protect from an infection. PrEP is a pill that you take every day that can lower your risk of getting HIV if you are exposed to the virus and don’t already have HIV.
Who can use PrEP?
Since PrEP is intended to be used pre-exposure, you may want to consider taking PrEP if you don’t have HIV but are at higher risk of getting it.
How effective is PrEP?
PrEP is most effective when taken consistently each day. Studies have shown using PrEP every day can lower your risk of getting HIV from sex by more than 85-100% and from injection drug use by more than 84%.
What are the side effects of PrEP?
Side effects of PrEP may include an upset stomach or loss of appetite. These symptoms are usually mild and go away within the first month. Some people may also experience a mild headache.
How do I start PrEP?
If you think you might benefit from PrEP, talk to your health care provider. If you and your provider decide that PrEP is right for you, next steps will include blood tests for HIV, other STIs, and proper kidney function. If these tests show that PrEP is safe for you to start, your clinician will write you a prescription.
What happens once I start PrEP?
There are different options available for PrEP based on the type of sex you are having and what works best for your sex life.
- Daily PrEP: You will take one pill every day, anyone can use this method, and it is the only reliable method for vaginal*/front hole sex as it can take up to 7 days for PrEP to build up in vaginal tissue to be effective.
- On demand PrEP: This is normally 2 pills between 2-24 hours before sex, 1 pill 24 hours after the first pill, and 1 pill another 24 hours after that (sometimes called 2-1-1 dosing). This only works for receptive anal sex, as PrEP builds up faster in anal tissue.
- You’ll need blood tests, including an HIV test, and STI testing every 3 months while taking PrEP, so you’ll have regular follow up visits with your clinician.
- If you have trouble taking PrEP at the right times or want to stop taking PrEP, your clinician can help plan next steps or alternatives.
- Using condoms with PrEP can help lower your risk of getting HIV even further and lower your risk of getting other STIs.
*We know that these aren’t the words everyone uses for their bodies (e.g. trans folks), and support you using the language that feels best for you.
How much will PrEP cost?
Most insurance plans, including OHIP+, the Ontario Drug Benefit (ODB), Trillium Drug Program, workplace/private plans and university and college plans cover the cost of PrEP.
If you don’t have insurance, PrEP will likely cost $250-$280/month.
Some private clinics offer subsidized PrEP – speak to your clinician for more details.
PEP
What is PEP?
PEP stands for “post-exposure prophylaxis”. PEP is a set of 3 medications you can take if you have recently been exposed to HIV to lower your risk of getting it.
Who can use PEP?
You may want to consider taking PEP if you don’t have HIV and have definitely or potentially been exposed to the virus, for example if you have had vaginal or anal sex without a condom or shared injection drug use equipment with someone who has HIV and who is not on effective treatment.
PrEP
What is PrEP?
PrEP stands for “pre-exposure prophylaxis”. The word “prophylaxis” means to prevent or protect from an infection. PrEP is a pill that you take every day that can lower your risk of getting HIV if you are exposed to the virus and don’t already have HIV.
Who can use PrEP?
Since PrEP is intended to be used pre-exposure, you may want to consider taking PrEP if you don’t have HIV but are at higher risk of getting it. (See page 4 for more about assessing risk).
How effective is PrEP?
PrEP is most effective when taken consistently each day. Studies have shown using PrEP every day can lower your risk of getting HIV from sex by more than 85-100% and from injection drug use by more than 84%.
What are the side effects of PrEP?
Side effects of PrEP may include an upset stomach or loss of appetite. These symptoms are usually mild and go away within the first month. Some people may also experience a mild headache.
How do I start PrEP?
If you think you might benefit from PrEP, talk to your health care provider. If you and your provider decide that PrEP is right for you, next steps will include blood tests for HIV, other STIs, and proper kidney function. If these tests show that PrEP is safe for you to start, your clinician will write you a prescription.
What happens once I start PrEP?
There are different options available for PrEP based on the type of sex you are having and what works best for your sex life.
- Daily PrEP: You will take one pill every day, Anyone can use this method, and it is the only reliable method for vaginal*/front hole sex as it can take up to 7 days for PrEP to build up in vaginal tissue to be effective,
- On demand PrEP: This is normally 2 pills between 2-24 hours before sex, 1 pill 24 hours after the first pill, and 1 pill another 24 hours after that (sometimes called 2-1-1 dosing). This only works for receptive anal sex, as PrEP builds up faster in anal tissue.
