PrEP, or pre-exposure prophylaxis, is a preventive medication for individuals at high risk of contracting HIV through sexual activity. When taken consistently as prescribed, PrEP is extremely effective, reducing the risk of HIV transmission by around 99%.

By blocking the virus from establishing itself and spreading in the body, PrEP serves as a powerful tool in HIV prevention. However, its effectiveness significantly decreases if not taken regularly. For optimal protection, we suggest that you take PrEP as prescribed by your medical provider.

1. How frequently you have sex
2. Whether you can plan sexual activity in advance

Since 2013, the U.S. Clinical Practice Guidelines, along with Thailand's HIV Prevention Guidelines since 2014, have recommended daily oral PrEP as a highly effective way to reduce the risk of HIV in adults.

Our PrEP recommendations are also informed by two European studies that explored different PrEP-taking strategies to maximize HIV prevention.

Daily PrEP (PROUD Study) - Take PrEP Daily for Maximum HIV Protection

*This method is the recommended PrEP regimen for everyone.

To achieve optimal HIV prevention, PrEP should be taken once daily as recommended. Taking PrEP daily works for both Truvada and Descovy PrEP. If you are currently taking Descovy, your doctor will prescribe this regimen for you. Here’s how to follow the daily dosing method effectively:

1. Start with a Lead-In Dose: Take one PrEP pill at the same time each day for 7 consecutive days without engaging in condomless sex. This gives the medication time to build protective levels in both rectal tissue (for anal sex) and vaginal tissue (for vaginal sex, if applicable).
2. Take with or Without Food: PrEP can be taken with or without meals.
3. Stick to a Daily Routine: Aim to take one pill daily. If you miss a dose occasionally, don't worry—occasional missed doses don’t significantly reduce protection.
4. Effective Protection Proven by Study: In the PROUD Study, no participants who took Truvada correctly contracted HIV, proving daily dosing is highly effective.

Since 2013, this daily PrEP regimen has been the recommended method to prevent HIV. At PULSE Clinic, we advise this approach for individuals who engage in frequent sexual activity, including men, women, and transgender women.

However, for people who have sex less frequently, a daily dose might feel excessive or too costly (especially in Western countries). For these individuals, PrEP on Demand may be a suitable alternative.

*This method is recommended only for men who are gay, bisexual, or engage in sexual activity with other men. People assigned female at birth (AFAB) may still need to follow the daily regimen due to differences in how the body processes the medication. On-demand PrEP is currently not as effective for HIV prevention in the vaginal area.

PrEP On demand (2-1-1 Regimen) is effective HIV prevention for planned anal sex. The On-Demand PrEP method, also known as the 2-1-1 regimen, offers flexible HIV protection for individuals who engage in anal sex and can plan their activity at least 24 hours ahead. This method is specifically for anal sex and is not recommended for vaginal sex. The on-demand regimen (2-1-1) only works with Truvada PrEP, as there is currently not enough evidence on the efficacy of on-demand Descovy PrEP. Here’s how the 2-1-1 dosing works:

• Pre-Sex Dosing: Take 2 Truvada pills 2 to 24 hours before sexual activity.
• Follow-Up Doses: Take 1 Truvada pill 24 hours after the initial dose, followed by another pill 24 hours later.
• Post-Sex Dosing: Continue with 1 pill daily until you’ve taken two doses after the last sexual encounter.

Backed by the IPERGAY Study, the 2+1+1 PrEP On Demand method is a reliable option for those who have sex infrequently but want effective, situational HIV prevention.

Seasonal PrEP (PrEP Holiday): HIV Protection for High-Risk Travel or Events

Seasonal PrEP, also known as PrEP Holiday, is ideal for individuals who are traveling to areas with high HIV prevalence or for those engaging in higher-risk sexual activity during special events or vacations. Whether you're attending a party, festival, or holiday, these occasions often increase your chances of having more sexual partners or engaging in riskier behavior. Here's when and how to take PrEP seasonally.

When to Use Seasonal PrEP:

• Traveling to high HIV prevalence countries like Thailand, the Philippines, or South Africa
• Having increased sexual partners without knowing their HIV status
• Engaging in unprotected sex with HIV-negative partners whose PrEP usage is unknown
• Having sex with HIV-positive partners without knowing their viral load status (undetectable or not)
• Using fewer condoms or forgetting to use them (due to intoxication or other reasons)
• Participating in chemsex or using substances during sex

How to Take Seasonal PrEP:

1. Pre-Event Dosing: Take one pill of PrEP once a day for 7 days leading up to and during the high-risk period. Make sure to avoid condomless sex during this time.
2. High-Risk Season: Continue taking one pill daily during high-risk events, such as cruise trips, circuit parties, pride months, or other high-risk seasons.
3. Post-Event Dosing: After the high-risk period ends, continue taking one pill daily for a short period to maintain protection.

Seasonal PrEP is an effective way to protect yourself during times of increased sexual activity and risk.