tuliptree™: Decision Aid

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What decision about PrEP are you trying to make?

I am not currently taking PrEP and I want to decide whether to start taking it. I am on PrEP now, and I want to decide whether to continue taking it.

You must select a choice to continue.

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What is motivating you to make this decision?

Check all that apply.

Making this decision is important for showing that I am a responsible person. I feel it is important for my health. I am feeling pressure from myself. I am feeling pressure from others. Making this decision is my own priority. I would like to prevent HIV. I am feeling guilty. Other—please specify.

I don't know why I am trying to make this decision.

You must select a choice to continue.

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How close are you to making a decision?

I have not started to think about it. I have started to think about it. I have thought about it and am close to a decision. I have made a decision. I have made a decision and am deciding whether to continue taking PrEP or not.

You must select a choice to continue.

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The next 4 screens will provide information about PrEP that you may wish to read through.

What is PrEP and who should take it?
How well does PrEP work and what is involved in taking it?
What are the benefits and side effects of taking PrEP?
How can I get PrEP and is it free?

Continue

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What is PrEP?

PrEP stands for oral pre-exposure prophylaxis. An HIV-negative person who is at risk of HIV infection can take PrEP pills by mouth to reduce their risk of getting HIV. PrEP is a prescribed pill that should be taken daily to be optimally effective. It has been approved for use by Health Canada since 2016 to reduce the transmission of HIV for people who are at risk of HIV infection.

Who should take PrEP?

People at risk for HIV should take PrEP. PrEP can be beneficial regardless of gender or race. A health care professional can recommend who should take PrEP. People at the highest risk for HIV may include the following:

men or trans women who have sex without a condom with men,
any person who has anal or vaginal sex without a condom with a partner with HIV who is not on treatment or a partner with unknown HIV status,
people who share injection drug use equipment.

PrEP cannot be taken by someone who already has HIV and does not protect against other sexually transmitted infections (STIs). PrEP can be taken by pregnant or breastfeeding women.

Continue

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How well does PrEP work?

PrEP prevents the HIV virus from taking hold and replicating in the body. Based on all the available evidence, PrEP is over 99% effective in preventing HIV in people who take it every day as directed. When taken every day, PrEP is safe and highly effective in preventing HIV. For receptive anal sex, PrEP reaches maximum protection from HIV after about 7 days of daily use. For women having sexual intercourse or injection drug use, PrEP reaches maximum protection after about 21 days of daily use. Information about how long it takes to reach maximum protection for men having sex with women is not yet available.

What is involved with taking PrEP?

PrEP is taken daily, one pill by mouth per day. To start taking PrEP, individuals will have an HIV test to make sure they are HIV negative. At the same time, they will also be tested for other Sexually Transmitted Infections (STIs) and have blood tests to check the function of their kidneys.

Once taking PrEP, individuals will be required to have regular follow-up visits with their doctor or nurse practitioner. Regular blood tests to check for side effects and sexually transmitted infections will also be scheduled.

Continue

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What are the benefits of taking PrEP?

The main known reason to take PrEP is for HIV prevention. In addition to lowering a person's chances of getting HIV, PrEP can also help to reduce fear or worry. The medication can be started during periods of higher risk and stopped during periods of lower risk. You must consult your healthcare provider if you need to stop taking PrEP.

Some people may find it difficult to ask their partner(s) to wear a condom or may choose to not use condoms every time. PrEP may be especially beneficial because it is a prevention strategy that a person can control without their sexual partner(s) knowing that they are using it.

People who inject drugs but are not able to use new injection equipment each time may also benefit from taking PrEP.

What are the side effects of taking PrEP?

Side effects are generally mild, temporary, and only affect between 1% and 10% of people who take PrEP. Possible side effects include nausea, vomiting, diarrhea, headache and dizziness. These side effects may negatively affect a person's quality of life and ability to take their medication every day.

In a small number of people, the use of PrEP has been associated with small decreases in kidney, liver and/or bone health. These side effects are rare. Regular doctor's appointments and blood work are important to monitor for any side effects. These side effects did not increase the risk of kidney or liver failure, or bone fracture, and the changes were reversible after stopping PrEP.

Although research suggests that the use of oral PrEP is generally safe and well tolerated, the long-term effects of using PrEP are less well known.

Continue

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How can I get PrEP?

An HIV negative person who wants to access PrEP can make an appointment with a doctor or nurse practitioner to talk about going on PrEP, get tested and get a prescription for PrEP. The prescription is taken to a pharmacy to get filled.

