HIV PrEP in Puerto Rico, with a video evaluation and your labs

PrEP stands for pre-exposure prophylaxis: HIV medicine you take before an exposure so the virus can't take hold. According to the CDC, "When taken as prescribed, both oral and injectable PrEP reduce the risk of getting HIV from sex by about 99%," and oral PrEP reduces the risk from injection drug use by at least 74%.

PrEP works when you take it as prescribed. Missing doses or stopping lowers the protection. And it doesn't protect against other STIs or pregnancy: that's what condoms, STI testing and, for some people, the doxy-PEP described below are for.

The CDC recommends talking about PrEP with everyone who is sexually active, and offering it to people more likely to be exposed to HIV. For example, if you have a partner with HIV whose virus isn't suppressed, if you don't always use condoms, if you had a bacterial STI such as syphilis or gonorrhea in the last 6 months, if you've used PEP more than once, or if you share needles.

Men, women and trans people can all take PrEP. The doctor asks about your sexual history without judgment, in English or Spanish, and decides with you whether PrEP fits and which option suits you.

We follow the lab protocol in the CDC PrEP guideline (2021 update):

Two daily pills are FDA-approved for PrEP in adults and adolescents weighing at least 35 kg: Truvada (emtricitabine and tenofovir disoproxil fumarate, also available as a generic) and Descovy (emtricitabine and tenofovir alafenamide).

Per its FDA label, Descovy is not approved for PrEP in people at risk from receptive vaginal sex, because it wasn't studied in that group. Kidneys matter too: Truvada's label doesn't recommend it for PrEP if your creatinine clearance is below 60 mL/min, and Descovy's, below 30 mL/min. That's why the doctor orders creatinine before deciding.

There is also injectable PrEP: cabotegravir (Apretude), with two starting injections 1 month apart and then one every 2 months, and lenacapavir (Yeztugo), which starts with an injection plus tablets and then is one injection every 6 months. Both are given at a clinic. We mention them so you know the options; the doctor helps you work out which one suits you.

They're usually mild. Per their FDA labels, the most frequent side effects in PrEP trials were headache, abdominal pain and weight loss with Truvada, and diarrhea with Descovy. If a side effect doesn't go away, tell the doctor at your follow-up visit.

Both labels carry a boxed warning, which is why two tests come before you start. The HIV test: if you already have HIV without knowing it and take PrEP, the virus can become resistant to these medicines, so PrEP is only prescribed once you're confirmed HIV-negative. The hepatitis B test: if you have hepatitis B, stopping PrEP suddenly can cause a severe hepatitis flare, so don't stop on your own; talk to the doctor first.

Doxy-PEP is something else: it doesn't prevent HIV but some bacterial STIs. Under the CDC's 2024 guideline, you take one 200 mg dose of doxycycline within 72 hours after oral, vaginal or anal sex, never more than 200 mg every 24 hours.

The CDC recommends it for men who have sex with men and transgender women who had syphilis, chlamydia or gonorrhea in the past 12 months. If you use it, you get STI testing at the start and every 3 to 6 months. For cisgender women and heterosexual men, the CDC makes no recommendation yet. The doctor evaluates with you whether doxy-PEP is appropriate and can assess it alongside your PrEP.

In Puerto Rico the age of majority is 21. So if you're under 21, a parent or legal guardian signs the consent, stays on camera for the whole visit and shows photo ID.

The visit is discreet: you join from a private place, and visits are not recorded. A doctor visit has a published price and includes the lab order. Reviewing your results is a follow-up visit. You pay the lab for the tests and the pharmacy for the medicine. See pricing for details. If you're looking for a no-cost HIV test, see our guide to HIV testing.