What is the 2:1:1 rule for PrEP? The 2:1:1 rule, also called on-demand PrEP or event-driven PrEP, is a dosing schedule studied for prevention of HIV from anal sex. It is only for HIV-negative adults assigned male at birth who have sex with men or transgender women who have anal sex, who do not have chronic hepatitis B, and who can plan sex at least 2 hours ahead. The schedule is: take 2 pills of generic Truvada (emtricitabine 200mg / tenofovir disoproxil fumarate 300mg) together 2 to 24 hours before sex, then take 1 pill 24 hours after the first 2-pill dose, and take 1 more pill 24 hours after that. If you have sex again before the 2-pill schedule ends, continue 1 pill daily until 48 hours after last sex. It was studied in the IPERGAY trial and showed high effectiveness for anal sex when followed correctly. It does NOT work for vaginal sex, for people with hepatitis B, or for daily unpredictable risk. It also requires Descovy not be used for 2:1:1, only Truvada generic is recommended. Discuss with a sexual health provider whether daily, 2:1:1, or injectable PrEP fits you.
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