HIV & PEP: WHAT YOU NEED TO KNOW

Few have heard of PEP, but this controversial treatment could be effective in reducing your chances of becoming infected with HIV after exposure to the virus.

PEP refers to a course of treatment that is administered soon after exposure to a harmful agent in order to reduce or block injury or infection (e.g., getting a tetanus shot after receiving an open wound). More specifically in relation to HIV, a short course of antiretroviral medications (hereafter referred to simply as PEP) are prescribed to block or reduce the chances of contracting the HI virus.

It is important not to confuse PEP with general antiretrovirals which are recommended as a life-long treatment regimen for individuals requiring treatment or in the advanced stages of the HIV/AIDS progression.

Traditionally, PEP has been administered to health care workers following exposure to contaminated blood (often called a needle-stick injury) or to survivors of sexual assault or rape. However, PEP is increasingly being administered to individuals considered to be at-risk, following a risky sexual encounter (e.g., condom breakage or slippage during consensual penetrative sex).

Men who have sex with men (MSM) have been found to be at an elevated risk of HIV and have been identified as a sub-population in which non-occupational PEP may be useful in reducing the rate of infection. What follows is a closer look at some of the arguments, facts, and information on where you can access PEP if necessary.

Arguments surrounding PEP

There are various arguments around the provision and use of PEP following a risky sexual encounter. Most experts agree that PEP serves as an effective method of HIV prevention following exposure. This argument is based on numerous studies that have repeatedly demonstrated that PEP is highly effective in reducing the likelihood of seroconversion (i.e., conversion from being negative to being positive) following exposure to HIV.

These studies have largely focused on animal models, occupational exposure among health care workers (e.g., a reduction in the risk of HIV infection by 81%), the transmission of HIV from mother to child (e.g., a reduction in the risk of HIV transmission by 67%), and the transmission of HIV between sero-discordant (i.e., one partner is positive and the other is negative) heterosexual couples (e.g., a reduction in the risk of HIV infection between partners by 92%).

In addition to these findings it has been found that the risk of HIV transmission from a single act of unprotected vaginal or receptive anal intercourse is similar, if not higher than, the risk associated with a needle-stick injury (for which PEP is now a standard of care), thus supporting the argument that PEP should be recommended and made available to all people irrespective of the nature of their exposure.

However, it should be noted that this recommendation is made in the context of continued uncertainties that still need to be explored. One of these uncertainties pertains to the frequency of exposure and failure to adhere with the PEP regimen (e.g., not take the full course) as prescribed by a medical practitioner. As such, it is unknown what the longer term implications are of:

• repeatedly being exposed to HIV and then taking PEP after each subsequent exposure;
• being exposed again during and/or after completing a course of PEP; and
• repeated PEP use and the efficacy thereof.

These uncertainties have led to the counter argument that despite PEPs demonstrated efficacy in certain contexts, PEP should not be recommended for exposure resulting from repeated casual sexual encounters as PEP is not 100% effective, can have severe side-effects, can become less effective over time, and could encourage unsafe sexual behaviour.

While this argument raises numerous questions, a recent study has shown that only 10% of people using PEP reported an increase in risk behaviour, whereas 74% indicated a decrease in risk behaviour following their PEP treatment. Furthermore, in the absence of certainty and another solution, PEP remains a viable option for now.

Lastly, it should be noted that treatment as prevention should be regarded as a part of a comprehensive, holistic prevention strategy, and as a compliment to ongoing HIV education, condom use, and behavioural change strategies.

The facts about PEP

• PEP is recommended if you have had unprotected insertive (top) or receptive (bottom) anal sex or vaginal sex with someone with an unknown, suspected, or known HIV status;
• PEP is not a ‘cure’ for HIV;
• PEP is not 100% effective;
• PEP may prevent or decrease the likelihood of contracting HIV;
• PEP must be taken within 72 hours after exposure;
• The sooner PEP is accessed the better;
• PEP consists of 3 anti-HIV drugs, consisting of 2 nucleoside analogues (NRTIs) and a boosted protease inhibitor;
• The PEP treatment should be taken for a month;
• It is crucial that the treatment course be completed, with doses adhered to at the right time and in the right way;
• Initial side-effects may include: nausea, vomiting, diarrhoea, tiredness, headaches, feeling tired, skin rash, difficulty sleeping, and kidney pain or tenderness.

Where to access PEP

You can access free PEP within 72 hours following a risky encounter at the following sites:

The Prism Lifestyle Centre at OUT in Pretoria
Call 012 430 3272 / 082 695 2182 / 082 520 7010

Health4Men at Baragwanath Hospital in Soweto
Call 011 989 9756

Health4Men in Green Point, Cape Town
Call 021 421 6127

Ivan Toms Clinic in Woodstock, Cape Town
Call 021 447 2844

For information on other PEP sites please call the OUT Helpline: 0860 OUT OUT / 0860 688 688.

For more information and advice on sexuality, safer sex and sexual health, log onto www.men2men.co.za. For more information on the services offered by OUT LGBT Well-being call 012-430-3272 or log onto www.out.org.za (Helpline: 0860 OUT OUT/ 0860 688 688)