Starting PrEP involves a conversation with a healthcare provider, a few baseline lab tests, and choosing the form of medication that fits your life. The process typically takes one or two appointments before you have a prescription in hand. Current CDC guidelines recommend that any sexually active person who asks for PrEP should be prescribed it, even if they don’t report specific HIV risk factors, so the barrier to getting started is lower than many people expect.
Who Can Get PrEP
PrEP is for anyone without HIV who may be exposed to the virus through sex or injection drug use. That includes people with partners of unknown HIV status, people who don’t consistently use condoms, people who inject drugs, and anyone who simply wants an extra layer of protection. Adolescents who weigh at least 77 pounds are also eligible.
The one firm requirement is that you must be HIV-negative before starting. Taking PrEP when you already have HIV (including a very recent infection you may not know about) can lead to drug-resistant HIV, which makes the virus much harder to treat. This is why an HIV test is the first step at every PrEP visit.
Tests You’ll Need Before Starting
Your provider will order a small panel of lab work at your first appointment. Expect the following:
- HIV test: Required for everyone. This confirms you’re negative before beginning medication.
- STI screening: Tests for chlamydia, gonorrhea, and syphilis are recommended for all sexually active adults.
- Kidney function: Required if you’re taking the daily pill form. Oral PrEP can affect the kidneys, so your provider needs a baseline reading.
- Hepatitis B screening: All oral PrEP candidates must be tested for hepatitis B. Having hepatitis B doesn’t disqualify you, but your provider needs to know so they can manage your care appropriately.
- Cholesterol and triglycerides: Needed if you’re prescribed the Descovy pill specifically.
Most of these are standard blood draws and urine or swab tests. Results usually come back within a few days, and many clinics can start your prescription at that same visit while results are pending.
Your Medication Options
Four FDA-approved PrEP medications are currently available in the U.S., and they fall into two categories: daily pills and periodic injections.
Daily Pills
Truvada (and its generic equivalents) is the original PrEP pill, taken once daily. It’s approved for all people at risk through sex or injection drug use. Descovy (also available as a generic) is a newer daily pill that tends to have fewer effects on kidney function and bone density. However, Descovy has not been evaluated for receptive vaginal sex, so it is not recommended for women or others at risk through that route.
Injectable PrEP
Apretude is a shot given every two months after an initial loading phase. You receive two starter injections one month apart, then switch to one injection every two months going forward. Yeztugo, the newest option, is a shot given every six months after initiation. Both injectables are currently approved for people at risk through sex (not injection drug use) and are not yet recommended for anyone under 18.
If you have severe kidney disease, injectable PrEP is the recommended option since the pills can stress the kidneys. If you’re pregnant or breastfeeding, Truvada is considered generally safe.
How to Choose Between Pills and Shots
The right choice depends on your routine and preferences. Daily pills give you flexibility: you can stop and start them, and they protect against HIV from both sex and injection drug use. But they require consistent daily adherence. Missing doses lowers your protection significantly.
Injections remove the daily commitment entirely. Once you’re on a maintenance schedule, you only need to show up for an appointment every two or six months depending on the medication. The trade-off is that you can’t simply stop on your own timeline. The drug stays in your system for weeks after the last injection, which means if you do acquire HIV during that tail period, resistance could develop. Your provider will plan around this.
On-Demand Dosing (the 2-1-1 Method)
If you don’t have sex frequently enough to justify a daily pill, there’s an alternative dosing schedule that’s been studied for Truvada specifically. It’s called 2-1-1: you take 2 pills between 2 and 24 hours before sex, then 1 pill 24 hours after that first double dose, then 1 more pill 24 hours later. This approach has shown strong protection in clinical trials for anal sex, though it is not recommended for vaginal sex exposure. Not all providers are familiar with this protocol, so you may need to bring it up yourself.
How Long Until You’re Protected
PrEP pills don’t work instantly. The medication needs time to build up to protective levels in the tissues where HIV enters your body. For receptive anal sex, daily oral PrEP reaches maximum protection after about 7 days of consistent use. For receptive vaginal sex, it takes approximately 21 days. During that ramp-up period, use condoms or other prevention methods.
For Apretude injections, protection begins after your first shot, though full efficacy builds over the initial loading doses. Your provider will walk you through what to expect during those first weeks.
Side Effects in the First Few Weeks
Some people experience what’s informally called “start-up syndrome” during the first few weeks on oral PrEP. Symptoms can include nausea, headache, fatigue, and stomach discomfort. These typically resolve within the first month as your body adjusts. Serious long-term side effects are uncommon, though your provider will monitor kidney function over time if you’re on a daily pill.
For injectable PrEP, the most common side effect is soreness or a reaction at the injection site. Some people also report mild fever or fatigue after shots, which usually passes within a day or two.
Ongoing Monitoring After You Start
PrEP isn’t a “set it and forget it” medication. You’ll have regular follow-up appointments that include repeat HIV testing (to make sure you remain negative), STI screening, and kidney function checks if you’re taking a daily pill. These visits are typically scheduled every three months for oral PrEP users and align with injection appointments for those on shots. This ongoing monitoring catches any issues early and keeps your prescription active.
Where to Get PrEP and How to Pay
You can get PrEP from a primary care doctor, an infectious disease specialist, a sexual health clinic, or a telehealth service. Many Planned Parenthood locations prescribe it, and some community health centers offer same-day PrEP starts.
Cost is often the biggest concern, but most people can get PrEP at little or no out-of-pocket cost. Under the Affordable Care Act, most private insurance plans are required to cover PrEP with no cost-sharing, including the medication, clinic visits, and lab work. If you’re uninsured or your insurance doesn’t cover PrEP, several assistance programs exist:
- Manufacturer patient assistance programs: All PrEP manufacturers offer free medication to people earning up to 500% of the federal poverty level who lack coverage. Call Gilead Sciences at 800-226-2056 for Truvada, Descovy, or Yeztugo, or ViiV Healthcare at 844-588-3288 for Apretude.
- Co-payment assistance programs: If you have insurance but face high out-of-pocket costs, manufacturers offer copay cards covering up to $7,200 to $8,000 per year depending on the medication.
Keep in mind that manufacturer programs typically cover only the medication itself. The cost of provider visits and lab tests may not be included, though many state programs and community health centers fill that gap. Your local health department can point you toward resources in your area.
Making the First Appointment
If you’ve decided PrEP is right for you, the practical next step is simple: schedule a visit with a provider who prescribes it. You can search for PrEP providers near you through the CDC’s PrEP locator tool or call your insurance company for in-network options. At the appointment, you’ll discuss your sexual health history, get tested, and walk out with either a prescription or a plan for starting once results come back. Many people complete the entire process in one to two visits spread over a week or two.