Injectable PrEP is a form of antiretroviral medication that protects HIV-negative people from getting HIV. The main form currently available is long-acting injectable cabotegravir (or CAB-LA). If someone uses PrEP injections correctly, their chance of getting HIV through vaginal or anal sex is close to zero. 

A trained health provider must administer the injections, which go in the fleshy part of the bottom. To begin with, the person must have an HIV test to check they are HIV-negative. Then two injections, one month apart, are given. After this, the person must come back to the clinic every other month for HIV testing and a booster injection. Some people find injectable PrEP easier and more discreet than taking a daily PrEP pill. 

PrEP injections are not widely available. To find out if PrEP injections are available where you are or if they are being trialled, visit www.prepwatch.org. 

The PrEP vaginal ring is a small, flexible ring that slowly releases antiretroviral medication into the vagina. Its brand name is the dapivirine ring. The PrEP vaginal ring can stop someone from getting HIV through vaginal sex. It cannot stop them from getting HIV through anal sex. 

The person using the PrEP ring inserts it into their own vagina. The ring must be inserted at least 24 hours before sex to get maximum protection. It can be kept in the vagina for up to 28 days, then it must be replaced with a new ring. 

The PrEP vaginal ring is less effective than the PrEP injection or the PrEP pill. But some people prefer PrEP rings because they can keep a supply at home, so they need to take fewer trips to the clinic. 

One way to work out if someone could benefit from PrEP is to find out the following things. 
 

In the past six months have they: 

• had sex with more than one person? 

• had sex without a condom? 

• had sex with anyone with HIV or whose HIV status they do not know? 

• experienced sexual violence? 

• used PEP (emergency HIV prevention)? 

• had a sexually transmitted infection? 

• injected hormones or drugs?

 If you want to find out this information, do it in a non-judgemental and supportive way, or the person you are speaking to might not give you honest answers.

Start by explaining that PrEP is a medication that people who are HIV negative can use to stop themselves from getting HIV through sex. 
 

Explain that PrEP comes in three different forms: pills, injections or vaginal rings. Then tell them which forms of PrEP are available in your area and how they work. Information on how each type of PrEP works is in this Boost unit. 
 

It is important to let people know that they do not need to use PrEP forever, they only need to use it when they have a high risk of getting HIV. (For example, if they regularly have sex without a condom or they do not know their partner’s HIV status.) 
 

Be clear that while PrEP is highly effective at protecting against HIV, it does not protect against other sexually transmitted infections, so using condoms is still important.

Clearly explain what PrEP is, how it works, and the different options available. 

Frame PrEP around the idea of self-care. Let young people know that using PrEP is a way to take care of their health. If they decide to use it, they should feel proud of themselves, not ashamed. 
 

Do not pressure any young person to use PrEP. Offer non-judgmental guidance, so they can decide whether PrEP is right for them. Plan your advice to suit each person’s needs and situation, and listen to their concerns. 
 

Regularly revisit the topic, and mention PrEP in other discissions with them if it seems relevant. This can help young people see the connections between their life and their HIV risk, and work out if PrEP might benefit them.

PrEP might not be the right choice for everyone. If someone is not at risk of HIV, for instance if they always practice safer sex, PrEP may not be necessary. 
 

If someone cannot commit to using PrEP as prescribed or if they have major concerns about side effects, it may be better to explore other HIV prevention options. 
 

Always ensure that a young person fully understands the options available to them and that they feel confident in the process of making decisions about their health.

Some people make negative judgments and assumptions about people who use PrEP. This is called PrEP stigma. These assumptions can include the idea that PrEP users are promiscuous or that they engage in risky sexual behaviour. 
 

Normalising PrEP by talking about it as a form of self-care and a responsible health choice can help to address PrEP stigma. It can be helpful to explain that PrEP is about protecting our health and is not an indication of behaviour. 

Provide empowering, non-judgmental support. If someone feels like they might be ‘in trouble’ or getting things wrong, they are less likely to come to you for advice. 
 

