Daily PrEP vs. Bi-Monthly PrEP: Which Option is Right for You?

Pre-exposure prophylaxis (PrEP) is a highly effective medication used to prevent HIV infection in people at risk. With advancements in HIV prevention, individuals now have two main options:

Daily PrEP (a once-daily pill)
Bi-Monthly PrEP (a long-acting shot every two months)

Both forms of PrEP are safe and provide exceptional protection against HIV when used correctly. However, choosing between them depends on lifestyle, adherence preferences, and medical history.

How Does PrEP Work?

PrEP uses antiretroviral medications to prevent HIV from establishing an infection in the body. If taken consistently, PrEP reduces the risk of acquiring HIV by 99% for sexual transmission and 74% for injection drug use.

The key difference between daily PrEP and bi-monthly PrEP is how the medication is administered and the frequency of doses required to maintain protection.

Daily PrEP

Options:

Truvada (Tenofovir/Emtricitabine) - Approved for all at-risk individuals.
Descovy (Tenofovir Alafenamide/Emtricitabine) - Approved for men and transgender women but not for individuals engaging in vaginal sex.

How Daily PrEP Works

Taken once daily to maintain continuous HIV protection.
Builds up protection in about 7 days for anal sex and 21 days for vaginal sex or injection drug use.
Works by preventing HIV from replicating if exposure occurs.

Pros of Daily PrEP

Highly effective when taken daily.
Widely available at pharmacies and clinics.
Can be stopped or restarted as needed based on risk level.
Lower cost and covered by most insurance plans.

Cons of Daily PrEP

Requires daily adherence - missing doses reduces effectiveness.
May cause mild side effects like nausea or headaches.
Descovy is not approved for vaginal sex - limiting options for some users.

Best for individuals who can commit to a daily routine and prefer oral medication over injections.

Bi-Monthly PrEP

Option:

Apretude (Cabotegravir) - FDA-approved as the first long-acting PrEP.

How Bi-Monthly PrEP Works

A single shot every two months provides continuous HIV prevention.
Ideal for individuals who prefer not taking a daily pill.
Requires in-person clinic visits for each shot.

Pros of Bi-Monthly PrEP

No daily pills required - reduces adherence concerns.
Provides continuous protection for two months.
May improve adherence for people who struggle with daily medication.
As effective as daily PrEP in preventing HIV.

Cons of Bi-Monthly PrEP

Requires clinic visits for each shot.
Mild side effects like shot site pain or flu-like symptoms.
Higher cost than daily PrEP (but covered by many insurance plans).

Best for individuals who prefer less frequent dosing and can attend regular clinic visits for shots.

Which PrEP Option is Right for You?

Choose Daily PrEP If…

You prefer taking a daily pill and want more flexibility.
You have easy access to a pharmacy or telehealth services.
You want a lower-cost PrEP option with broad insurance coverage.

Choose Bi-Monthly PrEP If…

You struggle with daily pill adherence.
You prefer long-acting medication over a daily routine.
You can commit to regular clinic visits for shots.

Not sure which option suits you best? Speak with one of our providers to find the best fit for your lifestyle.

Frequently Asked Questions (FAQs)

How long does PrEP take to start working?

Daily PrEP: 7 days for anal sex, 21 days for vaginal sex or injection drug use.
Bi-Monthly PrEP: Immediate protection after the first shot.

Can I switch from daily PrEP to bi-monthly PrEP?

Yes! Many individuals transition from daily pills to long-acting shots. Your provider can help determine the right timing for switching.

Is Bi-Monthly PrEP more effective than Daily PrEP?

Both options are equally effective at preventing HIV when taken as prescribed.

What if I miss a shot?

If you miss a shot, you may need to switch back to daily PrEP until your next scheduled shot. Consult your provider for guidance.

Does PrEP protect against other STIs?

No, PrEP only prevents HIV. Using condoms alongside PrEP is recommended for protection against STIs like chlamydia, gonorrhea, and syphilis.