How Can People Access Pep
The Canadian PEP guidelines recommend that PEP should be readily available in places where it is likely to be needed urgently. These include emergency departments, sexual health clinics and other clinics serving populations at increased risk of HIV.
The decision to provide PEP lies with the healthcare provider and is made on a case-by-case basis. Many healthcare providers are unaware of non-occupational PEP or may be unwilling to prescribe it. The Canadian guidelines outline practical advice for physicians providing PEP, including how to assess risk in people who present for PEP, how to provide monitoring and follow-up, and recommended drug regimens.
People starting PEP may be offered a starter pack of pills, so that PEP can be started right away, along with a prescription that needs to be filled to receive the full 28-day course of medications. Most emergency departments will have PEP starter packs available.
Anti-HIV drugs are expensive: a month-long course of PEP can cost $900 or more, depending on the drugs used. Although occupational PEP is normally covered by workplace insurance, coverage for non-occupational PEP varies across Canada. Non-occupational PEP medications are covered by some private and public health insurance plans coverage varies depending on the province or territory and the type of exposure.
Acknowledgement
Who Might Need Pep
- People who think they might have been exposed to HIV during sex
- People who have been sexually assaulted
- Drug users who recently shared needles or other related items
- Health care workers who think they’ve been exposed to HIV on the job
If you think you were exposed to HIV, go to the hospital or see your doctor as soon as possible. They can help you figure out whether you need PEP.
Guidelines For Prescribing Pep
In the UK, HIV and sexual health doctors have produced guidelines about when PEP may be an option to prevent sexual transmission of HIV. These take into account the type of sex you had and also what is known about the ‘source partner’ . PEP may also be an option if you have used injecting equipment previously used by someone who has, or may have, HIV.
These guidelines take into account the viral load of the person with HIV if this is known. If someone with HIV is taking HIV treatment and it suppresses their viral load to a very low level , there is no risk of passing HIV on during sex. PEP is not recommended in this situation.
effectiveness
How well something works . See also ‘efficacy’.
When you go to get PEP, you will be asked about the sort of sex you have had , to work out how high your risk of HIV infection is. You will need to have an HIV test to check you dont already have HIV. You will also need to agree to be tested again when you have finished the course of PEP. You might also need to have tests for sexually transmitted infections and hepatitis, depending on your situation.
The guidelines recommend the use of PEP where there is a significant risk of HIV infection. However, some people who have had possible exposure to HIV have had difficulty getting PEP. If this happens to you, ask to speak to the on-call HIV doctor, who will know when PEP can be given. You can call the THT Direct helpline on 0808 802 1221 for help and advice.
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How Do I Access Pep
If you think you have been exposed to HIV, do not wait for an appointment to see a GP. Call the PEP info line at the Victorian HIV Prevention Service for guidance and information about where to find your closest PEP provider.
Your PEP provider will ask you a series of questions to determine your risk and whether PEP is appropriate.
PEP is available from the emergency department of most public hospitals, sexual health clinics and some other general practice clinics which specialise in sexual health.
If the exposure happens after hours, emergency departments are often the best place to go to make sure you start PEP as soon as possible.
PEP is widely available in Victoria and further information can be found at:
Get yourself tested for STIs, and treated if necessary, by your local GP .
PEP is not a morning-after pill that makes it easy and safe to have sex without a condom. You must take the medication every day for 28 days for PEP to work.
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Does Hiv Go Away
HIV doesnt go away on its own. It inserts itself into your DNA so your cells think that its a part of you. There can be many years without symptoms after initial infection, but HIV can still be damaging your immune system even if you dont feel sick.
There may be periods while on medication where the virus is not detectable by an HIV test. In these cases, HIV can be hiding in your body, undetected. It can wake up and start destroying your cells again in the future.
This is why continuing to take HIV medication, even if you dont feel sick or the virus is undetectable, is extremely important. Without treatment, HIV will weaken your immune system until you cant fight off other serious illnesses.
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When Is Pep Used
PEP can be used after exposure to HIV in a work context or after exposure to HIV that is not work related such as sexual exposure or injection drug use .
Occupational PEP is when PEP is used by people who have an exposure to blood and/or body fluids that may contain HIV in their workplace for example, a healthcare worker who accidently experiences a needle-stick injury.
Non-occupational PEP is when PEP is used after a potential high-risk exposure to HIV that is not work related, such as unprotected sex, a condom breaking during sex, sexual assault, or sharing needles used to inject drugs.
Test Today Don’t Delay
Everyone should get tested at least once, and people at high risk should be tested at least once a year.
It is important for everyone to know their HIV status. Getting an HIV test is the first step for people living with HIV to get care and treatment and control the infection.
- The CDC says, All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
- Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year.