Make sure they understand that PrEP will only work if they use it properly. This means taking PrEP pills every day, going for repeat PrEP injections every other month, or changing their vaginal ring every 28 days. It also means getting regular HIV tests. If someone has not been using PrEP correctly and they get HIV, continuing on PrEP can make HIV treatment less effective. 
 

If someone is struggling with pill adherence, suggest using an alarm, smartphone app or pill organizer to help them stay on track. Reminders can also be set for injection appointments or changing the vaginal ring. 
 

Side effects can be a big concern. So address them before someone starts using PrEP, and offer support if side-effects happen. Have regular check-ins to discuss challenges and provide encouragement. Encourage them to connect with other young people on PrEP to share experiences, as this can make it easier to keep using PrEP.

Yes, PrEP is safe for transgender women on hormone replacement therapy (HRT). Research shows that PrEP does not interfere with the effectiveness of gender-affirming hormones. This means you can reassure transgender women that PrEP is compatible with HRT. 
 

It is advisable for transgender women on HRT to speak to a health provider before starting PrEP. To look up interactions between PrEP and other medications, visit www.hiv-druginteractions.org. 

Yes, it is safe for people who inject drugs to use injectable PrEP. This will protect them against HIV that may be transmitted during sex. But we do not yet know if it also protects against HIV from injecting drugs. 
 

If you are supporting someone who injects drugs, it is a good idea to speak to them about PrEP alongside other HIV prevention options, like condoms. It is also important to connect them with wider support services for people who inject drugs so they can reduce the health harms linked to their drug use.

PrEP (in any form) is safe to use if someone is trying to get pregnant, if they are pregnant or if they are breastfeeding. PrEP will not harm a person’s chances of getting pregnant. 
 

PrEP provides protection against HIV if a pregnant person uses it during their pregnancy. It will also protect the foetus from HIV during the pregnancy, and it will protect the baby during labour and breastfeeding. 
 

When advising people who are pregnant or trying to conceive about PrEP, it is important to let them know that a person is more at risk of getting HIV during their pregnancy and immediately after they have given birth. Getting HIV during pregnancy or breastfeeding also raises the risk of the virus being passed on to the foetus or baby.

Taking PrEP while not knowing that you have HIV is bad for your health. PrEP provides a low dose of antiretroviral treatment (ART). With good adherence, this amount of ART is enough to stop you from getting HIV, but if you already have HIV it could make you more likely to develop HIV drug resistance. This is where your ART stops working. Small amounts of ART are not enough to stop the virus from replicating, instead, the HIV virus is able to change itself so that it can by-pass the effects of ART and create new copies of itself anyway.

Testing regularly while you take PrEP means that you will find out if you have HIV as soon as possible, so you can avoid developing HIV drug resistance. Taking PrEP as prescribed will prevent you from getting HIV.

Yes! PrEP does not stop you from getting pregnant and is safe for women to take during conception, pregnancy and breastfeeding. PrEP is one of the ways that couples with different HIV statuses can try for a baby safely.

If you want to have a baby, but think you're at high risk of getting HIV, then PrEP might be a really good option for you. If mothers get HIV during pregnancy and breastfeeding, it puts their babies more at risk. This is because your viral load is especially high in the first few weeks after getting HIV. Taking PrEP protects both you and your baby, so you can stay HIV-negative throughout conception, pregnancy and breastfeeding.    

People have different experiences when taking PrEP. Many people have no side effects, while others might experience things like nausea, vomiting, fatigue and dizziness, but these usually disappear after a week or two.

Longer-term effects of taking PrEP are rare. Around 2% of users may have small decreases in kidney function, but this usually returns to normal once you finish taking PrEP. This is why it's recommended that people on PrEP have regular health check-ups so that healthcare workers can monitor their health.

If someone thinks they're experiencing side-effects to PrEP, they should speak to a healthcare worker.