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Post-exposure prophylaxis (PEP) – much like PrEP (pre-exposure prophylaxis), is the use of antiretroviral medication (usually for four weeks) to prevent HIV taking hold in your immune system. The window to start PEP is pretty short, you have up to 72 hours from potential exposure to start taking PEP and ideally you will get it sooner than that to have the best chances of success.
Head to the emergency room as soon as you can – as 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 these were not the circumstances, there may be additional costs.
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.
Condoms (and lube!), PrEP and U=U are the best ways to prevent HIV transmission – PEP is a bit of an emergency safeguard if something happens that you weren’t expecting, or didn’t have all the information about, during the encounter.
Basically, don’t think of PEP as part of your regular prevention toolbox – it’s more of the “break glass in case of emergency” box.
If you find that you’ve had to initiate PEP a couple of times now, it would be worth looking into whether PrEP is right for you.
If PEP doesn’t work or isn’t made available to you – it’s important to remember that with modern treatments and scientific understanding, being diagnosed with HIV today is very different to how it used to be.
If you are diagnosed with HIV, you can be connected to treatment immediately, no matter your situation or immigration status and it is very likely you will reach what is called an undetectable viral load (UVL) within a few months or even less. Having UVL means you will get the most health benefits from being on treatment, including not being able to transmit HIV through sex.
While prevention is a very important part of stopping new HIV transmissions, if PEP fails – remember that your life is far from over. Head to the U=U page to learn more and reach out to NZAF’s counselling services if you would like to talk to someone.
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