The U.S. Centers for Disease Control and Prevention (CDC) has updated its guidelines for PrEP, a medication that can lower risk of sexual transmission of HIV by 99% when taken daily. The new guidelines — which will inform local healthcare policies and doctors’ decision-making processes — recommend that healthcare providers share information about PrEP with any patient who is sexually active, and that they prescribe PrEP for any patient who requests it. Here’s what to expect from the changes.

How Updated CDC Guidelines Can Expand PrEP Access

PrEP usage has historically been low despite the medication’s effectiveness. In 2020, just 25% of those who could benefit from PrEP were taking it.

Under the former guidelines, many doctors only shared information about PrEP with patients who presently have multiple partners or a partner who is HIV-positive or unsure of their HIV status. In reality, more people could benefit from PrEP, including those who are single and sexually active.

Under the new guidelines, anyone who is sexually active should receive PrEP information from their healthcare provider, including adolescents. Given that many traditional sex education programs in schools throughout the U.S. aren’t providing LGBTQIA+ youth with the resources they need to stay safe and healthy, the new guidelines are also an important step toward more inclusive sexual education.

Opening up the conversation about HIV prevention to more individuals aligns with what Dr. Lisa Sterman, MD, MPH, shared during a conversation with Alto in October 2020.

“A lot of people may think, ‘I’m not at risk’ or, ‘that’s not my group of people,’” Sterman said. “The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status.”

Addressing fear of discrimination or stigma at the doctor’s office

Previously, many individuals were asked to disclose personal information about their sexual health or drug use in order to receive a PrEP prescription. However, many people at risk of contracting HIV don’t feel like they can speak openly with their healthcare providers, particularly LGBTQIA+ people of color, who face multiple forms of discrimination. This barrier to PrEP access has kept many individuals from starting the medication and contributed to racial disparities in HIV rates: according to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

The new guidelines aim to make PrEP more accessible for those who may be reluctant to share information about potentially stigmatized behavior with their healthcare providers. While conversations between doctors and patients about PrEP may initially cover a patient’s sexual health history, the CDC has recommended that anyone should receive a prescription for PrEP if requested.

There are more FDA-approved medication options for PrEP than ever before: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. The following resources can connect you with a provider who will prescribe PrEP for you:

Alto will coordinate with your doctor and your insurance provider, if applicable, to ensure you’re receiving the best PrEP option for your needs at the best price. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Editor’s Note: This post was originally published in July 2021 and has been updated for accuracy and completeness.

What Updated CDC Guidelines Mean for PrEP Access

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply.

What to Know About State-Funded PrEP-DAP Programs

Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs —  in four of the states that Alto serves.

The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.

You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:

To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you. 

Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.

If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.

If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.

Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.

To be eligible for California’s PrEP-AP, you must:

Have a negative HIV test dated within six months of the PrEP-AP application

Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income

Not be fully covered by Medi-Cal or other third party payers

Be enrolled in the manufacturer's assistance program, if eligible

Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.

If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.

You can apply online or by mail. You must provide the following documents:

Proof of income (one month's worth of paystubs, award letter, etc.)

Gilead Co-Pay Card, if you have insurance

PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.

The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with  PrEP and related medical services.

The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).

In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.

If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.

To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone or within the Alto app to answer any questions.

Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging! 

PEP is a medication you can take within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. Read on to learn more about who is eligible for it and when to use it.

What to Know About Using PEP to Prevent HIV Infection

PEP, or post exposure prophylaxis, is a medication you can take within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. While some research indicates that this groundbreaking medication may be able to lower your risk of HIV infection by up to 80%, it is only effective when taken as prescribed and is not intended to be a method of ongoing, recurring HIV prevention (see our article on PrEP to learn more about long-term preventative options).

Read on to learn more about what PEP is (and what it isn’t), who is eligible for it, and when to use it.

PEP is a medication regimen that you begin taking as soon as possible after potential exposure to HIV and continue with for at least 28 days. It typically consists of three medications: Truvada® (emtricitabine/tenofovir) with either Tivicay® (dolutegravir) or Isentress® (raltegravir). Your healthcare provider will recommend the best medication regimen for your health needs during your consultation.

