The Future of PrEP is Now.
Using Pre-Exposure Prophylaxis (PrEP) is a very effective way to prevent HIV. In Canada, using PrEP means taking a pill every day, or before and after sex (so-called “2-1-1” or “on-demand” PrEP). But what if pills weren’t the only option?
In some countries, long-acting options like injectable PrEP are now being offered to prevent HIV. For many Two-Spirit, gay, bisexual, trans, and queer men (2SGBTQM), long-acting PrEP increases choice when it comes to HIV prevention options and can even make PrEP more accessible. As researchers and members of the 2SGBTQM community, we want to prepare Canada for the arrival of long-acting PrEP. Our main goal is to better understand community needs and preferences for accessing and taking PrEP.
What is The Future of PrEP is Now?
“The Future of PrEP is Now” is a research project to prepare Canada for the arrival of long-acting PrEP, by studying how these new options can be made more accessible for 2SGBTQM. Our main goal is to better understand community needs and preferences for accessing and taking PrEP.
This research project is community-based, meaning our research team is led by members of the 2SGBTQM community, with input from community-based organizations across Canada.
PrEP and Long-Acting PrEP
PrEP, or Pre-Exposure Prophylaxis, is a medication that can be taken by HIV negative people to prevent HIV. In Canada, PrEP is currently only available in pill form, which can be taken daily or used “on-demand.” While PrEP pills are highly effective, taking pills every day doesn’t work for everyone. New, long-acting options for PrEP are being evaluated in studies around the world, and include injections, implants, and new types of pills. The closest option on the horizon in Canada is long-acting injectable cabotegravir (CAB-LA) – an injection every two-months.
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PrEP options available now
In Canada, PrEP is currently only available in pill form. This formulation of PrEP involves two antiviral drugs, emtricitabine and tenofovir, taken together as part of the same pill.
PrEP pills can be taken daily or used “on demand”. “On demand” PrEP involves taking PrEP periodically according to when you have sex: taking two pills 2–24 h before first having sex, then one pill daily for 48 h after your last sexual encounter. Research shows “on demand” PrEP is effective at preventing HIV transmission through anal sex. But, we don’t know if “on demand” PrEP works to prevent HIV transmission through vaginal/front hole sex, or drug use.
Injectable PrEP
Injectable PrEP involves an injection in the gluteal muscle (butt) every two months. It’s not yet approved for use in Canada, but research shows injectable PrEP is safe and works very well to prevent HIV. For some, injectable PrEP could be a better choice than oral PrEP because it doesn’t involve remembering to take pills or finding a safe place to store the medication. But, individual preferences for PrEP will vary. Using injectable PrEP will still require in-person appointments with a health care provider to receive the injection.
The drug used in injectable PrEP is called long-acting cabotegravir (CAB-LA). CAB-LA is already being used as a PrEP medication in the United States. In Canada, this drug is approved for use as HIV treatment when combined with another injectable drug called rilpivirine. CAB-LA also be approved in Canada as PrEP in the future.
More Long Acting Options
Along with injectable PrEP, a number of other long-acting PrEP options are being developed and tested. These technologies are at varying stages of development and none are currently available in Canada.
Implants
Long-acting implants are small devices placed under the skin that release an antiviral drug over time, which provides protection against HIV. More research is needed to support implants as a way to prevent HIV.
Antibodies
It’s possible that HIV antibodies (proteins part of the immune system) could be used as PrEP. Research is ongoing to see if periodically introducing HIV antibodies in the bloodstream intravenously (by infusing them into a vein through a needle) could effectively prevent HIV.
Dapivirine ring
The dapivirine ring is a soft silicone ring placed inside the vagina or front hole every month. The ring constantly releases small amounts of a drug called dapivirine, which works to prevent HIV. This option is available in some countries, but it isn’t fully effective at preventing HIV when used on its own. The ring was not designed to offer protection from HIV during anal sex.