If you don't have a healthcare provider, healthcare coverage or a drug plan, there are options for you. For more information about where and how to access PrEP, click here (this will open a new window or tab).

Is PrEP free?

PrEP is covered by most health insurance plans.

Continue

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The remainder of this tool is designed to help you decide whether to take PrEP or not and to help you feel confident in your decision. For those already taking PrEP, the remainder of this tool is designed to help you decide whether to continue taking PrEP or not. It is not a test and there are no wrong answers. You can skip any questions that you don't find relevant to you and your decision-making.

Continue

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We would now like to ask you about your feelings about PrEP specifically. We spoke with a number of people in Toronto about their views on PrEP. The following are some of the benefits and challenges of taking PrEP that they shared with us.

For each benefit and challenge, please move the slider to indicate how much it matters to you.

Benefits

HIV prevention.

matters a little matters a lot

More pleasurable sex.

matters a little matters a lot

Peace of mind.

matters a little matters a lot

Provides better protection from HIV than condoms.

matters a little matters a lot

Helps save people's lives.

matters a little matters a lot

Helps to alleviate the burden of HIV experienced by people.

matters a little matters a lot

Challenges

Side effects from the medication.

matters a little matters a lot

Requires taking medication daily.

matters a little matters a lot

Protects against HIV only, not other Sexually Transmitted Infections (STIs).

matters a little matters a lot

Cost of taking the medication.

matters a little matters a lot

Difficulty getting the medication prescribed.

matters a little matters a lot

Stigma from taking an HIV medication.

matters a little matters a lot

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Review of benefits and challenges of PrEP.

Based on your responses, here is your rating of how much the benefits and challenges of PrEP matter to you. You can compare your feelings about what you identified as benefits and challenges to help you decide what makes the most sense for you.

PrEP

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Continue

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In addition to PrEP, the following are some strategies that reduce the risk of HIV.

To learn more about any of these strategies, click on each one. When you're finished reviewing the available strategies, click Continue.

Abstinence from sex.

Abstinence is the practice of not having anal, oral or vaginal sexual intercourse.

Correct and consistent condom use.

Correct condom use is the appropriate use that ensures no breakage, leakage or slipping of a condom during vaginal, oral or anal sexual intercourse. It entails checking the expiry date before use, ensuring no breakage when opening the condom, and storing condoms in a cool dry place.
Consistent condom use implies use of a condom for every sexual act (vaginal, oral and anal sexual intercourse).

Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs.

For people who inject drugs, it involves avoiding the sharing of drug injection equipment.
Consistent use of sterile needles and syringes entails the regular use of new needles and syringes for injecting drugs.

Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load).

If you are having sex with an HIV positive partner, they should be on consistent HIV treatment for up to 6 months, adhere to treatment, and achieve and maintain an undetectable viral load.

Regular screening for sexually transmitted infections (STIs) and treatment.

Involves screening for STIs every 3–6 months and accessing treatment if the result of the screening is positive.

Continue

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The following are some of the known benefits and challenges of each of these risk-reducing strategies.

Click on a strategy to see the benefits and challenges. When you're finished reviewing the available strategies, click Continue.

Abstinence from sex.

Benefits

It is an effective way to prevent the sexual transmission of HIV, sexually transmitted infections (STIs), and pregnancy.

Challenges

Can be a difficult behavior to maintain.

Only prevents the sexual transmission of HIV.

Correct and consistent condom use.

Benefits

Prevents getting HIV.

Prevents getting some STIs.

Challenges

Requires that condoms are available, or individuals carry condoms with them.

Difficulty discussing sex and condom use.

Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs.

Benefits

Prevents the transmission of HIV and other blood-borne infections such as hepatitis C.

Challenges

Requires access to sterile needles.

Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load).

Benefits

Reduces your chances of getting HIV if you're having sex with an HIV positive sexual partner.

Challenges

Requires knowledge of partner's HIV status and medication use.

Regular screening for sexually transmitted infections (STIs) and treatment.

Benefits

Decreases likelihood of acquiring and transmitting HIV.

Timely diagnosis of STIs (many STIs are curable with treatment).

Challenges

Possible fear and anxiety over test results.

Requires blood work every 3–6 months.

Continue

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We've just given you a lot of information about PrEP and other options to prevent HIV infection. We will now ask you some questions to help guide your decision making.

Which of these options, in addition to PrEP, are you considering?

You may select at most two choices.

Abstinence from sex. Correct and consistent condom use. Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs. Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load). Regular screening for sexually transmitted infections (STIs) and treatment.

You may select at most two additional choices.

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How much do the benefits and challenges of these risk-reducing strategies matter to you?