These medications are antiretrovirals, a type of medication that blocks various stages of a virus’ life cycle. In this case, PEP prevents HIV from spreading throughout your body. Taking PEP medications as prescribed throughout the entire 28-day duration is critical to its effectiveness.

It’s important to reach out to a healthcare provider or pharmacist to start PEP as soon as possible if you believe you were exposed to HIV. The virus spreads very quickly — typically within 24 to 36 hours of exposure — and it is recommended to begin taking PEP within 72 hours, or three days, of potential exposure. 

And the sooner you begin your PEP regimen within that 72-hour window, the more effective the medication is at blocking the virus. If your potential exposure to HIV falls outside of that 72-hour window, you should still seek medical attention as soon as possible for further evaluation.

PEP may cause some side effects such as nausea, vomiting, diarrhea, and fatigue, however these are mild in most cases. Be sure to inform your healthcare provider of any other medications you currently take, as these may interact with PEP.

If you experience a rash or fever while taking PEP, you should contact your doctor as soon as possible, as these may indicate the early stages of HIV.

PEP works most effectively for people who may have been exposed to HIV within the last three days. That primarily includes anyone who had unprotected sex with or who shared needles or other drug paraphernalia with someone who may have HIV. It is also recommended in instances of sexual assault or if you used a condom that broke while having sex with someone who may have HIV.

PEP baseline testing and ongoing monitoring

Recommended baseline screening for PEP includes a rapid HIV test, kidney and liver function tests, a pregnancy test for women of reproductive age who aren’t using birth control, and screening for sexually transmitted infections (STIs). However, if baseline screening isn’t available when you reach out to a healthcare provider or pharmacist to start PEP, they will likely advise you to take your first dose before you complete the tests, in the interest of starting PEP as soon as possible. Additional HIV testing is recommended at 30 days and 90 days after the potential exposure to confirm your HIV status.

In all states, any licensed doctor or nurse can prescribe PEP. And in a growing number of states, including California, Colorado, and Nevada, pharmacists are also allowed to prescribe PEP. 

Since the medication should be taken as soon as possible after exposure, PEP is commonly prescribed by emergency room doctors. It is also available at many sexual health clinics and community-based health centers, but if you have been exposed to HIV after standard working hours, you should visit your nearest hospital’s emergency department as soon as possible.

PEP isn’t an ongoing method of HIV prevention

PEP is only for emergencies and infrequent exposures, as it is not 100% effective in preventing HIV even when taken as prescribed. It should not be considered a substitute for proven methods of long-term HIV prevention, including condoms and/or taking PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. It is also important to continue using condoms during your 28-day course of PEP.

If you have had several potential exposures to HIV, speak with your doctor about potentially taking PrEP to prevent HIV infection in the long term.

Alto can help you navigate PEP or PrEP access

Alto pharmacists will work with your insurance (if applicable) and any third party savings programs so that you can get PEP at the lowest possible price. 

There are several patient assistance programs designed to reduce the cost of PEP for individuals without insurance, including Gilead’s Advancing Access Program and ViivConnect. If you’re eligible, we’ll automatically enroll you in these programs as soon as we receive your prescription.

We can also help you get started with PrEP if you and your doctor decide that it’s right for you. In addition to support with navigating insurance and patient assistance programs, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support to eliminate extra deliveries each month and in-app reminders to stay on track

Pharmacists directly available through phone or within the Alto app seven days a week

Editor’s Note: This post was originally published in September 2021 and has been updated for accuracy and completeness.

September 27 is National Gay Men’s HIV/AIDS Awareness Day, an important reminder that the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect gay and bisexual men.

National Gay Men's HIV/AIDS Awareness Day

September 27 is National Gay Men’s HIV/AIDS Awareness Day, an important reminder that the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect gay and bisexual men. In 2019, these individuals accounted for 69% of new HIV diagnoses in the U.S.

The high rates of HIV and AIDS among these individuals date back to the origins of the epidemic in the 1980s and 90s, in part because the virus transmits more easily through anal sex than vaginal sex. And this deep-rooted prevalence of HIV and AIDS in LGBTQ+ communities perpetuates a cycle: since HIV and AIDS are historically more common among gay and bisexual men, other gay and bisexual men face a higher risk of contracting it.