- Men who have sex with men should have an annual screening for HIV. Some gay and bisexual men may benefit from more frequent testing .
- To find a testing site near you, go to GetTested.MT.gov
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What Questions Should I Ask My Doctor
- Am I at high risk for HIV?
- What can I do to reduce my risk of HIV?
- How can I make sure I take my medications correctly?
- What can I do to protect myself from other illnesses?
- How can prevent the spread of HIV?
- What do my test results mean?
- What do my blood counts mean?
- What vaccinations should I get?
A note from Cleveland Clinic
Treatments have come a long way since the height of the AIDS epidemic. You have the best chance of living a long life if youre diagnosed early and are able to get on and stick with ART medications. People living with HIV today are able to work, have active social lives and families, and pursue fulfilling relationships. In fact, this can have a positive impact on your well-being.
While weve come a long way with treatments, unfortunately, social stigmas around HIV still persist. In addition to the feelings of fear and uncertainty a new diagnosis can bring, you may wonder how those around you will respond. If youre hesitant to get tested or get treatment, or if you just arent sure what your next steps are, you can reach out to a community organization that specializes in HIV. Remember that you are deserving of support, compassion and high-quality healthcare.
Whats The Difference Between Hiv And Aids
The difference between HIV and AIDS is that HIV is a virus that weakens your immune system. AIDS is a condition that can happen as a result of an HIV infection when your immune system is severely weakened.
You cant get AIDS if you arent infected with HIV. Thanks to treatment that slows down the effects of the virus, not everyone with HIV progresses to AIDS. But without treatment, almost all people living with HIV will advance to AIDS.
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What Hiv Medicines Are Used For Pep
The Centers for Disease Control and Prevention provides guidelines on recommended HIV medicines for PEP. The CDC guidelines include recommendations for specific groups of people, including adults and adolescents, children, pregnant women, and people with kidney problems. The most recent PEP recommendations can be found on CDCs PEP resources webpage.
Your health care provider or emergency room doctor will work with you to determine which medicines to take for PEP.
How Long Does It Take To Develop The Disease
There is no fixed period between the first contact with HIV and the development of the disease. Signs and symptoms resulting from infection with HIV develop in stages. Many infected individuals may have no symptoms for several years. But others may develop symptoms within three years from the time of infection.
Symptoms of HIV infection are fever, swollen lymph glands in the neck and armpits, sweating, aches, fatigue, unexplained weight loss and diarrhea.
Within eight years, about 50 percent of all infected people develop specific conditions categorized as AIDS. These conditions include a lung disease called “pneumocystis carinii pneumonia,” skin tumours called “Kaposi’s sarcoma,” fungal and viral infections such as candidiasis and herpes zoster, and severe diarrhea.
Some AIDS patients also suffer from dementia resulting in problems with memory and thinking. AIDS patients are prone to various infections of the brain, just as they suffer from an unusually high number of cancers, bacterial and viral infections of other parts of the body.
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How Is Hiv Treated
There is no vaccine or cure for HIV infection. However, there are effective treatments that can prevent the transmission of HIV and the progression to AIDS, and help ensure a near-normal life expectancy.
These treatments are known as antiretroviral therapy . They stop the virus from reproducing itself, which leads to a lower viral load. The treatment involves a combination of drugs used together.
HIV-positive people who take ART daily exactly as prescribed and achieve an undetectable viral load cant sexually transmit the virus to an HIV-negative partner.
Thanks to the improvements in treatment, HIV infection is now a manageable chronic disease for many people in countries like Australia.
Other Things To Consider
It is best not to rely on PEP as a regular way of preventing HIV if you are having condomless sex or sharing drug injecting equipment. Condoms, when used properly, are an effective way of preventing HIV and most other sexually transmitted infections . PEP wont stop you getting other STIs while youre taking it, so its sensible to use condoms during that period as well. Staff at sexual health clinics can provide information and advice about sexual health and how best to protect yourself from HIV and other STIs.
If you have needed PEP more than once in the past, you might want to consider taking PrEP. This is a similar HIV medication that you take regularly to prevent HIV before youre exposed. A doctor or nurse at a sexual health clinic can help you think through whether you need PrEP and whether it is suitable for you. This will involve being asked about the type of sex you have been having and expect to have in the future.
Taking PEP at the same time as other drugs can cause drug interactions. When accessing PEP it is important to tell the doctor or pharmacist about anything else you take. This includes over-the-counter medication, vitamins, minerals, herbal remedies and recreational drugs. That way, you can avoid interactions that can result in serious side effects or drugs being ineffective.
If you are breastfeeding, you can still take PEP. Doctors will choose a regimen that is suitable for you and your baby and offer you advice.
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Who Is Pep For
PEP is taken after a known or suspected exposure to HIV to prevent HIV transmission.
