HIV prevention and COVID-19

April 14, 2020

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The current COVID-19 situation is impacting our lives and for many this includes the kind and frequency of sex we are having. Given the importance of our relationships and desire for human connection, it may not be easy to make new choices about how to best protect ourselves and others. Some people may want to stop their daily PrEP while others will continue taking it.

Safer-at-home recommendations may last for some time, and may change often and from city to city. Even as these orders are eventually eased in some ways, they may still present challenges for some people due to their own or their partner’s underlying health conditions or age.

(We focus on daily PrEP here. Those who use 2-1-1 PrEP for anal sex can continue using it as counseled and prescribed.)

COVID is spread by breathing in viral droplets or spreading them from our hands to our nose, mouth, or eyes. To prevent it’s spread, stay home if you can, keep yourself and others safe by physically distancing, and use other personal hygiene habits. There’s no evidence that PrEP drugs protect against COVID.

Many providers are communicating with their patients about any personal impacts. It may take time to hear back from your doctor, pharmacist, or others on the questions you have. Be patient and plan ahead. Call or email your provider first, or check their website for best ways to contact or access medical care.

If you currently take PrEP without any issues, PrEP care visits can probably be put on hold or handled by phone, text, patient message portals, or even video. As health systems adjust to COVID, you may start doing oral swabs, finger prick tests for HIV, or self-swabbing for STDs at home. Ask your doctor about the best way to keep up your PrEP care, including using various telehealth providers if needed.

If you experience symptoms of early HIV infection (such as fever, swollen glands, night sweats, rash, etc.) or what you think could be an active STD (or had sex with someone with an STD), contact your provider as soon as possible for next steps. It’s very possible to manage these medical needs remotely.

In addition to self-pleasure or masturbation, many people are getting creative with non-contact sex. Using sex toys, sharing fantasies, sexting, phone sex, video sex, and conference call group sex are some ways to stay frisky and keep physical distance during COVID. Be mindful of personal privacy when you do, and know the privacy settings of the devices and software you use.

Some people are choosing to take their PrEP throughout this period even though they're not having sex, or having a lot less of it. This can help maintain your pill routine, so you’re ready as life returns to some normalcy. It can also help with reducing stress and anxiety.

Some people are having sex with others within their households, or with people outside their homes (although this can increase the risk for COVID). If you are having sex or are unable to control the sex that occurs, it's good practice to keep up with PrEP even though you may be having sex with fewer partners.

Plan ahead for prescription refills, either through your insurance plan or with a telehealth provider. Consider drug store drive-thru, mail order, or home delivery options to avoid a trip into the pharmacy. Be aware shipping may take longer than normal (especially through the postal service). Contact your provider to see if your routine tests will be put on hold until later, or can be done from home or in person.

PrEP meds generally have few interactions with other drugs. These include: high-dose or multiple NSAIDs (aspirin, celecoxib, ibuprofen, naproxen, etc.); acyclovir, adefovir, cidofovir, ganciclovir, valacyclovir, and valganciclovir; and certain antibiotics (amikacin, gentamicin, neomycin, streptomycin, tobramycin). If you’re treating symptoms of a cold, the flu, or perhaps COVID, then check the ingredients list of any over-the-counter medicine you want to take and check with your doctor about possible drug interactions.

The manufacturer of PrEP drugs has stated that there isn’t a supply chain issue, so refills should not be a problem. 

Stopping daily PrEP is safe to do. However, if you have chronic hepatitis B, do not stop PrEP without first talking to your doctor. It’s a good idea to check in with your provider about your desire to stop and how to do it safely.

Some medical sites are making their own recommendations for stopping and restarting PrEP during COVID. The number of daily doses to take after the last time you had sex ranges from 2 to 28 doses (depending upon the type of sex and other factors). Again, ask your doctor about the best way for you to stop.

If you have sex without condoms while you're off PrEP, (especially if any of your partners aren’t undetectable), consider taking PEP. If you don’t use PEP, then talk to your provider before restarting PrEP to make sure you're HIV-negative.

Some provider networks are stating that if you didn’t have sex while off PrEP or only had condom-protected sex, then you can safely restart PrEP without getting blood work done. However, check with your doctor on the best way to restart, especially to ensure that you’re HIV-negative before restarting. (If you had condomless sex while off PrEP and didn’t take PEP, contact your PrEP provider before restarting.)

(In Europe, PrEP guidance for MSM around starting and stopping PrEP is somewhat different. You can read more on the websites from Terrence Higgins Trust, i-Base, and BHIVA.)

The state of California has extended open enrollment to August 31, 2020, to allow people to get coverage in case they lose their health insurance. People who make up to $17,237 qualify for Medi-Cal. Those who make $17,328 to $49,960 are eligible for a subsidy through Covered California. Telehealth options are also available, and the screening and testing for coronavirus is free for those with coverage. Enrolling in PrEP-AP is also an option.