Adjust the sliders to indicate how much each benefit and challenge matters to you.

No risk-reducing strategy selected.

Abstinence from sex.

Benefits

It is an effective way to prevent the sexual transmission of HIV, sexually transmitted infections (STIs), and pregnancy.

matters a little matters a lot

Challenges

Can be a difficult behavior to maintain.

matters a little matters a lot

Only prevents the sexual transmission of HIV.

matters a little matters a lot

Correct and consistent condom use.

Benefits

Prevents getting HIV.

matters a little matters a lot

Prevents getting some STIs.

matters a little matters a lot

Challenges

Requires that condoms are available, or individuals carry condoms with them.

matters a little matters a lot

Difficulty discussing sex and condom use.

matters a little matters a lot

Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs.

Benefits

Prevents the transmission of HIV and other blood-borne infections such as hepatitis C.

matters a little matters a lot

Challenges

Requires access to sterile needles.

matters a little matters a lot

Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load).

Benefits

Reduces your chances of getting HIV if you're having sex with an HIV positive sexual partner.

matters a little matters a lot

Challenges

Requires knowledge of partner's HIV status and medication use.

matters a little matters a lot

Regular screening for sexually transmitted infections (STIs) and treatment.

Benefits

Decreases likelihood of transmitting and acquiring HIV.

matters a little matters a lot

Timely diagnosis of STIs (many STIs are curable with treatment).

matters a little matters a lot

Challenges

Possible fear and anxiety over test results.

matters a little matters a lot

Requires blood work every 3–6 months.

matters a little matters a lot

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Review of benefits and challenges of other risk-reducing strategies.

Based on your responses, here are the HIV prevention strategies you are considering along with your rating of how much the benefits and challenges of each strategy matter to you. You can compare your feelings about what you identified as benefits and challenges to help you decide what makes the most sense for you.

No risk-reducing strategy selected.

Abstinence from sex.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Correct and consistent condom use.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load).

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Regular screening for sexually transmitted infections (STIs) and treatment.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Continue

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We would now like you to think about your support system, including friends and family, for making this decision. Please think about who else is involved in this decision.

If more than one person in the same group is involved in this decision, you can fill in the box to differentiate between them. For example, if you have 2 sisters and they are each involved in this decision, in the box you can write Older Sister for one sister and Younger Sister for the other sister.

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How much does each person's input matter in making this decision?

For each individual, drag the slider to the applicable position.

: no name given

matters a little matters a lot

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Which strategies do these people prefer for you?

For each individual, select one or more strategies you think they'd prefer for you. You may only select strategies for which you expressed a preference. If you do not know their preference or have not discussed it yet, you do not need to make a selection.

: no name given

Abstinence from sex. Correct and consistent condom use. Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs. Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load). Regular screening for sexually transmitted infections (STIs) and treatment. Daily use of Pre-exposure prophylaxis (PrEP).

Continue

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What role do you prefer in making the choice?

Share the decision with people supporting me. Decide for myself after hearing views of those supporting me. Let someone else decide. Decide for myself without hearing views from other people.

You must select a choice to continue.

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How can each person support you in making a decision?

In the box provided, please list what would be helpful for you. Others have indicated the following have been helpful: Listening to me, stop pressuring me, come with me to see my healthcare provider, learn more about PrEP, etc.

: no name given

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Here is your personal summary of what you thought of PrEP, your other HIV prevention options, your support system and how they can help you.

Here is your rating of how much the benefits and challenges of PrEP matter to you. You can screen shot this page to keep as a reference or to discuss with your healthcare provider.

PrEP

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Benefits and challenges of other HIV prevention options you are considering.

No other risk-reducing strategy selected.

Abstinence from sex.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Correct and consistent condom use.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Avoid sharing needles and syringes / consistent use of sterile needles and syringes for injecting drugs.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Ensure HIV positive partner is on HIV medication and has viral suppression (Undetectable Viral Load).

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

Regular screening for sexually transmitted infections (STIs) and treatment.

Benefits: %

matters a little matters a lot

Challenges: %

matters a little matters a lot

People you listed as supporting you and how they can help you.

: no name given

How much their input matters

matters a little matters a lot

How they can support me

Not given.

Continue

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We've provided you with a lot of information about PrEP and other HIV prevention options. Now that you've learned more about these options and PrEP, let's review how sure you are about your decision.

Click Yes or No for each statement.

Do you know the benefits and challenges of each option?

Yes No

Are you clear about which benefits and challenges matter most to you?

Yes No

Do you have enough support to make a choice?

Yes No

Do you feel sure about the best choice for you?

