Two Words: Oops & PEP
So, you’re bottoming and… the condom broke / you didn’t use one / you aren’t on PrEP / your partner doesn’t have an undetectable viral load – and you think there’s a chance you’ve been at risk of contracting HIV.
Take a deep breath and remember these three letters: P-E-P.
What is that?
Post-exposure prophylaxis (PEP) – much like PrEP (pre-exposure prophylaxis), is the use of a course of antiretroviral medication (usually four weeks) to prevent HIV taking hold in your immune system. The window to use PEP is pretty short, you have 72 hours from potential exposure to start taking PEP and ideally you will get it sooner than that to have the best chances of success.
What do I do?
Head to the emergency room as soon as you can- as the longer you leave it, the less chance it will be effective.
When you get there, the first people you encounter may not have heard of PEP but make sure you insist that you have potentially been at risk of HIV transmission and need to initiate emergency PEP within 72 hours. Most A&E/Emergency departments should have a supply of PEP but may need a little time to get prescription approvals.
The clinical staff may need to ask some pretty personal questions to assess your likelihood of exposure – this may feel a little awkward, but they’re just trying to make sure you get the care you need. So it’s important to be honest.
If you were the bottom (receptive anal sex partner) and you know your sexual partner was living with HIV and did not have an undetectable viral load – initiating PEP should be completely free. If these were not the circumstances, there may be a cost associated with the visit and prescription.
Once you have initiated PEP – make sure to follow the clinician’s instructions carefully and you will need to book follow up HIV tests to see whether PEP has been successful.
Condoms (and lube!), PrEP and U=U are the best ways to prevent HIV transmission – PEP is a bit of an emergency safeguard if something happens that you weren’t expecting or didn’t have all the information about during the encounter.
Basically, don’t think of PEP as part of your regular prevention toolbox – it’s more of the “break glass in case of emergency” box.
If you find that you’ve had to initiate PEP a couple of times now – it would be worth looking into whether PrEP is right for you.
If PEP doesn’t work or isn’t made available to you – it’s important to remember that with modern medicine and scientific understanding, being diagnosed with HIV today is very different to how it used to be.
If you are diagnosed with HIV, you can be connected to treatment immediately, no matter your situation and it is very likely you will reach what is called an undetectable viral load (UVL) within six months. Having UVL means you will get the most health benefits from being on treatment, including not being able to transmit HIV through sex.
While prevention is a very important part of stopping new HIV transmissions, if PEP fails – remember that your life is not over. Head to the U=U page to learn more and reach out to NZAF’s counselling services if you would like to talk to someone.