What Is PrEP? HIV Prevention Options in California and Alaska
What Is PrEP? HIV Prevention Options in California and Alaska
Pre-Exposure Prophylaxis, better known as PrEP, is medication used by people who are HIV-negative to lower their chance of getting HIV before an exposure happens.
The word “prophylaxis” simply means prevention. When taken or given as prescribed, PrEP is one of the most effective HIV prevention tools we have. Oral PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
At Be Well Medical Group, PrEP care is offered as part of comprehensive HIV prevention, STI screening, Doxy-PEP counseling, and ongoing sexual health care in California and Alaska.
For patients in Beverly Hills, Los Angeles, West Hollywood, Santa Monica, Pasadena, and across California, PrEP visits may be available in person or by telehealth when appropriate.
For Alaska patients, confidential telehealth PrEP care may be available across the state, including Anchorage, Fairbanks, Homer, Juneau, Mat-Su Valley, and rural communities.
Key Takeaways
PrEP is preventive HIV medication for people who are HIV-negative.
When taken or administered correctly, PrEP is highly effective at preventing HIV.
PrEP protects against HIV, but it does not protect against other sexually transmitted infections like gonorrhea, chlamydia, syphilis, herpes, HPV, or hepatitis C.
There are now several PrEP options, including daily pills and long-acting injections.
The “best” PrEP option is not the same for everyone. Cost, access, side effects, kidney health, STI screening needs, comfort with injections, and lifestyle all matter.
How PrEP Works
PrEP uses antiretroviral medications, the same broad category of medications used to treat HIV. If a person is exposed to HIV, PrEP helps stop the virus from completing the early steps it needs to take hold in the body.
Different PrEP medications work at different points in the HIV life cycle. Oral PrEP options like Truvada and Descovy interfere with reverse transcription, an early step HIV needs in order to copy itself. Injectable options work differently, but the overall goal is the same: to prevent HIV from establishing a permanent infection.
For PrEP to work well, enough medication has to be present in the body at the right time. That is why consistency matters, whether that means taking a daily pill, keeping injection appointments, or following an event-driven dosing schedule correctly.
The Main Types of PrEP Available
PrEP has expanded quite a bit over the last several years. That is a good thing, because different people need different options. The main categories are daily oral PrEP, event-driven oral PrEP in select patients, and long-acting injectable PrEP.
Daily Oral PrEP Pills
Daily oral PrEP is the most familiar option. These are once-daily pills that combine two HIV medications. For many patients, oral PrEP is simple, effective, and affordable. It also keeps patients connected to routine HIV testing, kidney monitoring when needed, and regular STI screening.
Truvada and Generic TDF/FTC
Truvada, also available as a generic, contains tenofovir disoproxil fumarate and emtricitabine, often abbreviated TDF/FTC.
It is FDA-approved to reduce the risk of sexually acquired HIV-1. It is also the oral PrEP option with the most data in people who inject drugs, and CDC guidance supports PrEP use for people with injection-related HIV risk.
In clinical practice, this matters. If access or cost is an issue, generic Truvada is still an excellent and effective PrEP medication. No medication is perfect, which is why medicine should be individualized, but Truvada remains a very strong option for many patients.
Descovy
Descovy contains tenofovir alafenamide and emtricitabine, often abbreviated TAF/FTC.
Descovy is generally easier on the kidneys and bones compared with Truvada. It is approved for HIV prevention through sexual transmission, except for people at risk through receptive vaginal sex, because it has not been adequately studied for that use.
One thing I like to clarify for patients: both Truvada and Descovy are very safe medications for most people. Descovy is not “safe” while Truvada is “dangerous.” That is not accurate.
Both are prodrugs, meaning the medication is converted into its active form in the body. They ultimately work through the same active medication pathway, but Descovy delivers more of the active drug inside cells and tends to create less strain on the kidneys. That can make Descovy a better fit for some people, especially those with kidney risk factors, but it does not mean Truvada is a bad option.
Long-Acting Injectable PrEP
Injectable PrEP can be a great option for people who do not want to take a pill every day or who have trouble staying consistent with daily medication.
The tradeoff is that injections require follow-up visits, on-time dosing, and a plan if you stop treatment.
Apretude
Apretude, also known as cabotegravir, is given as an intramuscular injection into the glute muscle. It starts with initiation injections, then continues every two months.
For many people, Apretude is a really good option. It removes the daily pill burden, which is often the biggest weak point with oral PrEP.
The most common side effect is soreness, swelling, or tenderness at the injection site. Some people also get a short flu-like reaction, such as feverishness, chills, fatigue, body aches, or generally feeling run down. In most cases, this happens after the first or second injection and lasts a day or two, then resolves. For a smaller number of people, those symptoms continue with later injections, and those patients may decide it is not worth staying on the medication.
If you are specifically interested in long-acting HIV prevention, Be Well Medical Group offers Apretude counseling and PrEP care in Beverly Hills, Los Angeles, California, and by telehealth when appropriate.
