HIV prevention has transformed in the past decade. Alongside condoms, testing and treatment (people on effective treatment with an undetectable viral load don’t transmit HIV sexually, often summarised as “U=U”), we now have medicines that prevent infection: PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis). Nurses in clinics, emergency departments, maternity and community services can make sure people who need them get them.
PrEP: before exposure
PrEP is taken by HIV-negative people at substantial risk of HIV to prevent infection. When taken correctly, oral PrEP is highly effective at reducing sexual transmission.
Who may benefit
- People with an HIV-positive partner who is not virally suppressed.
- Serodiscordant couples trying to conceive.
- People with multiple partners or recent STIs.
- Key populations: sex workers, men who have sex with men, people who inject drugs, adolescent girls and young women in high-incidence settings.
- Pregnant and breastfeeding women at ongoing risk: WHO considers PrEP safe in pregnancy and breastfeeding.
Options
- Oral PrEP: tenofovir disoproxil fumarate with emtricitabine or lamivudine, taken daily (or “event-driven” 2-1-1 dosing for some men who have sex with men).
- Dapivirine vaginal ring: recommended by WHO as an additional option for women.
- Long-acting injectable PrEP: cabotegravir every two months, and lenacapavir given twice a year, which WHO has recommended. Availability and cost vary greatly between countries.
Nursing role
- Confirm HIV-negative status before starting (and regularly thereafter).
- Check kidney function and hepatitis B status as per guidelines (oral PrEP).
- Explain that oral PrEP takes time to reach protective levels.
- Support adherence and offer STI screening; PrEP doesn’t prevent other STIs.
- Address stigma: PrEP is a responsible health choice.
PEP: after exposure
PEP is a 28-day course of antiretroviral medicines taken after a possible exposure to HIV.
- Start as soon as possible, ideally within hours, and no later than 72 hours after exposure.
- Exposures include: sexual assault, condom failure with a partner of unknown or positive status, sharing injecting equipment, and occupational exposures such as needlestick injuries.
- WHO-recommended regimens are typically based on tenofovir plus lamivudine/emtricitabine with dolutegravir.
- Baseline HIV test, then follow-up testing as per guidelines.
- Counsel on side effects, completing the full 28 days, and using condoms until follow-up testing is complete.
- For ongoing risk, discuss transitioning to PrEP after PEP.
Sexual assault survivors
Survivors need compassionate, trauma-informed care: PEP, emergency contraception, STI prophylaxis, hepatitis B vaccination, documentation, and psychological support. Respect their choices about reporting to police.
Nurses protecting themselves
If you have a needlestick or splash injury, act immediately. See our needlestick guide.
Talk without judgement
Many people avoid HIV services because of stigma. Use respectful, non-judgemental language, protect confidentiality, and focus on health. A welcoming nurse can be the difference between someone seeking prevention or not.
Related: HIV treatment and adherence · Syphilis in pregnancy
Based on WHO consolidated guidelines on HIV prevention, testing, treatment and service delivery, including WHO recommendations on long-acting PrEP options. Educational content: follow national guidelines.