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How to Prevent HIV in an Informed Way

Enjoy your sex life to the fullest, always in an informed way by using condoms, PrEP and/or medications to achieve an undetectable viral load.

Photo: Iniciativa Comunitaria

How to use a condom

Where to get an HIV test

PrEP AS A PREVENTION STRATEGY

Pre-exposure prophylaxis (PrEP) is a human immunodeficiency virus (HIV) prevention strategy that involves using antiretroviral medications approved by the United States Food and Drug Administration (FDA). It is intended for individuals who do not have HIV and wish to reduce their risk of acquiring the virus through sexual activity or the sharing of injection drug equipment.

Currently, there are various PrEP options available, including daily oral tablets and long-acting injections administered every two to six months. The choice of medication depends on an individual's specific needs, potential routes of HIV exposure, and an assessment by a healthcare professional.

When used as directed, PrEP is highly effective at preventing the acquisition of HIV. However, it does not protect against other sexually transmitted infections (STIs); therefore, it is recommended to combine it with other prevention strategies, such as the use of condoms and regular STI testing.

According to the Centers for Disease Control and Prevention (CDC), when used as directed, PrEP reduces the risk of acquiring HIV through sexual activity by approximately 99%. Oral PrEP also reduces the risk of acquiring HIV through injection drug use by at least 74%.

Approved Medications

Truvada® (emtricitabine/tenofovir disoproxil fumarate)
This is a daily tablet approved to prevent the acquisition of HIV through sexual activity or the sharing of drug-injection equipment. Generic versions are also available.

Descovy® (emtricitabine/tenofovir alafenamide)
This is a daily tablet approved to prevent the acquisition of HIV through sexual activity, except in cases involving receptive vaginal sex. It is not indicated for the prevention of HIV transmission related to the sharing of injection equipment.

Apretude® (cabotegravir)
This is a long-acting injectable option for preventing the acquisition of HIV through sexual activity. It is administered via an initial intramuscular injection, followed by a second dose one month later, and subsequently by an injection every two months, all under the supervision of a healthcare professional.

Yeztugo® (lenacapavir)
This is one of the most recent PrEP options, approved by the FDA in June 2025. It is administered via subcutaneous injections every six months, following an initial regimen that includes both oral and injectable medications. It is indicated for the prevention of sexually acquired HIV in adults and adolescents.

The choice of medication should be determined through an individualized clinical assessment. The availability and insurance coverage of these options may vary among healthcare providers in Puerto Rico.

How does it work?

HIV primarily affects CD4 cells, which are part of the immune system and help the body fight infections. The medications used as PrEP act at different stages of the HIV reproductive cycle, preventing the virus from multiplying and establishing a permanent infection in the body following a potential exposure. To achieve the highest level of protection, it is important to use PrEP as prescribed by a medical professional and to attend follow-up appointments.

Scientific background

Truvada® was approved by the FDA in 2012 as a strategy for HIV prevention, following three clinical studies on the effectiveness of this treatment for prevention purposes. In 2019, Descovy® was approved as an additional treatment option for HIV prevention, in the form of pre-exposure prophylaxis.

Who can use PrEP?

Pre-exposure prophylaxis (PrEP) is intended for people who do not have HIV and wish to reduce their risk of acquiring it. It is a prevention strategy that can benefit individuals of various ages, sexes, gender identities, and sexual orientations.

PrEP may be an option for:
• Sexually active individuals who wish to protect themselves against HIV.
• People who do not consistently use condoms during sexual activity.
• People who have sexual partners whose HIV status is unknown to them.
• People who have recently been diagnosed with a sexually transmitted infection (STI).
• People who have multiple sexual partners.
• People who inject drugs and share needles, syringes, or other injection equipment.
• People who have used post-exposure prophylaxis (PEP) more than once, or who continue to experience potential exposure to HIV.
• People who wish to add an extra layer of protection for their sexual health.

Important: You do not need to belong to a specific population group or identify as being at "high risk" to request PrEP. Anyone who does not have HIV and wishes to use it can speak with a healthcare professional to determine whether it is appropriate for their needs.

Before starting PrEP

It is necessary to confirm through testing that the person does not have HIV and to conduct a medical evaluation to select the most appropriate medication. Some PrEP options are approved for adults and adolescents weighing at least 35 kilograms (77 pounds).
PrEP may also be considered during pregnancy or breastfeeding, depending on individual needs and clinical assessment.

Where can you get PrEP in Puerto Rico?

In Puerto Rico, individuals interested in using PrEP can seek guidance and evaluation through healthcare providers, specialized clinics, and community-based organizations that offer HIV prevention services.

Protecting your sexual health is your decision.

Get informed, learn about your options, and choose the prevention strategies that best meet your needs.

The Puerto Rico Department of Health, through its STI, HIV, and Viral Hepatitis Prevention Program, promotes access to prevention strategies, screening tests, and services related to sexual health.Before starting PrEP, it is necessary to undergo an HIV test and complete the appropriate clinical evaluations. While using PrEP, periodic testing and medical follow-up are required, depending on the specific medication chosen.

THE EXTERNAL CONDOM AS A PROTECTIVE BARRIER

For maximum protection, condoms must be used correctly and consistently . Correct use increases the protection offered by condoms and prevents breakage, leakage, or semen spillage. It is important to use a condom from the start of sexual contact until after ejaculation. Consistent condom use decreases the likelihood of exposure to a sexually transmitted infection.

Effectiveness

According to the Centers for Disease Control and Prevention (CDC), the effectiveness of condoms in preventing STIs and HIV has been demonstrated by both epidemiological and laboratory studies.

Laboratory studies have shown that condoms act as an effective barrier even against the smallest STI microorganisms.

Epidemiological studies comparing HIV infection rates between people who use condoms and those who do not during sexual intercourse, and who have a sexual partner with an HIV-positive diagnosis, demonstrate that consistent condom use is highly effective in preventing HIV. Similarly, epidemiological studies have shown that condom use reduces the risk of acquiring other STIs.

Recommendations

Use a condom every time you have sex. Put it on before any sexual contact begins.
Read the package instructions and confirm the expiration date. Check that the condom is not damaged or torn.
Store condoms in a cool, dry place.
Use latex or polyurethane condoms (an alternative if you're allergic to latex). Use water-based or silicone-based lubricants to prevent breakage.

Correct use of the condom

References

Brewer, A. (2021). Descovy for PrEP: Get the facts on how it works and more. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/drugs-descovy-for-prep#how-well-descovy-works.

Centers for Disease Control and Prevention. (2021, May 13). Prep. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/basics/prep.html.

Gilead. (n.d.). What is DESCOVY for PrEP? Does DESCOVY for PrEP® Work? Retrieved from https://www.descovy.com/clinical-trial-efficacy-results.

NIH. (n.d.). Nucleoside reverse TRANSCRIPTASE INHIBITOR (nrti): NIH. Nucleoside Reverse Transcriptase Inhibitor (NRTI) Retrieved from https://clinicalinfo.hiv.gov/en/glossary/nucleoside-reverse-transcriptase-inhibitor-nrti.

Centers for Disease Control and Prevention. (2013). Condom Fact Sheet Summary. Retrieved from: https://www.cdc.gov/condomeffectiveness/spanish/brief.html