World AIDS Day 2025: Beyond the Condom – Modern HIV Prevention
For many years, the narrative about how to prevent HIV was driven mostly by one simple item: a condom. The purpose of condoms was solid, straightforward, and integral to people’s understanding of how to prevent sexually transmitted infections, including HIV. However, in the 40 years since HIV was first declared a global health crisis, the science of HIV prevention has grown significantly, expanding from one way to protect from HIV to a much more comprehensive strategy to protect individuals against HIV within a coordinated, multifaceted system of care.
Prevention today uses different methods besides condom use, such as medications, making sure people are using appropriate medications to protect themselves from HIV, and ensuring individuals receive treatment as quickly as possible after learning they have HIV. The two most effective medications available to protect against HIV transmission—the medications PrEP and PEP—have completely changed the way society can think of and approach sexual health and have brought society closer to achieving zero new HIV infections.
This comprehensive strategy—testing, immediate treatment of those who are HIV-positive (i.e., Treatment as Prevention or TasP), and the proactive use of PrEP and PEP—represents the backbone of efforts to eliminate the global epidemic. Therefore, understanding the place of PrEP and PEP in today’s sexual behavior and risk is critical for all individuals.
The Evolution of Prevention: Why We Needed More
While condoms remain critical—offering protection against HIV and other sexually transmitted infections (STIs)—relying solely on them has inherent limitations rooted in human behavior and relationship dynamics. Failure rates occur due to breakage, improper use, or simply the reality of spontaneous decisions. Furthermore, for specific populations—such as individuals in discordant relationships (where one partner is HIV-positive and the other is negative), professionals exposed through occupational risk (e.g., healthcare workers), or victims of sexual assault—a backup, pharmaceutical defense is absolutely necessary.
The game-changer came with the realization that the same powerful antiretroviral medications used to treat people living with HIV could also be used to prevent infection in those who are negative. This concept established two distinct, yet complementary, lines of pharmaceutical defense: PrEP (proactive) and PEP (reactive).
PrEP: The Proactive Shield
Pre-exposure prophylaxis or PrEP is a prescription that HIV-negative people can take to prevent contracting HIV through sexual intercourse. When used correctly and consistently, PrEP has been shown to be over 99 per cent effective in reducing the risk of getting HIV from sex.
The primary way that PrEP works is by saturating the body with medication that will stop HIV from becoming a chronic infection. When HIV enters into the body, PrEP prevents the replication of the virus in the body by inhibiting the replication factors of the virus, thereby preventing HIV from becoming an established infection.
Originally, the main delivery of PrEP was a single daily oral pill (the brand names Truvada and Descovy were the most common). The protection achieved from PrEP is dependent upon strict adherence (no missed doses), meaning that missed doses will drastically reduce the overall effectiveness of PrEP. Currently, there are injectable forms of PrEP that have been approved, such as Apretude, where one injection provides a HIV protection for two months, relieving the requirement of a person having to remember to take a pill every day.
Who Should Consider PrEP?
PrEP is not just for specific communities; it is for anyone who faces a substantial risk of HIV Pre-exposure Prophylaxis (PrEP) is intended for use by anyone who has significant exposure to HIV, not only people in specific communities. On the contrary, there is a lot of overlap in the populations using the drug:
- People who have a partner who is HIV positive and has not demonstrated that they do not have any HIV in their system.
- People who have sex with non-monogamous partners on a regular basis without using condoms.
- People with STIs diagnosed in the past six (6) months.
- People who use injectable substances and share needles.
However, it is essential to understand that PrEP is a prescription medication that requires ongoing care and quarterly testing for both HIV and STIs from a licensed provider to ensure that PrEP is safe and that an individual’s total sexual health is being monitored. Also, it is important to note that although PrEP protects against HIV, it does not protect against gonorrhea, chlamydia, syphilis, or hepatitis; therefore, barrier methods for STI prevention have to continue to be used.
PEP: The Emergency Brake
Pre-Exposure Prophylaxis (PrEP) is a daily preventative treatment that helps to prevent HIV infection. Post-Exposure Prophylaxis (PEP) is used after a patient has been exposed to HIV and is intended to stop the development of the virus in the body. PEP consists of a 28-day course of powerful medications and is used to stop the infection from taking hold before it has the chance to establish itself permanently in the host.
PEP can be given if a patient knows or thinks they have been exposed to HIV through one of the following routes:
– Sexual assault.
– Condom breaks while having unprotected sex with a person of unknown or HIV-positive status.
– Needle stick accident (work-related exposure).
– Needle or injection drug equipment sharing.
Time is the most important factor in whether or not PEP will work successfully. The sooner you start taking PEP, preferably within hours, and no later than 72 hours after you were exposed to the virus, the more likely you are to have a successful outcome. If a patient is unable to start PEP within the 72-hour window following their exposure, it is very likely that the virus has already begun to integrate itself into host cells, and PEP will not be able to stop the infection.
PEP is a medical emergency. If you believe that you may have been exposed to HIV, it is critical that you seek medical attention immediately, either from an emergency room or from an urgent care clinic. A medical provider will determine your level of risk, perform baseline tests, and provide you with a prescription for a 28-day course of medication, which you must take as prescribed for the full 28 days, even if you experience side effects while taking the medications.
The Future: A Collective Strategy
The strength of modern-day methods to prevent the HIV virus exists in the combination of all of these different methods of protection. PrEP supplies ongoing and continual protection for the risk that will occur because you are going to be exposed to the virus, whereas PEP is a necessary backup method for unexpected exposure to the virus after having been exposed. When you put this together with TasP Treatment as Prevention (i.e., a person who is HIV-positive and has a viral load of less than or equal to an undetectable level cannot pass on the virus) we have a very solid matrix in place to prevent spreading HIV from person to person.
This new strategy will require an open line of communication between you, the healthcare provider, and destigmatizing the act of seeking PrEP or PEP in your community. When you look to get either medication(s) from your healthcare provider, it is not an indication of promiscuity or an indication of reckless behavior; it is an example of being responsible for your health, to care for yourself and to protect the health of others.
At Oklute, our goal is to give you the knowledge and understanding that will help you to make informed decisions to take care of your sexual health in a responsible manner. With a significant amount of HIV testing showing high HIV infection rates, it is important for all of us to embrace these preventative measures to reduce the risk of becoming infected with the HIV virus.
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