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Injectable PrEP? PrEP Rings? PrEP Implants???

by | Sep 22, 2020 | PrEP 101

Let’s face it; not everyone is a pill-taker. Sometimes, we forget. Sometimes the pill is a horse tranquilizer, and we don’t know how we are supposed to swallow that thing with just a glass of water, hope, and determination. Sometimes, we just don’t want to take a pill every day.

Whatever the reason, we get. Truly. And so do researchers around the world currently testing new options for PrEP.

Often, we use the analogy of birth control to describe PrEP; a pill a day to keep the HIV away. However… that’s all we have right now, a pill a day (unless you take it differently for anal sex). That can be changing soon as more options for PrEP are completing their first and second stages of clinical trials! (This is exciting for me because one shot every two months, and I don’t have to think about HIV????? Uhm, yes please. [also, I don’t mind shots so much, but some people do, which is why it is important to have options!])

Injectable PrEP works better

Researchers at the 23rd International AIDS Conference back in July 2020 announced that injectable PrEP was discovered to be 66% MORE effective than Truvada pills in men who have sex with men and transwomen. This discovery means the injectable PrEP is superior to oral PrEP (they both work, one just works better). What does this mean? Basically, while Truvada for PrEP is 99% effective, injectable PrEP is also over 99% effective, but even closer to 100%. One of the reasons is that people don’t have to remember to take the pill every day, and there are no missed doses since the injectable lasts eight weeks.

Don’t get too excited though, because more trials need to happen and research needs to finish before this rolls out (okay, get a little excited). The drug manufacturer, ViiV, has the ultimate decision as to when (and if) this rolls out, pending approval from the FDA and them.

What about cisgender women, tho?

Ciswomen (women who identify as women and were assigned female at-birth) get left out of the conversation way too much. Even though the state of emergency for men who have sex with men and transwomen and HIV transmission, especially Black MSM and transwomen, is continuously rising, ciswomen still can and still get HIV. Not only ciswomen, but many transmen have vaginal sex, too. We can’t leave out people with vaginas like it just ain’t people walkin’ round, livin’ with vaginas!

In the great choices available for long-acting reversible birth control, vaginal rings are one option that many ciswomen prefer. It can be removed, it is discrete, it lasts for four weeks, and the side effects are milder in some people. Why isn’t there a ring that goes in the vagina for PrEP? I’m glad you asked! There is one in clinical trials right now, the ASPIRE trial. And we can’t forget the HOPE trial (which concluded in 2019) that was shown to be effective. There were even fewer infections than the researchers had previously thought by the trial’s conclusion.

It is important to note that a study of injectable PrEP is happening with women; its conclusions and results just haven’t been shared yet because it started a little after the first study with cismen and transwomen, and it is supposed to conclude May 2022.

Pills, rings, injectables – what else is there?

I feel like Shirley Caesar circa 2016. We got pills, bills, rings, things, injections, protections, implants- wait, that’s the new one. There are also implants being studied, much like Nexplanon, the little bar that goes right under the skin and prevents pregnancy by releasing no-baby-today hormones a little at a time. Think that, but HIV prevention drugs that release over time to protect against infection. Some studies are also looking to combine HIV protection with pregnancy prevention in ONE implant (whew, talk about convenient; it is the Walmart of prevention. All your prevention needs in one little, under-the-skin bar.) 

Merck & Co. is the company working on studies of the implant that is very thin and just a little longer than a penny (it’s little). The most exciting part about this method over the others; Merck believes that the implant could last one year or more. That would blow adherence issues out the water. You mean I have to go into the office, get this implant once, and I’m good for the YEAR? OR LONGER?

Wow, I’m calling that an AKeemboat dreamboat (this is what my best friend yells at poetry slams…don’t ask).

Get PrEP for FREE (or really cheap)

Aside from daily pills, injectables, rings, and implants, there has also been a study of antibody facilitated prevention. The researchers actually give participants powerful HIV antibodies that prevent HIV infection on their own, known as the AMP study (we have an AMP office here in Cleveland).

This is different from a medication. HIV antibodies exist and are produced by the human immune system, but they aren’t as specific as these. Those natural antibodies protect from a host of other infections, but the trial antibodies are specific HIV-haters that go right for the virus’s neck (metaphorically) and prevent HIV from gaining a foothold in the body and starting an infection. It’s like the Nicki Minaj of prevention, where HIV is the rival rapper, and the antibodies are Nicki blockin’ their bag.

A lot of people think, “there is a pill, why not just use that? Why do we need all that extra stuff?” Well, allow me to be extra-extra-read-all-about-it for a second. Yeah, we have PrEP pills, but many people don’t want pills for whatever reason or forget pills. Things can go wrong with daily pills, too.

  1. Imagine going on a vacay to Sizzle or Atlanta Pride or Amsterdam or Brazil, and you done packed up and got extra condoms, and maybe you got some lube because you wanna try some new stuff while you are there. Your plane takes off in twenty minutes, and BOOM- you realize you forgot your PrEP at home, and you’re already leaving for two weeks. What now?
  2. Another scenario that I am too familiar with; you didn’t put the top on well enough, and all your pills fall into the dishwater (don’t judge me…)
  3. PrEP gives you the bubble guts (rare, but some people get stomach aches from meds, even aspirin).
  4. You can’t swallow pills (my older sister has NEVER swallowed a pill in her life, cuz ).
  5. You go long periods of time where you don’t really have sex and then periods where you have more sex (this is known as “seasons of pleasure”).
  6. You have a lifestyle that could make taking a daily med difficult.

The list could go on and on and on, and as silly as some people may think it is, these are all valid reasons people don’t stay on or start PrEP, even being in a “high-risk” group. Having more options never hurt anybody. Do you walk into Baskin Robbins and tell them that they have too much ice cream because chocolate is your favorite and all the other 30 flavors are useless? No, and if you do, you hate fun. The more ways we can safely prevent HIV, the more HIV we can prevent, and the closer we can get to ending the epidemic.

(Like, seriously, who hates ice cream that much?)

Have more PrEP questions?

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Deemyi Scott, University Hospitals
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AKeem Rollins, MetroHealth
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