2+1+1 (on-demand) oral PrEP
with Truvada®
- Take 2 pills from 2 hours up to 24 hours before sex, then 1 pill per day for 2 days after your sex.
- Can take PrEP only with sexual activity. Fewer pills.
- Need to plan ahead for sex. Large pill size.
It’s PrEP only when you need it – aka 2+1+1 or “on-demand” and only around the time when you have sex.
The strategy involves taking 2 pills from 2 hours to 24 hours before you have sex and then 1 pill a day for 2 days after. If you have more sex, just continue taking a daily pill until 2 days after your last sex.
If you take the pills every time you have sex, per the 2+1+1 strategy, it works extremely well. It’s >99% effective when used in this way.
Anyone having anal sex.
Anyone who is the insertive partner during vaginal/front-hole sex.
Unlike daily Truvada®, studies have not shown that 2+1+1 PrEP is effective for receptive vaginal/front hole sex.
Every time you have sex plus 2 days after your last sexual encounter.
You take it every time you have sex and don’t forget the 2 days after.
No. The strategy only works if you take all 3 doses so it’s very important not to miss a dose.
There are a few side effects.
Headaches, abdominal pain, and weight loss are common but go away after a couple of weeks. Kidney problems and bone density loss can happen but are rare.
Yes. You must take 2 pills at least 2 hours before sex. So, some planning is needed.
Truvada® is available as a generic medication, which may be less expensive for you.
It will depend on your insurance. Without insurance or patient assistance programs, it costs about $40/month for daily use. It’s less for fewer pills for 2+1+1.
If you can plan your sex, you can match it with your PrEP use. That may mean you’ll take fewer pills than if you took PrEP daily.
You can also take it every day if you’re more active some months and then go back to 2+1+1 when you’re less active.
Alcohol and other drugs do not affect PrEP. Learn more.
You need to be able to plan your sex ahead of time – at least 2 hours.
Some think the pill is a little large.
Truvada® doesn’t affect hormone levels. There is no known effect of hormones on PrEP’s effectiveness.
Estradiol may slightly reduce PrEP levels. If you’re on estradiol, take PrEP with food.
Truvada® stops HIV from reproducing. So, it can’t infect you.