Examples of known or suspected exposure to HIV may include:
- Condom-less sex with a person whose HIV status you dont know or who is HIV-positive and not on treatment.
- Where a condom has broken or failed during sex.
- Sharing needles or other injecting equipment.
If your exposure to HIV is through a person with HIV who has an undetectable viral load, PEP is not recommended, as there is no risk of transmission.
Who Should Consider Taking Pep
PEP may be prescribed for people who are HIV negative or do not know their HIV status, and who in the last 72 hours:
- May have been exposed to HIV during sex
- Were sexually assaulted
- May have been exposed to HIV at work
If you think you were recently exposed to HIV, talk to your health care provider or an emergency room doctor about PEP right away.
A health care worker who has a possible exposure to HIV should seek medical attention immediately.
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What Does Hiv Do To A Person
HIV infects white blood cells of your immune system called CD4 cells, or helper T cells. It destroys CD4 cells, causing your white blood cell count to drop. This leaves you with an immune system that cant fight off infections, even those that wouldnt normally make you sick.
HIV initially makes you feel sick with flu-like symptoms. Then it can hide in your body for a long time without causing noticeable symptoms. During that time, it slowly destroys your T-cells. When your T-cells get very low or you begin to get certain illnesses that people with healthy immune systems dont get, HIV has progressed to AIDS.
AIDS can cause rapid weight loss, extreme tiredness, mouth or genital ulcers, fevers, night sweats and skin discolorations. Other illnesses and cancers often happen in people living with AIDS and can cause additional symptoms.
Whats a retrovirus?
A retrovirus is a virus that works backward from the way human cells do. Human cells have instructions that send a message to make building blocks for your body .
Retroviruses have their instructions written on RNA. When a retrovirus invades your cells, it changes its RNA to look like your cells instructions . Then it cuts your cells DNA and inserts its instructions into them. Your cell then acts as though the virus instructions are its own.
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What Is Postexposure Prophylaxis
PEP is taken in emergency situations when exposure to HIV may have occurred. When taken as directed, its effective at preventing HIV transmission. Some examples of situations where PEP may be used include after:
- engaging in consensual sex, especially without a condom or other barrier method or if a barrier method breaks
- sharing needles or other injection drug equipment
- having an occupational injury, such as a needlestick or a cut
Its important to note that PEP is for emergency use only. Its not a substitute for other HIV prevention methods, such as using a condom or other barrier method during sex or taking preexposure prophylaxis .
PEP is actually a combination of different antiretroviral drugs. These drugs work to prevent the virus from replicating effectively in the body. The combinations for most healthy adults and adolescents include:
- tenofovir/emtricitabine with raltegravir
- tenofovir/emtricitabine with dolutegravir
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Risks Of Contracting Hiv And Stds
Just as HIV and STDs are spread in the same ways, they can also share some of the same risk factors. A risk factor is anything that makes you more likely to contract a condition or disease.
For HIV and some STDs, risk factors include:
- having unprotected sex of any kind
- sharing injection needles
- sharing tattoo or piercing needles
- having sexual encounters under the influence of drugs or alcohol
The risks of contracting HIV or an STD are also higher among some populations and groups. This can be due to a variety of factors, like:
- lack of access to healthcare
- discrimination faced in accessing healthcare
- population size
47 percent of primary and secondary syphilis were among men who have sex with men. But STDs are common among all Americans. Its important for anyone of any gender or sexuality who has one or more risk factors to get tested and treated.
What If There Is An Actual Or Suspected Exposure To Hiv
The decision to begin a post-exposure prophylaxis for HIV infection is based on the judgment of a health care professional and should be a joint decision with the exposed worker. PEP often involves taking a combination of 2 or 3 antiretroviral drugs for about 4 weeks. PEP can help reduce, but not eliminate, a personâs risk of infection. The PEP should begin as soon as possible, as it may be less effective if started more than 72 hours after exposure.
Occupational Groups Risking Exposure to the AIDS Virus
The occupational groups listed below risk exposure to HIV in the workplace. The table that follows suggests preventive measures for these groups. For many situations, using all protective barriers listed in the table is not necessary, but workplaces should always make them available in case of emergency response scenarios.
Surgeons, Nurses and Nurses Aides
Surgeons, nurses and nurses’ aides should take precautions to avoid needlestick injuries, cuts with sharp instruments and exposure through skin lesions to potentially infectious blood and body fluids.
Physicians and Laboratory Workers
These people continuously handle infectious samples. Doctors, in diagnosing HIV patients, carry out physical examinations and collect blood samples. Laboratory technicians analyze potentially infected samples.
Ambulance Workers
Dental Workers
Embalmers
Embalming the bodies of persons with a HIV infection presents a risk because HIV can live for hours in a deceased body.
Cleaners
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