Public health fact series
PrEP: HIV prevention before exposure
Condoms remain important for preventing HIV and other sexually transmitted infections, but they are not the only option. PrEP, or pre-exposure prophylaxis, uses antiretroviral medicine before possible exposure to HIV to reduce the chance of acquiring HIV.
PrEP is for people who do not have HIV, and HIV testing is needed before starting PrEP and during follow-up. When taken as prescribed, PrEP reduces the risk of acquiring HIV from sex by about 99%. What matters is using PrEP as recommended, which is why regular follow-up remains important.
PrEP now comes in different forms. Oral PrEP can be taken daily, while event-driven PrEP is an option for some eligible people. WHO also recommends the dapivirine vaginal ring, long-acting injectable cabotegravir, and injectable lenacapavir. Not all of these options are available in every country.
PrEP may be considered by people without HIV who have an ongoing chance of exposure, including men who have sex with men, transgender women, sex workers, people who inject drugs, and partners of people living with HIV. The decision should still be based on someone’s own situation rather than identity alone.
In Indonesia, the 2023 Ministry of Health guideline focuses on oral PrEP. It includes daily PrEP and event-driven PrEP for eligible users. The guideline notes that implementation started in late 2021 in 7 provinces and had expanded in 2023 to 10 provinces, through designated puskesmas, clinics, and hospitals.
For oral PrEP, kidney function is also part of clinical assessment and follow-up. Monitoring may include creatinine, as well as testing for STIs and hepatitis depending on the clinical situation. PrEP does not prevent other STIs or pregnancy, so condoms can still have an important role.
Having more prevention choices can help people find an approach that fits their needs and circumstances.