In the fight against HIV, few tools have been as transformative as pre-exposure prophylaxis (PrEP). Originally introduced as a once-daily oral pill, PrEP has evolved significantly over the past decade. In 2025, individuals now have access to a broader array of options, including long-acting injectables, implants, and on-demand dosing strategies. These innovations are expanding access, improving adherence, and reshaping how we approach HIV prevention.
If you’re new to PrEP or want to stay informed about emerging preventive tools, this guide breaks down the latest research, approved medications, and upcoming technologies in PrEP—while addressing common concerns about accessibility, side effects, and how to choose the right regimen.
Understanding PrEP: A Quick Primer
Pre-exposure prophylaxis is a biomedical HIV prevention method in which HIV-negative individuals take antiretroviral medications before exposure to significantly reduce the risk of infection. Clinical trials and real-world studies have shown that PrEP can reduce the risk of HIV acquisition by up to 99% when taken as prescribed.
Originally, PrEP referred solely to the daily pill Truvada (tenofovir disoproxil fumarate/emtricitabine), but innovations have led to multiple alternatives now available or in advanced clinical trials.
Who Should Consider PrEP?
PrEP is recommended for individuals who are HIV-negative but at substantial risk of exposure. This includes:
- People with an HIV-positive partner
- Individuals with multiple sexual partners
- Those who do not consistently use condoms
- People who inject drugs and share equipment
- Individuals diagnosed with STIs such as syphilis or gonorrhea
Recent guidelines have emphasized PrEP access as a form of sexual health equity, especially for disproportionately affected communities including Black and Latino men who have sex with men, transgender individuals, and women in high-incidence regions.
Current PrEP Options in 2025
Daily Oral PrEP
Still the most widely prescribed option, daily PrEP has evolved with two primary FDA-approved choices:
- Truvada (TDF/FTC): Approved for all populations. Effective and generally well-tolerated, but may have mild kidney or bone side effects in long-term use.
- Descovy (TAF/FTC): A newer formulation with fewer renal and bone complications. Approved for men and transgender women but not yet for receptive vaginal sex in cisgender women.
Both require HIV testing before initiation and follow-up visits every three months to monitor kidney function and confirm HIV-negative status.
Long-Acting Injectable PrEP: Cabotegravir
One of the most promising developments is Apretude (cabotegravir extended-release injectable), a long-acting injectable PrEP option.
- Administered as an intramuscular shot once every two months
- Demonstrated superior efficacy in trials compared to daily oral PrEP
- Offers a discreet alternative for those concerned about stigma or pill fatigue
This option has become particularly popular among young adults and high-risk populations who struggle with daily adherence or face challenges in healthcare access.
On-Demand or “Event-Driven” PrEP
Also known as the 2-1-1 dosing strategy, this method involves taking:
- 2 pills 2–24 hours before sex
- 1 pill 24 hours after the first dose
- 1 more pill 24 hours later
While not yet FDA-approved in the U.S., this method is endorsed by international bodies like WHO and the European AIDS Clinical Society. It has been shown to be highly effective among MSM (men who have sex with men) and is increasingly used in countries with limited access to daily pills or injectables.
PrEP Implants (Coming Soon)
Clinical trials are underway for subdermal PrEP implants, similar to birth control implants. These small devices release tenofovir alafenamide or islatravir over several months.
Expected benefits include:
- No daily or bi-monthly maintenance
- Greater privacy
- Extended protection—some models propose up to one year of protection
Although not yet available commercially, PrEP implants represent the next frontier in HIV prevention technology.
Overcoming Barriers to PrEP Access
Despite its effectiveness, PrEP uptake remains lower than ideal, especially among marginalized groups. Key barriers include:
- Stigma: Concerns about being judged for seeking PrEP
- Cost and insurance: Although many plans now cover PrEP, out-of-pocket costs can still be a hurdle
- Lack of provider awareness: Many healthcare providers still don’t initiate conversations about PrEP, especially with women or heterosexual patients
- Misinformation: Fears about side effects or effectiveness persist, despite robust clinical data
In response, public health campaigns in 2025 have shifted toward normalizing PrEP as part of routine sexual wellness, much like contraception or STI testing.
Monitoring and Safety
No matter which PrEP option is selected, regular monitoring remains essential.
- Quarterly HIV testing is required to ensure users remain HIV-negative
- Kidney function tests are needed for oral PrEP users
- STI screenings and sexual health counseling are recommended at follow-up visits
- Injectable users typically require 6–8 clinic visits annually
The benefit of these visits extends beyond HIV prevention, offering opportunities for comprehensive sexual health support.
PrEP and Other Prevention Strategies
PrEP is highly effective but works best when combined with:
- Condom use, especially for STI prevention
- Regular STI testing to identify and treat infections early
- Communication with partners about status and prevention strategies
- Vaccination, including HPV and hepatitis B
The new model of care is holistic: not just focused on HIV, but on empowering individuals to take control of their entire sexual health.
What the Future Holds
The landscape of PrEP continues to evolve rapidly. On the horizon:
- Islatravir + lenacapavir combinations: long-acting injectables with biannual dosing potential
- Microneedle skin patches for self-application
- Oral dissolving films for rapid pre-sex protection
- AI-based adherence apps to remind users when to dose, track side effects, and connect to clinics
With ongoing innovation and destigmatization efforts, PrEP is moving toward universal accessibility and personalization, ensuring more people are protected in ways that fit their lives.
FAQs
Is PrEP 100% effective at preventing HIV?
No method is 100% effective, but PrEP reduces HIV risk by over 99% when used correctly.
Do I need to take PrEP forever?
PrEP is only taken during periods of potential HIV exposure. It can be paused or restarted depending on your risk profile.
Are there side effects with PrEP?
Most users tolerate PrEP well. Some may experience mild nausea, headaches, or changes in kidney function, especially with long-term use. Regular check-ups help monitor these effects.
Can women use PrEP?
Yes. Truvada is approved for women. Injectable PrEP may also be suitable depending on individual health factors. Ongoing trials aim to expand access and approvals.
How do I get PrEP?
You can start by talking to your doctor, visiting a sexual health clinic, or using telehealth platforms that specialize in PrEP services.