HIV pre-exposure prophylaxis drugs, otherwise known as PrEP, are powerful weapons against HIV. Through education and raising awareness of HIV exposures, the risks of getting the disease are lower than ever.

According to the Centers for Disease Control and Prevention, when taken as prescribed, these drugs can reduce the risk of getting HIV through sex by almost 99%.

“Preventing a service member who might otherwise be at very high risk from acquiring HIV infection ensures that this soldier, sailor, or airman [or Marine] stays in the fight and remains worldwide deployable,” said U.S. Army Col. Jason M. Blaylock, director for medical services at Walter Reed National Military Medical Center.

The Food and Drug Administration approved a daily oral PrEP pill in 2012, and in December 2021 approved a long-acting injectable version that’s given every two months. The pills are commonly available in the Military Health System, while the shot is less widely available.

“PrEP is recommended for people who are HIV-negative but are at risk for acquiring the virus from either sex or injection drug use,” said Blaylock.

The PrEP should be taken if you:

• Have had unprotected sex in past six month
• Have a sexual partner with HIV
• Have been diagnosed with a sexually transmitted disease in past six months
• Inject drugs and have an injection partner with HIV
• Share needles, syringes, or other drug injection equipment

Side effects of PrEP can include diarrhea, nausea, headache, fatigue, and stomach pain, and usually go away over time.

Barriers and Stigma Attached to PrEP

Service members may be reluctant to take the treatment due to a stigma that can be attached to these kinds of drugs or seeking help for sexually transmitted disease, according to U.S. Navy Capt. Nimfa Teneza-Mora, officer in charge at the Navy Bloodborne Infection Management Center.

“Stigma can be a significant barrier; it may cause patients to avoid initiating PrEP or discontinue PrEP if they are taking it due to fear of being mislabeled as promiscuous or sexually irresponsible,

said Teneza-Mora.

Blaylock noted the lack of knowledge and comfort level with evaluating a service member for PrEP, conducting the appropriate screening for STDs, and ensuring availability for the required three-month follow up evaluations as other reasons for low use.

The fear of sharing one’s sexual preference is also seen as a barrier.

“I believe that there are still many service members who are not comfortable divulging their sexual preferences to a provider in the MHS, mainly out of fear that this information might become visible to their chain of command or unit members and impact their work relationships,” said Blaylock.

Educating Service Members and Providers

With low participation throughout the MHS, further information sharing and education is important in raising awareness of the PrEP drugs.

“Education is really the key to becoming knowledgeable about what PrEP is and the role it can play in keeping our service members free from acquiring HIV infection as part of ensuring the optimal health of the force,” said Blaylock. “Providers must remain open to engaging with service members regarding their sexual health.”

Teneza-Mora said that “providers, leadership and others in the military community can do the following to help overcome these barriers: increase/improve provider knowledge on PrEP and find ways to improve provider cultural sensitivity/competence to facilitate the equitable prescribing of PrEP.”

Another important step is to provide patients with information to improve knowledge and perception of these drugs.

“Maintenance of good sexual health, which entails the prevention of sexually transmitted infections, can be discussed more openly as a part of a service member’s wellbeing and medical readiness,” said Teneza-Mora.

Maintaining Medical Readiness

Being diagnosed with HIV isn’t a dismissible event but can make you unavailable for a length of time, and is a lifelong ailment.

According to statistics published in the Armed Forces Health Surveillance Division’s September issue of the Medical Surveillance Monthly Report, 1,581 service members have been diagnosed with HIV since 2017, with 62% of those still in service as in 2022.

“Service members newly diagnosed with HIV infection are placed on temporary limited duty until their medical condition is controlled with antiretroviral therapy,” said Teneza-Mora. “The temporary limited duty period can last up to six months, and results in a significant number of lost days of training or fully medically ready status. Additionally, HIV infection is a life-altering medical condition for a newly diagnosed service member who must now take antiretroviral therapy consistently for life to keep this medical condition controlled.”

Taking medication like PrEP can increase the medical readiness of a service member by reducing their chances of acquiring HIV and enable them to serve.

PrEP can be taken while you are actively serving but patients are advised to stop the medication while deployed and to practice safe sex. The lack of HIV testing resources, and CDC-required monitoring in the field, are reasons for why service members should cease taking the medication while deployed.

Technology, increased awareness and education, and tolerance are all reasons that HIV is now a treatable disease.

“We are entering an exciting era of military medicine with the emergence of long-acting injectable agents for both HIV treatment and prevention,” said Blaylock. “It will be exciting to see what potential roles might exist for these antiretrovirals for use for the warfighter.”