In recent years there has been significant progress toward reducing the annual infection rate. New cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. But there’s still much more progress to be made. Several factors contribute to HIV’s continued disproportionate impact upon gay and bisexual men, including ongoing stigma around HIV — which can deter people from seeking HIV prevention services and testing — race/ethncity discrimination, and disparities in healthcare access.

Even as HIV cases continue to decline and more effective treatment options allow individuals with the virus to have active, full lives, it’s important to stay vigilant about testing and prevention services. 

An estimated 1.2 million people in the U.S. are living with HIV, and about 13% of them aren’t aware of their HIV status. According to the CDC, nearly 40% of new HIV infections are transmitted by people who do not know that they have the virus.

Getting tested is the only way to know your HIV status. It’s free, it’s confidential, and it’s one of the most important things you can do to protect your health and the health of potential sexual partners.

If your test results are positive, there are effective treatment options that can keep you healthy. Antiretroviral therapy (ART) is a combination of medications that reduce the amount of HIV in your bloodstream (known as your viral load). When taken every day as prescribed, ART can help you reach an undetectable viral load. Maintaining an undetectable viral load can keep your immune system strong and prevent you from transmitting the virus to others.

It’s important to start ART as soon as possible, so reach out to your healthcare provider right away if you’ve tested positive for HIV. Delaying treatment can put you at a greater risk for developing AIDS or transmitting the virus to others.

If your test results are negative, you can continue to protect your health by using condoms and taking an HIV prevention medication called PrEP if you and your doctor decide it’s right for you.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. 

In recent years, PrEP has become even more accessible, with generic medication options and expanded health insurance coverage of PrEP. In addition, a handful of states, including California and Colorado, recently passed legislation that allows pharmacists to prescribe the HIV prevention medication. 

The following resources can connect you with a provider who may prescribe PrEP:

Using PEP for emergencies and accidental exposures

There’s another HIV prevention medication to be aware of: PEP, or post-exposure prophylaxis, which is taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. 

PEP can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. The sooner you begin taking PEP, the more effective it is at blocking the virus, so if you have been exposed to HIV after standard working hours, visit your nearest hospital’s emergency department as soon as possible.

PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, consider asking your doctor about taking PrEP for long-term protection.

The HIV prevention landscape is regularly evolving, and we have an extensive library of PrEP, PEP, and HIV-focused content to help you understand and access HIV prevention medications and services. Consult with a healthcare provider to make the best decisions for your needs.

Here are just a few of the resources we offer:

Getting PrEP for HIV prevention at an affordable cost

Expanded PrEP access at pharmacies: What to know

What updated CDC guidelines mean for PrEP access

Alto can help you navigate HIV treatment and prevention medication

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the best price. 

To learn more, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

World AIDS Day, observed on December 1st every year, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

Take Action for World AIDS Day 2021

World AIDS Day, observed on December 1st every year since 1988, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

AIDS (acquired immunodeficiency syndrome) was heavily stigmatized from the beginning of the epidemic in the 1980s. Four years passed between the first cases of AIDS in the U.S. in 1981 and the Reagan administration’s first public mention of the disease. There were many misconceptions about how HIV (human immunodeficiency virus) — the virus that causes AIDS — can be transmitted and who is at risk of contracting it.

The stigma and lack of information about transmission and prevention led to many preventable cases of HIV/AIDS in the U.S. At the peak of the epidemic in 1995, complications from the disease were the leading cause of death for adults ages 25-44, and to date, more than 700,000 people in the U.S. have died from an HIV-related illness.

The HIV and AIDS landscape looks dramatically different today than it did back when World AIDS Day was first established. With greater awareness of HIV and AIDS, and more government funding of research, new HIV infections in the U.S. decreased by 73% between 1984 and 2019. Still, the fight to end AIDS isn’t over, with more than 1.2 million people living with HIV in the U.S.

In honor of World AIDS Day 2021, take a look at what has already been accomplished in the fight against AIDS and learn about what is needed next.

