You know about PrEP, but have you heard of PEP?

Editor’s Note: This post was originally posted on aidschicago.org in May 2019. All information was accurate at the time of publishing.

Let’s say you went out yesterday for a night on the town, but you didn’t use a condom, the condom broke or something else unexpected happened during your night out like sharing needles while injecting drugs. Or perhaps you feel bad or confused about the sex you had in the moment or the morning after or you were a victim of sexual assault. Now you may be concerned about being exposed to HIV, especially if you’re unsure of the HIV status of your partner. What now? Thankfully there is an option for these types of situations, called PEP. Let’s talk about PEP! What is it? How do you access it? Here are the answers to some common questions.

What is PEP?

PEP, also known as post-exposure prophylaxis, is a prescribed series of HIV medications to prevent someone from contracting HIV after possible exposure.

How is it different from PrEP?

While both PEP and PrEP involve the use of antiretroviral (ART) medications commonly used in treating HIV, PEP is intended for emergency use only and is taken after someone has potentially been exposed to HIV as a regimen of daily pills taken for 28 days. PrEP, on the other hand, is a daily medication taken over a sustained period of time that prevents someone who is HIV-negative from contracting HIV sexually.

If PrEP is comparable to birth control as a daily pill for HIV prevention, PEP can be seen as the “morning-after pill” for preventing HIV and is intended for infrequent, emergency use. PEP may not be right for everyone, but everyone has the right to ask about PEP.

When should I use PEP?

PEP is intended for use by individuals who are HIV-negative or do not know their HIV status who may have been exposed to HIV. Per the CDC’s recommendations, you should think about using PEP if:

• You think you may have been exposed to HIV during sex (for example, if the condom broke or if you did not use one)
• You shared needles to prepare drugs
• You were sexually assaulted

If you’re unsure if PEP is the right choice for you, here is a short, helpful quiz to help determine if it is.

There are two important considerations when using PEP as a prevention technology:

First, you should not expect to take PEP after every instance of unprotected sex. If you could be exposed to HIV frequently or otherwise have an ongoing vulnerability for HIV, PrEP is a better prevention method.

Second, time is paramount when using PEP and every hour counts. If you believe you have been exposed to HIV, you should seek PEP treatment as quickly as possible. PEP must be taken within 72 hours of exposure or it will have little to no effect in preventing an HIV transmission. In fact, PEP is the most effective when it is taken within 24 hours. Remember: PEP is effective at preventing HIV only when administered correctly, but it is not a guarantee that you will not become HIV positive even after taking it. You should still use safe injection and safer sex practices even while on and after using PEP to prevent HIV transmission.

While taking PEP after possible exposure is not a guarantee that you will not acquire HIV, it has been shown to be very effective. While there have not been studies comparing those who have taken PEP with those who have not due to ethical concerns, a 2016 review of six observational studies of PEP use by the CDC showed that of 1,535 men who took PEP, 1,487 remained HIV negative while only 48 acquired HIV. Of the cases where men were later diagnosed with HIV, most were attributed to ongoing sex that made them vulnerable to HIV while only 8 cases were considered a possible representation of PEP failure. That equates to 5.2 transmissions per 1,000 PEP users, only a .5% failure rate.

What should I expect when trying to access PEP?

Since every hour counts with PEP, many resources encourage individuals to go directly to an emergency room to access it. However, there can be significant barriers to accessing PEP in an emergency setting, including a lack of awareness and limited quantities of the medications required, in addition to the often time-consuming, bureaucratic and impersonal nature of emergency rooms.

Per a 2013 article from POZ, many experts advised those looking to access PEP to skip the hospital emergency room and go straight to a local clinic or primary care physician for the medications. It’s also recommended that you visit a provider with whom you are conformable discussing topics such as sex, needle sharing and STIs.

In the real world however, this is not always possible, especially if you are seeking PEP on the weekend or late at night when your local clinic or doctor’s office is likely closed. In the instance that the emergency room is your only option, it is important to go into the experience with the right questions and information to ensure timely treatment.

Jim Pickett, Senior Director of Prevention Advocacy and Gay Men’s Health at the AIDS Foundation of Chicago, encourages those who go to the ER looking for PEP to show up with a fact sheet or have information cued up on a smartphone to show medical professionals if there is any confusion or delays. Good sources of information are PEP411.com or hiv.gov.