Yes No

You must select yes or no for all options.

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Let's plan the next steps based on your needs.

Some things that you could try are listed below. Please click on the suggestions that you feel could be helpful to you.

Knowledge

If you feel you do not have enough facts. Things you can try…

Find out more about the options and chances of the benefits and risks. List your questions. List where to find the answers (e.g., library, health professionals, counsellors).

Values

If you are not sure which benefits and risks matter more to you. Things you can try…

Find people who know what it's like to experience the benefits and risks. Talk to others who have made the decision. Read stories of what mattered most to others. Discuss with others what matters most to you.

Support

If you feel you do not have enough support. Things you can try…

Discuss your options with a trusted person (e.g., health professional, counsellor). Find help to support your choice (e.g., funds, transport, child care).

If you feel pressure from others to make a specific choice. Things you can try…

Focus on the views of others who matter most. Share your responses to this guide with others. Ask others to fill in this guide. If you disagree on facts, get more information. If you disagree on what matters most, consider the other person's views. Take turns to listen to what the other person says matters most to them. Find a person to help you and others involved.

Certainty

If you feel unsure about what matters most to you. Things you can try…

Work through the steps, focusing on your needs.

Please use the following space to list any other things that you could try that are not listed here. Other things you can try…

My List of Questions

Please use the following space to indicate the questions you still have about PrEP or your feelings.

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My plan.

Here is a list of things you can try to help you make the decision about whether or not to take PrEP or whether or not to continue taking PrEP.

You didn't select any strategies on the previous page. Here is a list of possible strategies as a reminder of things that you could try.

Find out more about the options and chances of the benefits and risks.
List your questions.
List where to find the answers (e.g., library, health professionals, counsellors).
Find people who know what it's like to experience the benefits and risks.
Talk to others who have made the decision.
Read stories of what mattered most to others.
Discuss with others what matters most to you.
Discuss your options with a trusted person (e.g., health professional, counsellor).
Find help to support your choice (e.g., funds, transport, child care).
Focus on the views of others who matter most.
Share your guide with others.
Ask others to fill in this guide. If you disagree on facts, get more information. If you disagree on what matters most, consider the other person's views. Take turns to listen to what the other person says matters most to them.
Find a person to help you and others involved.
Work through the steps, focusing on your needs.

Here are some additional things you can try:

Here are some questions you asked:

You can take a screen shot of this page to keep as a reference or to discuss with your healthcare provider.

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Thank you for using the tuliptree™ Decision Support Tool.

You indicated that you feel sure about the best choice for you. If you would like to take PrEP, you should speak with a healthcare provider to request a prescription. For more information about how and where to access PrEP, click here.

Thank you for using the tuliptree™ Decision Support Tool. Making a decision about whether to take PrEP can be difficult—this tool is designed to help you feel good about your decision. You can use this tool as many times as you wish to help you think about whether or not to use PrEP. Feel free to login to this tool if you feel uncertain about your decision or if you would like to review any of the information. Good luck with your decision!

Finish

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Thank you for using the tuliptree™ Decision Support Tool.

You indicated that you are not sure about one or more aspects about the best choice for you. Making a decision about whether to take PrEP or whether to continue taking PrEP can be difficult—this tool is designed to help you feel good about your decision by helping you learn more about PrEP, understanding what is important to you and identifying your support system. You are encouraged to use this tool as many times as you wish until you are sure of your decision about whether to take PrEP or not or whether to continue taking PrEP. If you would like to review any of the following information now, please click on the links below and you can work through the tool again:

Knowledge: to review information about PrEP, please click here.
Values: to review the benefits and challenges of PrEP and how they matter to you please click here.
Support: to review the information about your support network and how they can help you with your decision, please click here.
Certainty: to review your feelings about the best choice for you and your needs, please click here.

If you do not wish to review this information now, please log in at your convenience, until you feel certain of your decision. Good luck!

Finish

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Thank you for completing the tuliptree™ Decision Support Tool for PrEP! Please use this tool as often as you like to help with your decision needs. Best of luck with your decision.

This screen provides information about PrEP that you may wish to read through.

What is PrEP?

PrEP stands for oral pre-exposure prophylaxis. An HIV-negative person who is at risk of HIV infection can take PrEP pills by mouth to reduce their risk of getting HIV. PrEP is a prescribed pill that should be taken daily to be optimally effective. It has been approved for use by Health Canada since 2016 to reduce the transmission of HIV for people who are at risk of HIV infection.

Who should take PrEP?

