PrEP & PEP: Essential Tools in HIV Prevention

By Ramesh Vadiveloo (04.03.2025)

Introduction

HIV prevention has come a long way, with biomedical advancements providing powerful tools to reduce transmission. Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are two highly effective strategies that help individuals take control of their sexual health. By ensuring early prevention and intervention, PrEP and PEP significantly reduce the risk of HIV infection. However, awareness and accessibility remain key challenges. This article explores the role of PrEP and PEP in HIV prevention, their effectiveness, and the importance of regular testing.

What is PrEP?

PrEP (Pre-Exposure Prophylaxis) is a medication regimen designed to prevent HIV before exposure. It is recommended for individuals at high risk, including those with HIV-positive partners, people with multiple sexual partners, and individuals who engage in condomless sex.

Daily vs. Event-Driven PrEP

PrEP can be taken in two different ways:

  • Daily PrEP: Taken once a day, this method provides continuous protection and is the most recommended approach for all individuals at risk, especially those who engage in frequent sexual activity.
  • Event-Driven PrEP (ED-PrEP): Also known as on-demand PrEP, this involves taking pills only when needed. The “2+1+1” dosing method involves:
    • Two pills taken 2-24 hours before sex
    • One pill per day for the next two days
    • This method is effective for cisgender men who have sex with men (MSM) but is not recommended for women or transgender individuals, as drug absorption rates differ.

How Effective is PrEP?

PrEP is highly effective in preventing HIV:

  • Daily PrEP reduces the risk of HIV from sex by 99% and from injection drug use by at least 74% (CDC, WHO).
  • The PARTNER Study, which followed 1,000 serodiscordant couples (one partner with HIV and one without), found that PrEP users had zero HIV transmissions, reinforcing its effectiveness when taken correctly.

What is PEP?

PEP (Post-Exposure Prophylaxis) is an emergency medication taken within 72 hours after potential HIV exposure. It is meant for unexpected or accidental situations, such as condom failure, sexual assault, or needle-sharing.

Challenges: The High Cost of PEP

While PEP is effective, its high cost remains a significant barrier to access. In private healthcare settings, a full 28-day PEP course can cost between RM1,500 and RM3,000. Government facilities offer subsidized or free PEP for select individuals, but availability is often limited. This highlights the need for prevention strategies like PrEP, which are more affordable in the long run.

How Effective is PEP?

  • When taken correctly, PEP reduces the risk of HIV by more than 80% (CDC).
  • The effectiveness depends on strict adherence to the 28-day course.

Why PrEP & PEP Are Critical in HIV Prevention

The PARTNER Study provided groundbreaking evidence that consistent PrEP use, combined with Undetectable = Untransmittable (U=U) principles, prevents HIV transmission entirely. For individuals without HIV, PrEP offers control over their risk, while PEP serves as a safety net in emergencies.

Beyond individual protection, PrEP and PEP play a key role in reducing overall HIV transmission rates within communities. Countries with widespread PrEP adoption have seen a decline in new HIV infections, reinforcing its impact as a prevention tool.

Addressing Common Misconceptions

1. “PrEP is just for promiscuous people.”

PrEP is for anyone who wants to protect themselves from HIV. Just like birth control or vaccines, PrEP is a preventive measure, not a judgment on personal choices.

2. “Taking PrEP means you don’t need condoms.”

While PrEP is highly effective against HIV, it does not protect against other STDs like syphilis, gonorrhea, or chlamydia. Using condoms alongside PrEP provides comprehensive protection.

3. “PrEP users face stigma.”

Unfortunately, PrEP stigma exists, with some assuming that users are irresponsible or engage in high-risk behavior. Overcoming this requires normalizing conversations about HIV prevention and highlighting PrEP’s role in public health, just like condoms or vaccines.

The Importance of Regular STD Screening

Whether you are on PrEP, considering PEP, or engaging in any form of sexual activity, routine STD screening is essential. Many STDs, including HIV, can be asymptomatic, making regular testing the best way to ensure early detection and treatment. Annual or bi-annual testing is recommended for everyone, while those on PrEP should test every three months.

Conclusion

PrEP and PEP are game-changers in the fight against HIV. While PrEP empowers individuals with long-term prevention, PEP serves as an emergency safety net. Both interventions significantly reduce HIV transmission and, when combined with regular STD screening, create a strong, proactive approach to sexual health.

At KLEM Clinics, we provide PrEP and PEP consultations to help you stay protected. Take charge of your health today—get tested, get informed, and stay safe.

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