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Yeztugo
Yeztugo, also known as lenacapavir, is a newer long-acting injectable PrEP option. It is given as a subcutaneous injection every six months after starter dosing.
From an effectiveness standpoint, Yeztugo is very impressive. It lasts a long time and can be an important option for people who struggle with daily pills or more frequent injections.
That said, I am a little less enthusiastic about Yeztugo as an automatic first-line choice for every patient.
The main reason is injection-site nodules. Yeztugo forms a long-acting medication depot under the skin, which is how it lasts so long. But that depot can also create palpable bumps or nodules. Some people may also develop granuloma-type reactions. For some patients, this may be tolerable. For others, the idea of persistent bumps under the skin is a dealbreaker.
There is also a practical sexual health issue. If someone only needs a PrEP visit every six months, they may be less likely to keep up with routine STI screening. That matters. PrEP is not just about preventing HIV; good PrEP care should also include regular testing for gonorrhea, chlamydia, syphilis, and other relevant infections.
For many people, the structure of every-2-to-3-month follow-up helps keep sexual health care on track. So while Yeztugo may be a great fit for some patients, especially those who really need the longest possible dosing interval, it is not automatically the best choice just because it lasts the longest.
What About Event-Driven PrEP?
There is also an “event-driven” or “as-needed” oral PrEP method, sometimes called the 2-1-1 schedule.
This involves taking Truvada or generic TDF/FTC before and after sex rather than every day. The 2-1-1 method has been studied primarily in adult gay and bisexual men. It is not right for everyone, and it requires being able to plan ahead and follow the dosing schedule carefully.
For some people, daily PrEP is simpler. For others, event-driven PrEP can be a reasonable choice when sex is less frequent or more predictable.
This should be discussed with a clinician before starting, because the timing matters and it is not appropriate for every type of HIV exposure risk.
Key Things to Know Before Starting PrEP
PrEP is very effective, but it works best when it is part of an actual sexual health plan — not just a prescription.
PrEP Does Not Protect Against Other STIs
PrEP only prevents HIV. It does not prevent gonorrhea, chlamydia, syphilis, herpes, HPV, hepatitis C, or pregnancy.
That does not mean everyone on PrEP “must” use condoms all the time. It means condoms, Doxy-PEP when appropriate, vaccines, and routine STI screening are still part of the larger conversation.
At Be Well Medical Group, we usually talk about PrEP and Doxy-PEP together when appropriate, because HIV prevention and STI prevention often overlap.
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PrEP Requires Routine Testing
Before starting PrEP, we need to confirm that someone is HIV-negative. This is important because taking PrEP while actually having undiagnosed HIV can lead to drug resistance.
Follow-up testing usually includes HIV testing, kidney function monitoring for oral PrEP, hepatitis B screening when appropriate, and STI screening. The exact schedule depends on the medication and the patient’s situation.
This is one reason I do not think of PrEP as a one-time transaction. It is ongoing prevention care.
PrEP Is Flexible
PrEP does not have to be forever.
Some people use PrEP during a specific season of life when their HIV exposure risk is higher. Others stay on it long-term because it provides reassurance and protection. Some start, stop, and restart depending on relationships, sexual activity, substance use, travel, or other life changes.
The key is to stop and restart thoughtfully, ideally with guidance, because timing matters.
How to Choose the Right PrEP Option
The right PrEP option depends on several factors:
Route of HIV exposure
Kidney function
Bone health
Ability to take a daily pill consistently
Comfort with injections
Side effect history
Cost and access
Need for routine STI screening
Personal preference
In clinical practice, I do not think of PrEP as one-size-fits-all. I think of it as matching the medication to the person. For someone who wants the most affordable, accessible, proven option, generic Truvada may be perfect. For someone with kidney concerns, Descovy or injectable PrEP may make more sense. For someone who cannot stay consistent with pills, Apretude can be a great option. For someone who needs the longest possible dosing interval and understands the nodule issue, Yeztugo may be worth considering.
The goal is not to pick the newest medication. The goal is to pick the medication someone can actually use safely, consistently, and comfortably.
If you are in Beverly Hills, Los Angeles, West Hollywood, Santa Monica, Pasadena, or elsewhere in California, Be Well Medical Group can help you compare PrEP options and decide what makes sense for your health and your life. Alaska patients can also access confidential telehealth PrEP care when clinically appropriate.
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How Effective Is PrEP?
PrEP is highly effective when used correctly.
Oral PrEP reduces the risk of HIV from sex by about 99% when taken as prescribed. For people who inject drugs, oral PrEP is also recommended for those with injection-related HIV risk, with TDF/FTC being the best-studied oral option in this population.
Apretude is also highly effective and may perform better than daily oral PrEP in some real-world settings because it removes the need to remember a pill every day.
Yeztugo has shown extremely strong trial results and may become an important option for people who need longer-lasting HIV prevention.
The biggest reason PrEP fails in real life is not usually the medication itself. It is missed doses, delayed injections, gaps in care, or starting and stopping without a plan.
