PrEP (Pre-Exposure Prophylaxis) isn't just "take a pill every day." You have three distinct options depending on your lifestyle, all with near-identical protection when used correctly.
Important: Oral modes apply to Truvada (TDF/FTC) and generic equivalents. Descovy (TAF/FTC) users must take it daily—On-Demand is NOT approved for Descovy.
🟢 Mode 1: Daily Oral (The Gold Standard)
If you want maximum coverage and don't want to think about it — this is your mode. One pill, every 24 hours, and you're always ready.
- Startup: You need 7 days of pills before you're protected for anal sex.
- Missed a dose? If you hit 4+ pills a week you still have high protection for anal sex. But aim for 7/7.
- The vibe: "Set and forget."
🔀 Mode 2: On-Demand (2-1-1)
If you have sex less frequently and can plan at least 2 hours ahead, this uses fewer pills with near-identical protection — but only if you follow the timing exactly. Truvada (TDF/FTC) or generic equivalents only — not Descovy.
The Protocol:
- Double Dose (2 pills): Take 2 pills 2 to 24 hours BEFORE sex.
- Single Dose (1 pill): Take 1 pill 24 hours after the first dose.
- Single Dose (1 pill): Take 1 pill 24 hours after the second dose.
The "Weekend" Scenario:
- Friday 6 PM: Take 2 pills (Planning for 8 PM sex).
- Saturday 6 PM: Take 1 pill.
- Sunday 6 PM: Take 1 pill.
- If you keep having sex on Saturday/Sunday: Continue taking 1 pill daily until 2 days after your last hookup.
Critical Warning: You MUST take the "after" pills. If you skip the tail, the virus can sneak in.
💉 Mode 3: Injectable PrEP (Cabotegravir / Apretude)
No pills, no daily routine. If adherence to a daily pill is genuinely hard, or you just want nothing to remember, this is the option. Brand name Apretude (US, EU, UK) — the same drug is called Vocabria when used as part of HIV treatment, so tell your doctor which you're on.
- How it works: A long-acting injectable (given as a gluteal IM injection by your doctor or nurse). No pills. No daily routine.
- The Schedule:
- Month 0: First injection at the clinic.
- Month 1: Second injection (4 weeks later).
- Every 2 months after that: One injection every 8 weeks.
- The Startup: Unlike oral PrEP, you are not fully protected between your first and second injection. Use condoms or oral PrEP during that first 4-week gap.
- Efficacy: Non-inferior to daily oral TDF/FTC—the HPTN 083 trial showed it was actually slightly more effective in practice (because adherence is easier when there's no daily pill to forget).
- The Catch: If you stop injections (or miss one), the drug lingers in your body for months at slowly declining levels. During this "tail," you could be exposed with levels too low to protect you but still high enough to allow resistance to develop. If you stop, bridge immediately with oral PrEP until your doctor confirms the drug has cleared.
- Availability: Not yet universally available. Check your country's healthcare access guides.
Emerging Option: Twice-Yearly Injectable (Lenacapavir)
Lenacapavir (PURPOSE 2 trial) showed approximately 96% efficacy in a broad population including gay and bisexual men, with only two injections per year. As of early 2026 this is in the process of regulatory approval in various countries. Ask your sexual health clinic if it has become available in your region.
⚠️ Side Effects & What to Expect Long-Term
Starting oral PrEP: the first couple of weeks can bring nausea, headaches, or what some people charitably call "gurgle-gut." It passes within 1–2 weeks for most people. Don't stop — try taking it with food or right before bed to sleep through it. Mild nausea for a week versus HIV risk: the maths is simple.
Injectable PrEP: mainly injection-site reactions — some soreness, occasionally a small nodule. Usually gone within days.
The long-term picture (oral PrEP):
- Kidneys: your doctor checks creatinine (kidney function) every 6–12 months, typically alongside your quarterly swabs.
- Bones: TDF has rare, reversible density effects. Descovy has a better bone and kidney profile if that becomes a concern.
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