There were 34,800 new HIV infections in 2019

13% of those living with HIV don’t know it

57% of those living with HIV are virally suppressed (meaning they are not at risk of transmitting the virus to others)

Milestones in the history of HIV and AIDS

AIDS first emerged in the U.S. in 1981, but researchers did not learn that HIV caused AIDS until three years later in 1984. The history of HIV medication dates back to 1986, when clinical trials for azidothymidineor (AZT), the first antiretroviral HIV/AIDS medication, began. AZT was approved to treat HIV a year later.

Highly active antiretroviral therapy, often referred to as antiretroviral therapy (ART), became the frontline treatment for HIV in 1997. ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others.

The U.S. Food and Drug Administration (FDA) first approved a PrEP medication in 2012. PrEP, or pre-exposure prophylaxis, can lower the risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

With these breakthroughs in HIV treatment and prevention therapies, the U.S. government recently announced a goal to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030, preventing an estimated 250,000 additional cases of HIV.

Next steps in the fight against HIV and AIDS

Despite the progress that has been made in the fight against HIV and AIDS, prevention, care, and treatment remain inaccessible for many individuals at risk of contracting HIV — both in the U.S. and around the world. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, in recognition of how health inequities contribute to the epidemic.

In the U.S., racial discrimination and deeper inequities in healthcare have contributed to HIV’s disproportionate impact upon people of color. Black and Latinx individuals — particularly gay and bisexual men — are among the groups disproportionately affected by HIV. A variety of factors contribute to these disparities, including income inequality, unequal access to healthcare, and lower use of HIV prevention and treatment services. According to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

Fortunately, HIV prevention medication continues to become more accessible, with generic medication options and expanded health insurance coverage of PrEP. And legislation in a handful of states, including California and Colorado, allows pharmacists to prescribe PrEP. There are also a number of organizations working hard to make HIV services more accessible to communities of color, like NMAC and Black AIDS Institute.

Getting an HIV test is one of the most important things you can do for World AIDS Day. Not only will learning your HIV status give you the information you need to take control of your health, it will also help combat the stigma surrounding HIV and AIDS. Each person who makes use of testing and prevention services — and each person who speaks openly about HIV and AIDS, without perpetuating fear or stigma — brings us closer to a future without AIDS.

Search for a free and confidential HIV testing site near you.

View the CDC’s HIV stigma language guide to learn the power of the words you use when discussing HIV and AIDS.

Get support navigating HIV treatment and prevention medication

At Alto, we’re committed to doing our part to make HIV treatment and prevention services as accessible as possible. Our extensive library of HIV-focused content covers the information you need to make informed decisions about your health. And if you take PrEP or ART, our team will coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option for your health needs at the lowest price.

Editor’s Note: This post was originally published in November 2021 and has been updated for accuracy and completeness.

How to Take Action for World AIDS Day 2021

While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

All About HIV: Stages, Symptoms and Treatment

More than 40 years have passed since AIDS, the disease caused by HIV, was first identified in the United States. While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

HIV (human immunodeficiency virus) is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV.

If untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which is also considered the last stage of HIV. When HIV progresses into AIDS, your immune system has been significantly weakened by the virus.

Currently, there is no cure for HIV, but taking HIV medicine called antiretroviral therapy (ART) as prescribed stops the progression of the disease. As a result, most people living with HIV in the U.S. do not develop AIDS. There are also HIV prevention medications, PrEP and PEP, which are effective at preventing the transmission of HIV through sex or intravenous drug use.

As the HIV epidemic emerged in the U.S. in the 1980s and 90s, gay and bisexual men were disproportionately affected — in part because the virus transmits more easily through anal sex than vaginal sex — and subsequently stigmatized as carriers of the virus. However, the medical community soon discovered that anyone can contract HIV regardless of gender identity or sexual orientation, as the virus can be transmitted through anal sex, vaginal sex, or the sharing intravenous drug equipment such as needles or syringes.

In recent years, there has been significant progress toward reducing the annual HIV infection rate, and new cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. Still, gay and bisexual men accounted for 69% of all new HIV diagnoses in the U.S. in 2019. And in recent years, Black and Latinx individuals have been disproportionately affected by HIV. Racial and ethnic discrimination and disparities in healthcare access — which can discourage people from seeking HIV prevention services and testing — factor into HIV’s outsized impact on these communities.

There are three primary stages of HIV: acute HIV infection, chronic HIV infection, and stage 3 HIV, or AIDS.

