Do I need PEP

[Stormyyy]

Hello,

I have a problem. I'm undertreatment at my local HIV hospitalcenter, and in the last 2 years I've been 3 times to the Emergency Room to get PEP.

I've got alot of issues so when I don't feel well, my behaviour is high-risk, I have a psychiatrist who helpes me with this, but ofcourse the issue can't be fixed in a short amount of time  .

I've had contact with 8 males (anal + oral), receptive, and I don't know the status of one of them. What do I need to do?! I'm so shamed to go to the hospital for PEP again ... And I don't know what to do... Can someone help me out??

I've also heard of PrEP but I believe they don't give a prescription for that in Holland.

Thanks..

[Ann]

Stormy,

It's not clear if you've been having unprotected anal intercourse. If you've been using condoms, then you have not been at risk.

Ann

[jkinatl2]

The sex was not protected, it was unsafe sex with different individuals.

Then assuming the events took place less than three days ago (less than one day is ideal) then yes, PEP would be a good idea. As would asking your doctor about prescribing PrEP if s/he can.

I assume/seriously hope you are discussing this latest setback with your therapist? Maybe s/he could also be of assistance in obtaining PrEP, as you do pose a threat to your own health and that of others if you continue without intervention.

[Stormyyy]

Then assuming the events took place less than three days ago (less than one day is ideal) then yes, PEP would be a good idea. As would asking your doctor about prescribing PrEP if s/he can.

I assume/seriously hope you are discussing this latest setback with your therapist? Maybe s/he could also be of assistance in obtaining PrEP, as you do pose a threat to your own health and that of others if you continue without intervention.

Alright then. I do am a bit afraid for the reaction of the HIV Nurses who give the prescription. Yes, I made an appointment with my psychiatrist for tommorow.

I talked about PrEP with the specialist, and he said that the stand point is not to prescribe PrEP because it isn't proven to help and could make me resistant for Truvada(/Atripla) in the future in the case I do get infected. Is this true? That's also the stand point of the dutch SOA-Aids Proffesionals Community, ofcourse if a doctor would see that PrEP is right to prescripe, he/she is allowed to do it.

What would you advise me? Push on to get PrEP?

[Ann]

Stormy,

I've removed your second post and reproduced it here - to enable you to have one free post left.

Stormy,

It's not clear if you've been having unprotected anal intercourse. If you've been using condoms, then you have not been at risk.

Ann

The sex was not protected, it was unsafe sex with different individuals.




In order to obtain PEP, you must first be given a rapid hiv test, and the result must be negative.

However, if you've had other instances of unprotected anal intercourse within the past six weeks with someone of unknown hiv status, the test is only going to tell you that you were negative six weeks ago.

If you've been having other instances of barebacking (other than the one you're currently worried about), you could already be hiv positive but not have enough antibodies yet to test positive.

One thing you mentioned in your first post is particularly worrying:

I've had contact with 8 males (anal + oral), receptive, and I don't know the status of one of them. 

Chances are very good that you don't actually accurately know the hiv status of any of these eight men. Far too many people only assume they're hiv negative. If they're barebacking with other people besides you, their hiv status is always going to be in doubt.

Also, unfortunately some people will lie about their hiv status, usually out of fear of rejection or discrimination, sometimes out of shame. And a small minority are just jerks and will lie about anything.

You need to assume anyone you have intercourse with is hiv positive and protect yourself accordingly by using condoms. You simply cannot go by what someone tells you about their hiv status, regardless of what you think you - or they - know about their hiv status.

The ONLY time serosorting works for the purpose of barebacking is when both parties are hiv positive and admit it to each other. Attempting to serosort when hiv negative is a fool's game and playing roulette with your health and life.

This is all very relevant to your questions - in a nutshell, if you've been having unprotected intercourse with people you are assuming are hiv negative, you've been at risk all along. You could already be hiv positive, rendering PEP and PrEP a moot point.

Now on to PrEP.

Before you are prescribed PrEP, you must first make certain that you are not already hiv positive.

This means you must test out to three months following your last incident of unprotected anal intercourse.

During those three months, you must either abstain from anal intercourse, or make certain that a condom is used every single time, regardless of what they claim regarding their current hiv status.

Once you've made sure you're hiv negative, PrEP is definitely an option for you. It has been proven to work and it is approved in some countries as an hiv prophylactic.

HOWEVER. It MUST be taken every single day, without fail. This criteria is what worries your doctor.

If you are not taking it every single day, and you have unprotected intercourse and become infected because you're not maintaining the necessary levels of Truvada in your blood, then carry on taking Truvada again (while not realising you've been infected), that is when you may have resistance problems.

In order for an hiv positive person to avoid resistance, three drugs, from at least two different classes, must be taken every day. Truvada is only two drugs and while it will enable you to avoid infection, it is not enough on it's own to deal with an established infection without resistance occurring.

If you are not already hiv positive and you decide to press for PrEP, you MUST be committed to taking it every single day, without fail. This cannot be stressed enough.

Also, PrEP is not actually designed to enable people to stop using condoms. It is meant to be used in conjunction with condom, not replace them. PrEP is an added safe-guard in the case of a broken condom, for example. It is not actually a stand-alone prophylaxis.

Ann