If you’re uncomfortable or unsure of how to approach the subject, click here on what to expect when visiting the emergency room along with a guide on what to say.

“If an individual feels that they have had a potential HIV exposure, they should be very direct and honest about their risk with the medical provider and should not be afraid to request PEP directly,” says Dr. Temitope Oyedele, Attending Physician at John H. Stroger Jr. Hospital of Cook County.

It’s possible that the doctor you see is not an HIV specialist and may be unfamiliar with PEP, but professional support is available to help your doctor in selecting and monitoring a PEP regimen through the National PEPline at 1-888-448-4911. Keep in mind that it is intended to be used only by health care professionals.

Wherever you access PEP, it is likely that the health care provider will want to discuss your exposure to HIV, including the date, time and nature of exposure to evaluate whether PEP will be safe, effective and necessary for you. In addition, you will be asked to take an HIV test. The provider must ensure that you are currently HIV-negative in order to prescribe PEP, because PEP is not intended to be taken by those already living with HIV. If you are HIV-positive, your health care provider should discuss making a treatment plan with you. If you refuse an HIV test, you may be unable to receive PEP.

Where can I access PEP and how much does it cost?

In addition to accessing PEP in an emergency-room setting, many local sexual health clinics, in addition to your doctor, can prescribe PEP.

For those living in Chicago:

• Howard Brown provides PEP on a walk-in basis during regular business hours at their various locations. Click here for more information.
• Planned Parenthood can also be a good option for those looking to access PEP. Click here for more information and to find a Planned Parenthood Health Center.
• PEP is also available free of charge at the Screening Clinic on the first floor of the CORE Center between 8:30 am – 3:30 pm Monday to Friday.

A full course of PEP treatment without insurance is costly: usually between $600 to $1,000 at a hospital ER, in addition to other emergency medical costs. Thankfully, PEP is covered under Illinois Medicaid and most private insurance companies.

If you are uninsured, many pharmaceutical companies offer “Patient Assistance Programs” to help cover or offset the cost of certain medications. Click here and here for more information about Patient Assistance Programs and the companies that offer them for PEP prescriptions. Be warned however that dealing with pharmaceutical companies can be difficult and time consuming and that each company has different policies for their PEP programs. To ease the process, make sure you have all the relevant information on hand, including your date of exposure, the type of therapy you need, as well as income, insurance and personal information.

If you are prescribed PEP after a sexual assault, you may qualify for partial or total reimbursement for care through the Office of Victims of Crime, funded by the U.S. Department of Justice. In Illinois, you can visit any emergency room and receive free state-mandated care, including PEP and emergency contraception. Contact the Illinois Rape Crisis Hotline for more information at 888-293-2080.

How do I take it and what side effects are there?

PEP is not just a one-time pill, but rather a regimen where you take multiple pills daily for at least 28 days (four weeks). It is imperative that you take every pill as directed at the same time each day, otherwise PEP may not be as effective. It’s not recommended to stop or skip doses and you should only stop taking PEP if directed by your health care provider.

If you obtain PEP through your healthcare provider, they should explain how to properly take the medication at the time of your visit and you will be asked to fill the prescription after your visit. If you obtain PEP through an emergency room, you may be given the first dose at the time of your visit, along with a few days’ supply, giving you time to fulfill the prescription for the remaining treatment.

If you forget a dose, take it as soon as you remember and do your best to make sure it doesn’t happen again. However, don’t double dose as doing so may be hard on your system.

Not everyone on PEP will experience side effects, but you may experience some nausea, vomiting, diarrhea, headaches and fatigue. Talk to your doctor or health care provider if the side effects are particularly disruptive.

What happens after I finish my PEP regimen?

After completing the full PEP regimen, your healthcare provider will need to verify that it has successfully prevented an HIV transmission. Your provider will likely ask you to be tested one month and three months after completing PEP. In some cases, your doctor may recommend another HIV test six months after you finish PEP. You may also be offered other services, including education on HIV/STI prevention, needle exchange services or counseling. If you feel like you need these services but have not been offered them, you should feel empowered to ask your provider for a referral.

If you have an ongoing vulnerability to HIV, your provider may recommend PrEP as a more sustainable prevention option. If you think PrEP is a good choice for you, talk to your provider for more information and visit PrEP4love.com or call the Chicago PrEP line at 872-215-1905.