We know this will be disappointing news - but the decision has not been made lightly.
You can be started on PEP – a short course of anti-HIV medication that may be able to prevent you from getting infected.
PEP needs to be taken within 72 hours of an exposure to be effective, though ideally it's taken as soon as possible. Evidence shows that while PEP can reduce the chance of becoming infected with HIV, it is not as effective as using condoms and lube for sex. So it presents an extra safety net in the case of a condom breaking, but is not a replacement for condom use.
There is some data that suggests PEP will work, but there have also been cases where it has failed. The effectiveness of PEP varies, depending on issues such as the delay between exposure and treatment, and the HIV viral load of the person you had sex with.
Using condoms and lube for anal and vaginal sex is an effective way to prevent sexual transmission of HIV as well as other STIs.
Head to the emergency room as soon as you can – 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 you 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 for those eligible for publicly funded healthcare in New Zealand. If you don't meet these criteria ask your doctor about self-funding - they can still write a prescription and you can pay for your own PEP pills at the pharmacy (approx $80-100).
Once you have initiated PEP – make sure to follow the doctor’s instructions carefully and you will need to book follow up HIV tests to see whether PEP has been successful. Your doctor will advise you on when is the best time to do this.
What’s the difference between PrEP and PEP?
PrEP and PEP are both HIV medications taken by people who do not have HIV.
PrEP (Pre-Exposure Prophylaxis) is an HIV medication for people who are HIV negative - taken to reduce the risk of acquiring HIV by up to 99%.
PEP (Post-Exposure Prophylaxis) is a medication given to people who may have been exposed to HIV. Although PEP is not foolproof, if taken within 72 hours of being exposed to HIV, it is likely to reduce the chances of contracting HIV. For PEP to be most effective, it needs to be taken as soon as possible after an episode of unprotected anal sex.
I had sex with a guy and I was the top. I came inside him and the condom broke. Should I get PEP? This was anonymous sex and I don't know this man. How much does PEP cost?
If the condom broke then there is a risk of contracting HIV. While the risk is greatest for the bottom, it is still high-risk for the top because if the bottom has HIV it can be highly concentrated in the lining of his ass which can then enter the tip of your penis.
PEP is free under certain circumstances, for example if you know that the person you were having sex with is HIV positive. If you aren't sure about his status then you may have to pay. In either case, we recommend visiting your local sexual health clinic or the emergency department of your nearest hospital as soon as possible to find out about your options. For PEP to be effective it needs to be started as soon as possible and no later than 72 hours after exposure to HIV.
The NZAF network