Getting on PrEP is straightforward: you need an HIV test, a prescription from a provider, and a follow-up plan. PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed, and the process from first appointment to filled prescription can happen within a single week.
Who Can Get PrEP
Current CDC guidance is simple: PrEP should be prescribed to anyone who asks for it, including sexually active adults and adolescents who don’t report specific HIV risk factors. You don’t need to justify your request or prove you’re “high risk enough.” If you’re sexually active and HIV-negative, you’re eligible.
PrEP is also recommended for people who inject drugs that aren’t prescribed to them, people whose sexual partners have HIV, and transgender and nonbinary people using gender-affirming hormones. Adolescents weighing at least 77 pounds (35 kilograms) can also be prescribed PrEP.
Where to Get a Prescription
Your primary care doctor can prescribe PrEP. You don’t need to see an HIV specialist. If you don’t have a regular doctor, or if you’d prefer a provider already experienced with PrEP, the CDC’s National Prevention Information Network runs a PrEP locator tool at preplocator.org where you can enter your zip code and find nearby providers. Sexual health clinics, community health centers, and Planned Parenthood locations also commonly prescribe it.
Telehealth services are another option. Several online platforms now offer PrEP consultations, lab orders, and prescriptions entirely by video or phone, with medication shipped to your door. This can be especially useful if you live in an area with few PrEP providers or prefer more privacy.
What Happens at Your First Appointment
The main requirement before starting PrEP is confirming you’re HIV-negative. Your provider will order a blood-based HIV test (not an oral rapid test, which is less sensitive and can miss recent infections). If you’ve had a possible HIV exposure in the past few weeks, your provider will also ask about any flu-like symptoms you’ve had recently, since those can signal a very new infection that standard tests might not yet catch.
Beyond HIV testing, expect screening for chlamydia, gonorrhea, and syphilis. If you’re being prescribed an oral form of PrEP, your provider will check your kidney function with a blood test and screen for hepatitis B. None of these are reasons to delay the appointment. Hepatitis B, for example, doesn’t disqualify you from PrEP. These tests just help your provider choose the right option and monitor your health going forward.
Choosing Between Pills and Injections
There are three FDA-approved PrEP options, and they work differently in practice.
- Truvada (emtricitabine/tenofovir disoproxil fumarate): One pill daily. Approved for all adults and adolescents at risk of HIV through any route, including receptive vaginal sex. Requires adequate kidney function. Available as a generic, making it the most affordable option.
- Descovy (emtricitabine/tenofovir alafenamide): One pill daily. Approved for people at risk from sex, but specifically not approved for people at risk from receptive vaginal sex (the clinical trials didn’t include this group). It’s easier on the kidneys than Truvada, so it may work for people with mildly reduced kidney function. Your provider will also check cholesterol and triglyceride levels before prescribing it.
- Apretude (cabotegravir): An injection given in the buttocks by a healthcare provider. You get two starter injections one month apart, then one injection every two months after that. There’s a flexible window of 7 days before or after your scheduled date. No kidney monitoring is needed. This option works well if you don’t want to think about a daily pill.
If you’re considering the injection, your provider may offer a one-month trial of oral cabotegravir first to make sure you tolerate the medication before committing to long-acting shots.
On-Demand Dosing for Some Users
If you don’t have sex frequently and prefer not to take a daily pill, there’s an event-based dosing strategy called the “2-1-1” schedule. You take 2 pills 2 to 24 hours before sex, then 1 pill 24 hours after that first dose, then 1 pill 24 hours after the second dose. This approach has been studied in men who have sex with men and is not recommended for other groups. Talk to your provider about whether it fits your situation.
How to Pay for PrEP
Cost shouldn’t be a barrier. Most private insurance plans cover PrEP with no copay, since it’s rated as a top-tier preventive service by the U.S. Preventive Services Task Force. Medicaid also covers PrEP in all states.
If you don’t have insurance that covers prescriptions, the federal Ready, Set, PrEP program provides PrEP medication at no cost. To qualify, you need to test negative for HIV, have a valid prescription, and lack prescription drug coverage. You can enroll at getyourprep.com or by calling 855-447-8410.
Manufacturer copay assistance programs can also help with remaining out-of-pocket costs for lab work or provider visits. Gilead, which makes Truvada and Descovy, runs an assistance program that covers copays up to a set annual amount. Many community health centers offer PrEP services on a sliding fee scale based on income.
What to Expect After You Start
PrEP doesn’t reach full protection instantly. For receptive anal sex, daily oral PrEP reaches maximum protection after about 7 days of consistent use. For receptive vaginal sex, it takes about 21 days. The injectable version builds protection over the first week after the initial injection.
Common side effects of oral PrEP include nausea, headache, and mild stomach discomfort. These typically fade within the first few weeks. The injection can cause soreness or mild swelling at the injection site that usually resolves within a few days.
Once you’re on PrEP, you’ll have follow-up visits roughly every 3 months. These include repeat HIV testing (to confirm you’re still negative), STI screening, and kidney function checks if you’re on an oral form. These visits are quick and can often be done via telehealth between in-person lab draws. If you’re getting injections, the follow-up visits naturally align with your injection schedule every 2 months.