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THE PEP STEP

PEP or Post Exposure Prophylaxis is a treatment that may stop you becoming HIV after exposure to the virus, but many gay men don’t know much about it. Kieron McKinney and Gay Health Strategies are on the case.

Just before last Christmas, Gay HIV Strategies facilitated a monitoring exercise, on the Irish Government’s response to HIV over the past five years. The results varied and there were many opinions on how well the Government has performed. However, one particular question stood out: the on Post Exposure Prophylaxis (PEP). (See sidebar for information.)

A very high number of respondents were unclear as to what PEP was or that it could be made available for sexual exposures as well as occupational ones.

A number of people knew that PEP was available for ‘needle stick’ injuries but did not know that that it could be given to people who have had a sexual exposure, ie. a condom break or unprotected sex. Very few people knew where it might be available or what the process might be.

Quite a number of people said that there were differences in how occupational and sexual exposures were regarded and implied that sexual exposures were ‘someone’s fault’. There were fears that sexual exposures in casual sex would be seen as different to ones in long-term relationships where each partner has a different HIV status.

PEP has been available to gay and bisexual men in the UK for more than a year. There were concerns that it would be regarded as a ‘morning after pill’ but this was not the experience of the pilot programmes and the service is being rolled out nationally.

Irish gay and bisexual men should have consistent access to PEP. At the moment its availability is not promoted or advertised, meaning that people who already know about it are at a significant advantage. But even knowing about it doesn’t mean you’ll get it. One agency described how despite their best efforts to have a gay man assessed for PEP within the 72 hour window he eventually flew to London to request and receive the treatment.

This is why the Gay Health Network (GHN) is producing a new information leaflet on PEP. We want gay and bisexual men to know that it can play a vital role in HIV prevention. It is not an alternative to safer sex but is an emergency back-up when potential exposures happen.

One colleague summed up a prevailing attitude when asked whether PEP was widely available in Ireland “Not at all. PEP is still seen as pertaining to occupational exposure for HSE staff and not seen as primary prevention for sexual exposure. The difference between ‘innocent’ victims versus people who contribute to their infection.” If you have a sexual exposure to HIV you should contact your nearest sexual health clinic (or A&E if necessary) within 72 hours but ideally as soon after the exposure as possible. You will be assessed by a clinician, as s/he has to be satisfied that the treatment is appropriate.

THE LOWDOWN ON PEP

• PEP might stop a person getting infected with HIV 
• It must be started as soon as possible after unsafe sex or a condom not working - and definitely within 72 hours (3 days) 
• It means taking anti-HIV drugs for 4 weeks 
• Side effects are common and can be nasty 
• It’s not guaranteed to work 
• Not everyone wanting PEP will get it - doctors decide who gets it using the information given to them 
• PEP is not available at all clinics or hospitals


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