Post Exposure Prophylaxis (PEP)

PEP is for HIV-negative people who have potentially been exposed to HIV. PEP is a short course of HIV medication, that if taken within 72 hours of exposure to HIV, can significantly reduce the chance of getting HIV.

Potentially being exposed to HIV in a sex work setting is not grounds alone for being prescribed PEP. The doctor or nurse will make an assessment of whether you should be prescribed PEP based on:

  • what type of HIV exposure you experienced (i.e. receptive or insertive vaginal, anal or oral sex, injecting or other) and its risk of transmission.
  • the HIV status of the person/s involved. If you do not know the HIV status of the person you think may have exposed you to HIV, the prescribing doctor will use HIV prevalence data to assist them in determining your need for PEP.
  • whether you currently have HIV. PEP is not effective or prescribed for people who already have HIV.

For example, the ASHM PEP for HIV: Australian National Guidelines generally do not recommend PEP for people who have had unprotected vaginal receptive intercourse with a person whose HIV status is unknown to them. You may not be prescribed PEP if a condom breaks while having vaginal receptive intercourse with a client whose HIV status is unknown to you. However, if the client is a man who has sex with other men (MSM) or from a high prevalence country, the health professional will investigate further whether you need PEP.

If a condom breaks while having receptive anal intercourse with a client whose HIV status is unknown to you and the client is an MSM or from a high prevalence country, the ASHM Guidelines generally recommend the prescription of PEP. However, there may be a broader range of circumstances that a healthcare professional may prescribe PEP for unprotected receptive anal intercourse with a person whose HIV status is unknown to you.

While there are guidelines for PEP prescription, healthcare professionals assess whether an individual is eligible for a prescription on a case-by-case basis. For this reason, it is highly recommended that you speak to a health care professional to assess whether you should be prescribed PEP if you think you have been exposed to HIV.

You must start taking PEP before 72 hours have passed since you were possibly exposed to HIV for it to be effective. If it has been over 72 hours since the potential exposure, it is still recommended that you seek medical attention to figure out what your options are.

When you are starting PEP, the health care professional will usually take a blood sample to test for HIV. This test is to see whether you had HIV before you started your PEP treatment. While you are taking PEP, you will be required to have a follow-up test for HIV and other STIs, and 3 months after your treatment, you will need another HIV test to make sure that the PEP treatment was effective.

When you start PEP treatment, you must take the medication every day for 28 days. If you miss a dose, do not double dose to catch up. Take the medication as soon as you can and contact your prescribing doctor or a healthcare professional that specialises in HIV to discuss whether taking your dose late will impact the effectiveness of the treatment and what your options are.

Some people do not experience any side effects when taking PEP while others do. The side effects of PEP are usually considered to be mild to moderate and can include nausea, diarrhoea, headaches, fatigue, and vomiting. Usually, the side-effects fade after about a week of taking PEP and they will completely go away after you finish your PEP treatment.

If you are experiencing side effects or have any other concerns while taking PEP, speak to your prescribing doctor. Your prescribing doctor may be able to alter the PEP medications you are taking to minimise the side effects. You may also be able to get a doctor’s certificate if you need some time off work.

You can get PEP from the emergency department of most public hospitals, sexual health centres, and prescribing doctors and clinics. Most states have a 24 hour PEP Hotline or information line or you can find out where you can get PEP in your state or territory via https://www.getpep.info/get-pep-now/. There are some hospitals and sexual health centres that dispense PEP free of charge. Otherwise, there may be a co-payment to getting your prescription filled. If you are not Medicare-eligible, there may be additional costs involved. Other drugs, such as vitamins, prescription drugs, and recreational drugs, can interact with PEP, changing the way PEP works and impacting the severity of PEP’s side effects. If you are taking other drugs or plan to, it is recommended you discuss this with your prescribing doctor to minimise the impact this may have on your PEP treatment. PEP should not replace safer sex practices.