Post-Exposure Prophylaxis (PEP) After HIV Exposure
According to data from the UNAids AIDS Epidemic Update published in November 2009, global estimates indicate that at the end of 2008, 33.4 million people were living with HIV in 2008. Data from the U.S. Centers for Disease and Control Prevention (CDC) indicates that during 2007 there were an estimated 22,472 new diagnoses of HIV infection in 34 U.S. states between male to male sexual contact (excluding drug use). Canadian statistics from the Centre for Infectious Disease Prevention and Control (CIDPC) show that in 2007, there were 514 new infections reported in the exposure category among men who have sex with men (excluding injection drug use). In Australia, the National Centre in HIV Epidemiology and Clinical Research reports that there were 837 new male HIV diagnoses reported in 2008. Statistics from the Health Protection Agency in the United Kingdom during 2008 show that 2,422 new cases were reported where HIV was probably acquired through sex between men (excluding injecting drug use and blood or tissue products).
Bareback sex is the riskiest form of sex, because it involves potential skin damage caused by bare skin rubbing against bare skin, along with the potential of bodily fluids including pre-cum and cum exchanging from one sexual partner to the other. In addition to this, men who have sex with men account for the highest number of new HIV infections at the current time. Bareback sex can be a pleasurable experience and many of us may still engage in unprotected sex with other men knowing these statistics, whether it be with a partner in a monogamous relationship, with a fuck buddy or with a random guy. The level of risk also changes based on various situations including the partner type, whether bodily fluids are exchanged, the viral load if one person is infected, along with a number of other reasons.
As careful as we can be when it comes to trying to navigate bareback sex in the safest way possible by checking the HIV status of barebacking partners and doing a risk assessment, attempting to remain HIV negative cannot be guaranteed. Taking the best possible precautions can still result in becoming exposed to HIV and this is something which every barebacker must consider. It is not possible to make bareback sex perfectly safe, but there are precautions which can be taken such as communication, serosorting and avoidance in some cases, although HIV can still be contracted when taking these precautions. You are about to be introduced to Post-Exposure Prophylaxis (PEP), which is a treatment which may assist with reducing the risk of seroconversion.
If you are ever in a situation where you have tried to be as careful as possible and had unprotected sex with someone who you believed was HIV negative, but you later you found out otherwise, it is possible for you to take action to help prevent contracting HIV. A guy may tell you that he is HIV negative in order to have bareback sex with you, then after wards he may admit to being HIV positive or unsure about his HIV status, or he may genuinely believe that he is HIV negative, but he may not be. The first thing you need to do is remain calm, because if you panic, it’s difficult to remain focused on finding a solution. It’s easy for someone to say remain calm in such a stressful situation, but it is important and providing you with this information may help you remain calm if such a situation ever arises in your life.
Post-Exposure Prophylaxis (PEP) is a course of antiretroviral drugs thought to reduce the risk of seroconversion after being exposed to HIV. Timing is critical for PEP to be effective, as treatment should begin within an hour of possible infection and no longer than 72 hours after exposure, as the treatment may be ineffective if commenced after 72 hours of post-exposure. The treatment involves taking a course of medication for a period of 4 weeks. During this time, the patient requires close compliance and unfortunately the medication can have unpleasant side effects including malaise, fatigue, diarrhea, headache, nausea and vomiting. It is important to note that while PEP after exposure is effective, there have been some cases where it has failed, so this is not a foolproof solution.
You may be wondering whether it is possible to take PEP medication prior to engaging in unprotected sex as a way of avoiding HIV transmission and trying this as a form of protection instead of using condoms. Research is currently underway as to the effectiveness of Pre-Exposure Prophylaxis (PrEP). PrEP has not yet been proven to be successful and further testing and research is required before any conclusions can be drawn. As a result of the current PrEP, it is not advisable to use PrEP as an HIV reduction method each time you have unprotected sex.
PEP is available through hospitals and sexual health clinics and an assessment is firstly made by a doctor or health care professional to determine whether to commence the PEP treatment. This will include a doctor or health care professional asking a series of questions about whether the other person is known to be infected with HIV, the type of exposure and whether there is a risk of transmission. At the first visit to the doctor or sexual health clinic, blood tests will be performed to check whether you are already infected with the virus. Tests will usually be repeated at six weeks, three months and at six months. When there is a definite risk of exposure to HIV, PEP would usually be recommended.
Here are a few points to consider:
• PEP consists of a combination of drugs taken for four weeks. These drugs have been shown to reduce the risk of infection following accidental exposure to HIV. They do not protect against repeated or long term exposure to HIV. Common side effects include malaise, fatigue, diarrhea, headache, nausea and vomiting.
• For PEP to be effective, treatment should be commenced as soon as possible (within an hour of the risk event is preferable). This gives the drugs the best chance to work against HIV before it becomes established in the immune system. There may still be a significant benefit in taking PEP if it’s started within 24 to 48 hours after possible exposure. In some situations PEP may still be of use up to 72 hours after the risk event.
• PEP should not be used regularly as a way to avoid contracting HIV, it should only be used in emergency situations, such as having unprotected sex whilst being affected by alcohol or another substance, forced unprotected sex (rape), or when a person lies about their HIV status.
• Taking PEP is not guaranteed to stop you from being infected with HIV and is not a replacement for safer sex. Taking PEP will not make you immune to further exposures.
The way the treatment works and the importance of commencing the treatment as soon as possible, is that it can take a few days for HIV to become permanently established in the body following exposure. The PEP drugs given at this time may help the body’s immune system stop the virus from multiplying in the infected cells of the body. The cells originally infected would then die naturally within a short period of time without producing more copies of the virus. There is currently no known cure for HIV once it has established itself in the body, which is why it’s so important to commence the PEP treatment as soon as possible. Research indicates that taking PEP makes infection with HIV a lot less likely, but PEP doesn’t work each time, as some anti-HIV drugs don’t work against some strains of HIV, the initial amount of HIV in the body (viral load) was too great, the virus was multiplying too quickly for the drugs or body’s immune system to control or the body’s immune system was already damaged.
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