Stories and podcasts WBW Stories Combating HIV through Pre and Post Exposure Prophylaxis: Myths and Misconceptions Busted Have you ever been at risk of HIV? What action did you take to prevent yourself from contacting the virus? I will take you through Post-Exposure Prophylaxis (commonly known as PEP) and how it has been a relief for people who experienced what is considered a potentially “risky” sexual exposure to HIV/AIDS (but more on that later!). According to the World Health Organization (WHO), PEP is a short term antiretroviral treatment that minimizes the likelihood of HIV infection after potential exposure. Given that HIV/AIDS is transmitted through contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids, sexual situations in which bleeding is more likely increase the likelihood of transmission. This means that HIV/AIDs can be transmitted through unprotected sexual intercourse (and in particular, during anal sexual intercourse where tearing or bleeding is more likely), sexual assault, or even through occupational risks such as needle injuries, which mostly affect healthcare professionals. To counteract this in situations where someone believes they may have been exposed to HIV, PEP is a 28-day dose antiretroviral treatment that can make the difference between contracting the virus, or simply… not. PEP should be administered as soon as someone has experienced potential risk of infection, and no later than 72 hours afterwards, because its efficacy is compromised the longer it goes unadministered. There is no inherent lack of morality in HIV/AIDS, though due to its common reasons for transmission, there is stigma associated with it. For people who have anal sex or use needles – whatever their reason – they must be informed that they can minimize risk by avoiding sharing needles or having unprotected sex. PEP is not a substitute for HIV-prevention mechanisms such as condom use, and neither is it a cure for HIV. Everybody should continue using protection during sexual intercourse, even when taking PEP. Healthcare providers are advised to properly protect themselves by using safety devices and barriers that will aid in minimizing the chance of virus transmission while caring for patients with HIV. PEP drugs should not be shared. PEP is administered for free in government health facilities in Kenya, following consultation with a doctor. However, there is a worrying concern among healthcare providers that sexually active youth are using PEP in the place of safe sexual protection. It is observed that mostly after weekends and holidays, young people flock health centers to make PEP requests, citing condom breakage as the reason. It is also reported that the same group are less likely to finish the fully prescribed doses of PEP, leading to antimicrobial-resistant HIV – essentially, that the virus is mutating to the point that is becomes resistant to the medicine used to treat it. Those under frequent risk of exposure (those who do not use condoms, have multiple partners, are frequent PEP users, or inject drugs) should consult healthcare professionals on the use of Pre-Exposure Prophylaxis (PREP), which is taken prior to exposure to HIV. PREP works by blocking HIV and stopping it from spreading within the body, and are highly effective if taken according to the prescription. According to the Center for Disease Control and Prevention, PREP minimizes the risk of HIV infection from sex by more than 90%, more than 70% for those who inject drugs - and the risk could be lower if you combine PREP with other HIV prevention methods like condom use. Discordant couples, where one is HIV-positive and the other negative, are the biggest beneficiaries of PREP. Challenges in accessing PEP and PREP include lack of information about the availability of the treatment, unavailability of health centres in certain localities, stigma, and disrespectful healthcare providers. An acquaintance of mine, who previously worked at a health center, intimated to me that generally speaking, health care providers are judgmental when people request PEP or PREP following consensual sex. Because PEP drugs are, in most cases, administered for 3 days, whereupon the patient is asked to report back to the hospital for the next dose, challenges ensue. Some patients do not report back to complete their doses following negative interactions with health professionals, or after experiencing side effects. The most commonly experienced side effects of PEP include vomiting, headaches, fatigue, profuse sweating, diarrhea and nausea. These effects are not life threatening. PEP patients should therefore not stop the dosage because of the side effects. Even so, WHO recommends guidance and counseling for those taking PEP, and that healthcare providers provide one-time prescriptions to enhance dosage completion. PEP has been lauded as a great intervention in the fight against HIV. It is important to raise awareness about its use and caution people against abuse. A lot needs to be done to encourage people to adopt HIV-prevention strategies such as condom use, getting regularly tested, and taking PREP or PEP as appropriate. People living with HIV are capable of having normal lives. pursuing their life goals, and can even have HIV-negative children. As such, we must embrace treatment options for, and end the stigma and discrimination against, people living with HIV… or trying to prevent it. About the Author.