Acute HIV infection, the first stage of HIV, may develop within two to four weeks of contracting the virus. During this stage of HIV, the virus multiplies rapidly and there is a high amount of HIV in your bloodstream (also known as your viral load). While the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

Some people with acute HIV infection quickly experience flu-like symptoms including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The only way to know your HIV status is by getting tested. If you have any of these symptoms and believe you may have been exposed to HIV, seek prompt medical care and take an HIV test. Find a free and confidential HIV testing site near you..

Experiencing these symptoms does not necessarily mean that you have HIV, as they overlap with symptoms of the flu and other illnesses. And some individuals with HIV develop these symptoms later, while others never develop them at all, which is why it’s critical to get tested for HIV on a regular basis — ideally every three months. You can still transmit the virus to others even if you do not have noticeable symptoms of HIV.

During the chronic HIV infection stage, the virus replicates less rapidly than it did in the acute stage, but it continues to damage your CD4 cells and weaken your immune system.

Many people experience no symptoms or mild symptoms during this latent period, which is also sometimes referred to as asymptomatic HIV infection or clinical latency. However, just like during the acute HIV infection stage, you can still transmit the virus to others even if you are not experiencing symptoms.

Without effective treatment, your viral load will increase and your CD4 cell count will decrease as this stage of HIV progresses. You are more likely to experience symptoms of HIV when your viral load is high and your CD4 cell count is low. Taking HIV medication as prescribed can help you maintain a low or even undetectable viral load and prevent your HIV from progressing into AIDS.

AIDS is the third and most advanced stage of HIV. In this stage, your immune system is severely weakened, your viral load continues to increase, and your CD4 cell count continues to decrease. 

HIV progresses into AIDS when you have a CD4 cell count of less than 200 cells per cubic milliliter or when you develop an opportunistic infection (OI), an illness that occurs more frequently in individuals with HIV because of their weakened immune systems.

Opportunistic infections experienced by individuals with HIV include kaposi’s sarcoma, a type of cancer that develops in your blood and lymph vessels; pneumocystis pneumonia (PCP), and mycobacterium avium complex (MAC), tuberculosis-related bacteria. However, OIs continue to occur less frequently as HIV treatment becomes more effective.

There are many effective HIV treatment options that can keep you healthy and help you maintain a low viral load. The primary treatment for HIV is called antiretroviral therapy (ART), a combination of medications that lower the amount of HIV in your bloodstream.

If you take your HIV medication every day as prescribed, you can maintain an undetectable viral load. This will preserve the strength of your own immune system and prevent you from transmitting the virus to others.

Starting ART as soon as possible after you receive an HIV diagnosis is critical to lowering your risk of developing AIDS and preventing you from transmitting the virus to others. If you have tested positive for HIV, reach out to your healthcare provider right away to begin treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health: PrEP and PEP.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. Pharmacists in a growing number of states can now prescribe PrEP.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

We’re here to help you navigate HIV treatment and prevention therapies

Editor’s Note: This post was originally published in December 2021 and has been updated for accuracy and completeness.

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When you have questions about side effects, or are worried about missing a dose, or not sure if you’re administering it correctly — we’re here to lend a hand.

With Alto, you won’t have to fight the lines at the pharmacy. Our couriers hand-deliver your medication to your door, whenever and wherever you need it.

Ask your doctor to send your prescription directly to Alto or ask us to transfer refills from your old pharmacy. We’ll look for any savings, including coupons and assistance programs, and reach out when it’s time to schedule your free delivery.

Yes. As a full-service pharmacy, Alto can fill nearly all medications, including specialty, over-the-counter, brand, and generic. Alto’s pharmacists have deep expertise in many clinical areas, including heart and lung health, diabetes, fertility, HIV/PrEP/HRT, and more.

Yes. We accept most major insurance plans, including government-administered plans, and always work to get you the lowest price. Please note that coverage varies by state. For up to date information on coverage in your area call us at 1 (800) 874-5881.

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

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National Gay Men's HIV/AIDS Awareness Day

What to Know About Using PEP to Prevent HIV Infection

What to Know About State-Funded PrEP-DAP Programs

How Updated CDC Guidelines Can Expand PrEP Access

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.