People at risk for HIV should take PrEP. PrEP can be beneficial regardless of gender or race. A health care professional can recommend who should take PrEP. People at the highest risk for HIV may include the following:

men or trans women who have sex without a condom with men,
any person who has anal or vaginal sex without a condom with a partner with HIV who is not on treatment or a partner with unknown HIV status,
people who share injection drug use equipment.

PrEP cannot be taken by someone who already has HIV and does not protect against other sexually transmitted infections (STIs). PrEP can be taken by pregnant or breastfeeding women.

How well does PrEP work?

PrEP prevents the HIV virus from taking hold and replicating in the body. Based on all the available evidence, PrEP is over 99% effective in preventing HIV in people who take it every day as directed. When taken every day, PrEP is safe and highly effective in preventing HIV. For receptive anal sex, PrEP reaches maximum protection from HIV after about 7 days of daily use. For women having sexual intercourse or injection drug use, PrEP reaches maximum protection after about 21 days of daily use. Information about how long it takes to reach maximum protection for men having sex with women is not yet available.

What is involved with taking PrEP?

PrEP is taken daily, one pill by mouth per day. To start taking PrEP, individuals will have an HIV test to make sure they are HIV negative. At the same time, they will also be tested for other Sexually Transmitted Infections (STIs) and have blood tests to check the function of their kidneys.

Once taking PrEP, individuals will be required to have regular follow-up visits with their doctor or nurse practitioner. Regular blood tests to check for side effects and sexually transmitted infections will also be scheduled.

What are the benefits of taking PrEP?

The main known reason to take PrEP is for HIV prevention. In addition to lowering a person's chances of getting HIV, PrEP can also help to reduce fear or worry. The medication can be started during periods of higher risk and stopped during periods of lower risk. You must consult your healthcare provider if you need to stop taking PrEP.

Some people may find it difficult to ask their partner(s) to wear a condom or may choose to not use condoms every time. PrEP may be especially beneficial because it is a prevention strategy that a person can control without their sexual partner(s) knowing that they are using it.

People who inject drugs but are not able to use new injection equipment each time may also benefit from taking PrEP.

What are the side effects of taking PrEP?

Side effects are generally mild, temporary, and only affect between 1% and 10% of people who take PrEP. Possible side effects include nausea, vomiting, diarrhea, headache and dizziness. These side effects may negatively affect a person's quality of life and ability to take their medication every day.

In a small number of people, the use of PrEP has been associated with small decreases in kidney, liver and/or bone health. These side effects are rare. Regular doctor's appointments and blood work are important to monitor for any side effects. These side effects did not increase the risk of kidney or liver failure, or bone fracture, and the changes were reversible after stopping PrEP.

Although research suggests that the use of oral PrEP is generally safe and well tolerated, the long-term effects of using PrEP are less well known.

How can I get PrEP?

An HIV negative person who wants to access PrEP can make an appointment with a doctor or nurse practitioner to talk about going on PrEP, get tested and get a prescription for PrEP. The prescription is taken to a pharmacy to get filled.

If you don't have a healthcare provider, healthcare coverage or a drug plan, there are options for you. For more information about where and how to access PrEP, click here (this will open a new window or tab).

Is PrEP free?

PrEP is covered by most health insurance plans.

To see PrEP resources, select a country from the list above.

We don't currently have information for countries outside of those listed in the above dropdown.

Resources researched for tuliptree™ are currently based around Toronto, Canada. Other metropolitan areas will be coming soon!

Resources offering PrEP or PrEP information in Toronto

Prepared in April, 2020. For a more extensive list of available clinics, visit get-prep.com.

prep for individuals with no ohip (ontario health insurance plan) or drug plan

prep for individuals with ohip, but without a drug plan

OHIP+
Trillium Drug Plan: to apply, submit this form.

prep clinics

Please visit ontarioprep.ca/clinic-finder.

Some clinics may offer PrEP at a discounted rate and to individuals without OHIP. Please contact these clinics directly or your healthcare provider to learn more.

Welcome to the HIV PrEP Decision Support Tool.

It is designed to help individuals make decisions about whether or not to take PrEP or whether to continue taking PrEP. We encourage you to be thoughtful about it and let your responses reflect what you really know, think or feel. Please read through and enter information in the document as many times as you need to help you feel more confident in your decision. It is not a test and there are no wrong answers. You can skip any questions that you don't find relevant to you and your decision-making. Your responses are confidential. We hope this tool helps you to feel confident in your decision about PrEP.

Before beginning, please enter the first two letters of your first name and 4-digit year of birth, for example, DA1989.

You must provide the first two letters of your first name and 4-digit year of birth to begin.