- You’ll need blood tests, including an HIV test, and STI testing every 3 months while taking PrEP, so you’ll have regular follow up visits with your clinician.
- If you have trouble taking PrEP at the right times or want to stop taking PrEP, your clinician can help plan next steps or alternatives.
- Using condoms with PrEP can help lower your risk of getting HIV even further and lower your risk of getting other STIs.
How much will PrEP cost?
Most insurance plans, including OHIP+, the Ontario Drug Benefit (ODB), Trillium Drug Program, workplace/private plans and university and college plans cover the cost of PrEP.
If you don’t have insurance, PrEP will likely cost $250-$280/month.
Some private clinics offer subsidized PrEP – speak to your clinician for more details.
PEP
What is PEP?
PEP stands for “post-exposure prophylaxis”. PEP is a set of 3 medications you can take if you have recently been exposed to HIV to lower your risk of getting it.
Who can use PEP?
You may want to consider taking PEP if you don’t have HIV and have definitely or potentially been exposed to the virus, for example if you have had vaginal or anal sex without a condom or shared injection drug use equipment with someone who has HIV and who is not on effective treatment.
*We know that these aren’t the words everyone uses for their bodies (eg. trans folks), and support you using the language that feels best for you.
How effective is PEP?
PEP can lower the risk of getting HIV after being exposed by more than 80%. Because some people studied didn’t take PEP consistently, taking PEP consistently likely lowers the risk of getting HIV by more than that.
What are the side effects of PEP?
Side effects of PEP may include nausea, fatigue and diarrhea, but vary depending on the medication.
When can I start PEP?
You can start PEP within 72 hours after being exposed to HIV. It is more effective the sooner you start it, ideally within 24 hours.
How do I start PEP?
To start PEP, you would generally visit a hospital emergency room (and some specialty HIV clinics) as soon as possible after you have been exposed to HIV. You will need to do a blood test for HIV, other STIs, and tests to see how your kidneys are working.
If you go to the hospital, the clinicians seeing you may or may not know about PEP. You may have to advocate for yourself and request an infectious disease specialist to be involved.
What happens once I start PEP?
- You will need to take medication once or twice every day for 28 days, depending on what medications you get.
- PEP is designed to lower the risk of getting HIV after a single exposure. Condoms can further lower your risk of being exposed to HIV while you are taking PEP. If you are exposed to HIV again while taking PEP, your course of PEP may not work as well for that exposure. If this happens, talk to your clinician.
- If you have trouble with taking pills every day or want to stop taking PEP, your clinician can help plan next steps or alternatives.
- After completing treatment, you will be re-tested for HIV to make sure the PEP worked. This may mean re-testing at the end of your course of PEP and then again 12 weeks and 6 months after you were exposed to HIV.
How much will PEP cost?
Most insurance plans cover the cost of PEP. This includes OHIP+, the Ontario Drug Benefit (ODB), Trillium Drug Program, workplace/private plans and university and college plans
If you don’t have insurance, PEP will likely cost $750-$1300/28 days
If you don’t have drug coverage and can’t afford PEP, ask your clinician about options to get PEP for a lower cost or free.
How do I know if I’m at higher risk of getting HIV?
- To be able to get HIV from someone, they must have HIV already and not be on effective treatment.
- If they have HIV but are taking their HIV medications consistently and have an undetectable viral load, they cannot pass HIV on with unprotected sexual intercourse
- Higher-risk activities for getting/passing HIV include:
- condomless anal or vaginal sex
- sharing injection drug use equipment
- Consider talking to your partner(s) about their HIV status, testing history, and safer sex practices. Check out our Talking About Safer Sex factsheet
- For more info about HIV and transmission check out our HIV/AIDS factsheet
- Your clinician may use specific guidelines to assess if you can use PrEP. These are often based on what demographic groups the medications have been studied in. Studies aren’t inclusive of all genders and group-level risk statistics may not reflect your individual risk level. If you think you’re at higher risk of getting HIV and don’t fit what the guidelines say about who should use PrEP, you may still be able to use it- talk to your clinician for more details.
More resources
- CATIE factsheets:
- The Sex You Want (for guys into guys): thesexyouwant.ca
- The Works (safer injection equipment and harm reduction services)