Many PrEP users are already taking the daily oral treatment, but a new shot might be a game changer in the fight against HIV…
“Is your booty ready?” That’s the question Canada’s Drag Race season one contestant BOA asks in a new social media ad by Ontario’s The PrEP clinic. The ad is just one example of how PrEP providers are building awareness for a new HIV preventative treatment in Canada.
Approved by Health Canada in 2024, injectable PrEP is a new alternative to oral PrEP. The treatment, called Apretude, is the first long-acting injectable PrEP option in the country and a major advancement in the fight against HIV. Containing the anti-HIV drug cabotegravir, which has been used to treat people with HIV, it’s a liquid injected into the buttocks. The new PrEP option is not a vaccine and needs to be taken bi-monthly to be effective.
Health Canada is also currently reviewing a semi-annual injection which may become available next year.
But how does injectable PrEP work? What are the differences? Are there side effects? We’ve put together some top facts for you to consider. However, it’s important to consult your health care provider to truly know which PrEP option is right for you.
How Apretude does it work?
Unlike the daily oral pills, injectable PrEP is a shot taken in the buttocks. When patients first start treatment they need to take two injections a month apart. After the two initial shots, patients need to return every two months. This means you’ll only need six shots a year after starting.
Why would I switch to injectable PrEP?
There are many reasons to consider switching. Forgetfulness is a big factor. People may forget to take a pill if their daily routine suddenly changes or forget to pack it when travelling. Even with daily alarms to remind yourself, it is very easy to hit snooze or stop on those alarms and go on with your day. While you can miss a pill on occasion, missing a series of pills back-to-back means your protection begins to decrease.
Taking an injectable version allows for peace of mind for two months. Plus, your health care provider will likely remind you of upcoming appointments to get it.
Privacy concerns are another reason. Some people may live in multi-person or inter-generational households and be closeted in those situations. For these individuals there is a fear that someone may discover their PrEP pills. Since Apretude is taken on-site at a medical facility, it reduces the worry of pill bottles being discovered.
Some people also have side effects when taking oral PrEP – beyond the general ones most people experience. While the injectable version also has some, it may not be as bad for certain people.
What’s the difference between oral and injectable PrEP?
There are a lot of differences and similarities between the two prevention treatments and it’s important to speak to a health care provider to know which version is right for you.
One similarity is that both forms are effective in preventing HIV if taken as prescribed. In fact, a blog post by Freddie noted how some studies found Apretude to be “about 60 per cent more effective than Truvada or generic Truvada.” Don’t forget, those oral options have already been proven to reduce HIV risk by 99 per cent when taken properly.
After your two initial treatments, patients need to go in bi-monthly. This means you only need six shots a year as opposed to taking 365 pills in that same time period.
However, the shots are administered in-person meaning you’ll need to have six visits per year. This could also mean more time spent at a medical facility as you need to get lab testing done in addition to getting the shot. The oral version requires less in-person visits. Lab work is completed every three months and your prescription can be delivered or picked at your convenience.
Since injectable PrEP is new, some private insurance plans cover it while the oral solution is covered by most plans. As of March, Quebec is the only province to publicly reimburse Apretude. However, most PrEP providers can help you reduce the cost through government programs.
While oral PrEP can be taken on an on-demand schedule, the shot cannot. The shot is also only approved for HIV prevention through sex, whereas the pills are also approved for HIV risk associated with injecting drugs.
There are also still side effects. According to Freddie the most common ones for Apretude are diarrhea, fatigue, fever and headache, which are similar to oral PrEP. However, the PrEP provider goes on to say that since its an injection, the site where the needle enters could see reactions such as “pain and tenderness, swelling, bruising and lumps or bumps under the skin.” It goes says side effects can last longer as the Apretude stays in a person’s system for longer. Oral PrEP side effects can usually be quickly resolved by stopping the medication.
The biggest, and maybe most obvious difference, is you need a shot. It’s fair to say some people are afraid of needles and that could be the ulitimate dealbreaker for sticking to the pills.
Would you take a PrEP shot?
We asked members of the community their thoughts on switching to injectable PrEP and got a mixed response.
Some people would welcome a treatment that is every two months versus having to remember to take daily pills. For others it’s a natural part of their daily routine and doesn’t bother them.
PrEP user Kevin said the daily option puts his health in his own hands. “It feels like I have total control over my health. Daily safety and reminder check.”
Fear of needles was another big factor with user Nuno saying he’d keep taking the pills. “I hate needles!”
PrEP users who take other medications said they would take the shot to reduce the number of pills they need to take daily.
Regardless of which option you choose, PrEP is important in the fight against HIV. So make sure to check in with your health care provider about your options.
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