That is why a good PrEP plan should feel realistic, not just medically ideal.
What Are the Main Side Effects?
Most PrEP side effects are mild and temporary, but each medication has its own profile.
Truvada and Generic TDF/FTC Side Effects
The most common early side effects are nausea, headache, and fatigue. Some people call this “start-up syndrome.” It usually improves within the first few weeks.
The main long-term monitoring issue is kidney function, and sometimes bone mineral density, especially in people with other risk factors. Serious kidney issues are uncommon, but monitoring is part of safe PrEP care.
Descovy Side Effects
Descovy can cause similar early side effects, such as nausea or headache, but it is generally gentler on the kidneys and bones than Truvada.
It can be associated with modest weight gain or cholesterol changes in some people, so those factors may be part of the decision.
Apretude Side Effects
Apretude commonly causes injection-site soreness, swelling, or tenderness. Some people also experience headache, fatigue, feverishness, chills, body aches, or a short flu-like feeling.
For most people, if the flu-like symptoms happen, they are brief and occur around the first or second injection. For some, they persist or recur enough that stopping the medication makes sense.
Because Apretude stays in the body for a long time, it is especially important to stay on schedule with HIV testing and follow-up injections.
Yeztugo Side Effects
Yeztugo’s most notable issue is injection-site reactions, especially nodules or firm bumps under the skin.
These nodules are related to the long-acting drug depot and may last for months. Some people may also develop granuloma-type reactions. For some patients, this may be acceptable. For others, it may not be worth it.
This is one of the reasons I approach Yeztugo thoughtfully rather than treating it as an automatic upgrade over other PrEP options.
PrEP vs. PEP
PrEP and PEP are easy to mix up, but they are used at different times. PrEP is taken before a possible HIV exposure. It is for ongoing or anticipated protection. PEP, or Post-Exposure Prophylaxis, is taken after a specific possible exposure, such as a condom break, needle stick, or unprotected sex with a partner whose HIV status is unknown or positive with unclear viral suppression.
PEP must be started within 72 hours of the exposure and is taken for 28 days. If someone needs PEP more than once, that is usually a sign that PrEP may be worth discussing.
FAQ
What Is the Purpose of PrEP?
PrEP is used by HIV-negative people before a possible exposure to reduce the risk of getting HIV. It works by keeping enough medication in the body to prevent HIV from establishing infection.
Which Is Better, PEP or PrEP?
Neither is better. They are used for different situations. PrEP is for prevention before exposure, especially when there is ongoing or recurring risk. PEP is emergency medication after a specific possible exposure and must be started within 72 hours.
Do I Still Need Condoms on PrEP?
PrEP protects against HIV only. It does not protect against other STIs or pregnancy. Obviously, my medical recommendation is to still use condoms for sexual activity. Additionally, I understand that we don’t always practice our preferred behavior, cultural norms vary between groups, and adults are allowed to make their own decisions in regards to their behavior and riks tolerance. Some people choose to use condoms with PrEP. Some do not. The important thing is to understand what PrEP does and does not cover, your risk profile, mitigations strageties, and to keep up with your individual safer sex plan.
Is Descovy Safer Than Truvada?
Descovy is generally easier on the kidneys and bones, but both Descovy and Truvada are very safe medications for most people. If cost or access is an issue, generic Truvada is still a very effective and appropriate choice for many patients.
Is Injectable PrEP Better Than Pills?
Not always. Injectable PrEP can be better for people who struggle with daily pills or prefer not to think about PrEP every day. But injections have their own downsides, including injection-site reactions, scheduling requirements, and longer medication “tail” periods after stopping.
The best option is the one that fits the person.
Getting Started With PrEP in California and Alaska
Starting PrEP should feel straightforward and non-judgmental.
At Be Well Medical Group, we help patients choose between oral PrEP, injectable PrEP, Doxy-PEP when appropriate, and routine STI screening based on their real life — not assumptions.
For California patients, visits may be available in Beverly Hills or by telehealth when appropriate. We serve patients in Beverly Hills, Los Angeles, West Hollywood, Santa Monica, Pasadena, and throughout California.
For Alaska patients, confidential telehealth PrEP care is available across the state, including Anchorage, Fairbanks, Juneau, Mat-Su Valley, Kenai Peninsula, Homer, and rural communities.
Be Well Medical Group also provides inclusive sexual health care for LGBTQ+ patients, cisgender patients, transgender patients, and nonbinary patients. The goal is simple: clear options, respectful care, and prevention that fits your life.
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Schedule PrEP Care With Be Well Medical Group
You do not have to figure out PrEP alone.
Whether you are comparing Truvada, Descovy, Apretude, Yeztugo, Doxy-PEP, or routine STI screening, we can help you understand your options and choose a prevention plan that makes sense.
Schedule an appointment with Be Well Medical Group to talk through PrEP care in Beverly Hills, California, or by telehealth in Alaska.
Call 310-810-3666 or schedule online to book your visit.
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