PEP Questions and Answers for Women


    1) What is PEP? PEP can stop you from getting HIV

Post-Exposure Prophylaxis (PEP) is a daily dose of anti HIV medications (in pill form) taken over four weeks that can stop HIV infection after exposure. PEP must be started within 72 hours of exposure. The sooner you start taking it the better.

    2) When should I get PEP?

You should consider getting PEP to stop HIV as soon as possible if you have:
· had a condom break during vaginal or anal sex,
· had vaginal or anal sex with no condom, or
· shared syringes for injecting any substance.
    Accessing PEP is especially important when you know your partner has HIV. It is often appropriate in cases when you don’t know their HIV status as well.

    You may also need PEP in a situation where there is a risk to you for HIV because of a sexual assault or because of an accident at work, usually in a medical or EMS work setting.

      3) What should be as my first consideration for getting PEP:
      - Time and quick access: the first 72 hours is the critical time for a successful result. After this time the effectiveness of the medication is under doubt.
        - Getting a Prescription: as soon as possible from your family physician or any other available doctor.
        - Go to a hospital emergency room as soon as possible. It’s important to calmly and clearly explain to emergency staff the situation that put you in a possible exposure to HIV. You may have to go through some uncomfortable details, but it is all about your health and future. Emergency room staff may not be familiar with how to use PEP in a sexual or injection drug use situation. They may need to consult with an infectious disease physician in order to move forward with your request. You can ask for this.
        - Be ready for a full month treatment. Completion of the 28 day course of treatment is required for it to work.
          - Talk to your Doctor or other health care providers about your current or previous health conditions, such as pregnancy, breast feeding, any liver, bone or kidney disease, any medications, or sensitivity or difficulty tolerating drugs.
          - In Toronto, Women’s College Hospital has the most experience in sexual assault and domestic violence, and St. Michael’s Hospital is the oldest referral centre for PEP, but any local emergency room should be able to offer this service.
            - The Toronto General Hospital Immunodeficiency Clinic has also an HIV Prevention Clinic that works closely with the emergency departments at the Toronto General, Mount Sinai and Toronto Western. Your family physician can also refer you to this service.
            - Payment: PEP is offered for free for sexual assault victims and occupational exposures. For other exposures you may have to pay $900- 1300 for a complete treatment course. Your private health insurance may cover it.

            - Note: money should not be a reason not to access medication. If you are unable to afford the medications, you can ask if it can be provided to you free of charge. They should talk to their HIV treatment clinic if they have one in the hospital.

              4) Is there any age limitation for asking for PEP?

            No, just for children. As with other medications there is weight-based dosage, which should be done under paediatrician supervision.

              5) After beginning PEP, what is the follow- up process?

            It is important to consider that PEP is a 28 day course of medication. Follow-up appointments to receive support, more or other medication if needed, and to monitor side effects and blood work.

              6) What is important to mention to my Doctor?

            If you have current or history of any of the following health conditions:
                  • Pregnancy or breast feeding
                  • Any bone, liver, or kidney disease
                  • Any abnormality in blood tests
                  • Taking any medication, even the over-the counter ones

              7) What if I am pregnant?

            Don’t worry. You still can take the medication based on your Doctor’s tailored regimen. The good point is that PEP will protect the fetus, too.

              8) Does PEP affect my fertility?

            No. But for your peace of mind, it’s best to postpone any decision about pregnancy, at least until your PEP treatment is complete and your status confirmed. After the final results, you may ask for a pregnancy counselling session.

              9) Does PEP reduce my sexual activity?

            No. PEP itself has no effect on libido; however, the anxieties of possible exposure to HIV, or taking new medications, can lower libido.

              10) Can I have sex while on PEP?

            Yes. Using condoms and getting checked regularly for STIs is good practice for you and your sexual partner(s) to reduce the risk for getting HIV.

              11) What about my sexual partner?

            Being honest about the potential risk, and asking your partner for support is always the best way. Besides, until the final follow-up results (and even better always) it’s best to be sure and use condoms, as protection. For further support you may contact an AIDS Service Organization (ASO). They have free condoms and lube and are experts on HIV. (Find the closest to you at www.HIV411.ca)

              12) I can’t tolerate the medication; what if I stop taking it?

            Before making any decision, speak with your Doctor. Usually the effective dosage to fight against HIV is standard, but if you are experiencing heavy side effects, your doctor may be able to make adjustments that will still protect you, but reduce the impact of any side effects. Any discontinuation of the drugs can lead to the treatment failure and virus resistance to other HIV medication.

              13) Can I get PEP more than once?

            Yes. However, you should be prepared that some medical providers may be concerned about your health if you have a medical issue that has changed since the last time you took PEP – for example a concern regarding your liver. If you are in a situation where you may constantly be exposed to HIV, talk to your doctor about the situation to find the best solution for your situation.

              14) What are my responsibilities with PEP?
                - Be positive and look forward.
                - Follow you Doctor’s instructions.
                - Continue using condoms as protection.
                - Stay in touch with your Doctor or other health care providers to monitor any possible side effects.
                - Choose a counselor for your mental health support.
                - Never use any medication without your Doctor’s supervision.
                - Knowledge is power .Be prepared for an emergency situation. Get connections with an ASO, for further information on HIV.

            For more information explore the following resources!

            Other Resources
              1) Post-exposure Prophylaxis to prevent HIV infection, Joint WHO / ILO guidelines, WHO 2007
              2) Boily MC, Baggalaey RF, Wang L, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and met analysis of observational studies. Lancet Infect Dis 2009; 9:118-29.
              3) HIV prophylaxis following non-occupational exposure including sexual assault. Albany: New York State Department of AIDS Health Institute, 2004.
              4) Prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med 1998; 339:1409-14.