How does exposure happen?

You can be exposed to H.I.V. if you:

• have vaginal or anal sex with a person who has, or might have, H.I.V.;
• share needles or syringes with a person who has, or might have, H.I.V.; or
• get H.I.V. positive blood in your eyes or in an open sore.

If you don't use a condom there is a high risk of exposure. Even if you use a condom there will be a risk if the condom is not used all the time during penetration, or if the condom breaks. Either person having sex can be exposed.

Oral sex is not considered a high risk, but it may be a risk if you have a mouth ulcer or other broken skin and the person you are with ejaculates in your mouth.

He was very persuasive and said he'd pull out before he came. So I said "fine". And he did pull out but he got excited and left it a bit late and we weren't sure whether he'd done it in time ... Jeremy

I was on the receiving end, and when he pulled out we saw the condom had busted ... Adam

I thought he was negative. We shared a fit, and then he told me he was positive ... Kelley

So what is this new treatment?

The new treatment is called P.E.P.. It is a four week course of drugs that you can take if you have been exposed to H.I.V.. The P.E.P. drugs, which must be prescribed by a doctor, are actually the same drugs that are used for people who are already H.I.V. positive.

When should I take the drugs?

P.E.P. may be able to stop exposure leading to infection, but you must act fast. To be most effective it should be started within a few hours of exposure. If you go to a doctor more than seventy-two hours after exposure they may advise you that it is not likely to be of use.

How does P.E.P. work?

H.I.V., like any virus, works by infecting some cells then replicating itself and spreading to other cells. There is evidence that it may take a few days from the time of exposure for H.I.V. to establish itself in the body. The aim of P.E.P. is to prevent H.I.V. replicating itself in those first cells. The cells then die naturally within a short time, without having produced more copies of H.I.V..

Does P.E.P. mean I can now forget safe sex and safe injecting?

No! P.E.P. is not a vaccine, nor is it a cure for H.I.V. / H.I.V.. It does not always work, and therefore is a "last resort" treatment. Safe sex and safe drug injecting practices are the most effective ways to avoid H.I.V. infection.

I've been in a relationship for about four years and never had a condom break. I don't know what happened this time. I pulled out and there it was ... both of us were worried because my partner is H.I.V. positive. I went to his doctor, who suggested I go on P.E.P. ... Tom

We were blasting coke all night. Our fits might have got mixed up. One of the guys was positive. He said I should find out about P.E.P. ... Carol

Will P.E.P. work for me?

P.E.P. may prevent H.I.V. infection, particularly if started very soon after exposure and continued for the full course of four weeks. But it is not yet proven.

Most of the information about P.E.P. comes from studies on health care workers who were given P.E.P. after needle-stick injuries. A study in the U.S. found that health care workers who took P.E.P. after an exposure to H.I.V. were up to 80 per cent less likely to become infected than those who did not.

Other research supporting the use of P.E.P. comes from studies where the children of H.I.V.-positive women were treated with anti-H.I.V. drugs soon after birth.

There is also support for the use of P.E.P. from studies using animals. At this stage, the long-term safety of anti-H.I.V. drugs used in this way is unknown.

Is the course of drugs easy to follow?

If you and the doctor feel that you might benefit from P.E.P., then you will be started on a four-week course of drugs. For the best result you will need to take these drugs exactly as prescribed, with a strict dosing schedule and perhaps a special diet.

If you know that the person you had sex with or shared needles with is H.I.V. positive, it is important to tell the doctor. Other information that may be important is what treatment they are taking (if any) and their viral load (the amount of H.I.V. present in their bloodstream).

The drugs used in P.E.P. are highly potent and often cause side effects such as nausea, headaches and fatigue. You will be closely monitored by your doctor to manage these side effects.

It's better than worrying about it and thinking there's nothing you can do, even though it was hard taking all the pills at the right time and so on ... Chris

The treatments made me feel pretty lousy. I had terrible diarrhoea, but it got better after the first week. I wouldn't want to take them again but I'm pleased they were available ... David

I hope I never become positive because there's no way I want to take these drugs for the rest of my life ... Kym

Where do I get P.E.P.?

You can get P.E.P. from sexual health clinics and from G.P.s who specialise in H.I.V. / AIDS. It is also available 24 hours a day from all hospital accident and emergency departments in N.S.W..

Information on where you can get P.E.P. is available in N.S.W. by calling 1800 P.E.P. now (1800 737 669).

P.E.P. is also available in some other parts of Australia and overseas. If you are outside N.S.W. you can find out where to get P.E.P. from the AIDS Council in that State. AIDS organisations in other countries will also be able to give you information about how to access P.E.P. if it is available.

How much does P.E.P. cost?

For four weeks? supply of one drug you will be charged $15.00 (or $3.30) for people with a Health Care Card). But the doctor may recommend you take two or three different drugs as part of the P.E.P. treatment, so it may cost more.

Should I still have an H.I.V. test?

Yes. P.E.P. may not prevent infection, so you can't be sure. In a few rare cases it has just delayed infection by up to six months. Therefore you should be tested for H.I.V. before you begin P.E.P. and then one, three and six months afterwards.

What about sex while I'm on P.E.P.?

Don't risk further exposure to yourself or others by having unsafe sex (or sharing needles) while on P.E.P..

There is no evidence that P.E.P. will protect against another exposure to H.I.V. while you are taking the treatment.

What about other drugs while I'm on P.E.P.?

P.E.P. drugs can affect the way in which other drugs (prescription or non-prescription) work in the body.

They can affect the way in which the liver processes other drugs. This can lead to an increase in blood levels of some drugs to a point that is dangerous or even lethal. The protease inhibitor class of drugs, particularly ritonavir (Norvir), can greatly increase blood levels of ecstasy (M.D.M.A.), amphetamines, methadone, Valium, Rohypnol, anabolic steroids, ketamine (Special K) and Viagra. It is important to discuss with your doctor any other drugs that you are taking or intend to take.

I had unsafe sex at a party. I panicked and then headed straight for the hospital. I was still out of it and didn't know what P.E.P. was called. I had to tell the nurse what I had done and that I'd heard about this treatment. It was bloody embarrassing but she didn't seem phased ... Don

Taking P.E.P. was a bit of a wake-up call. I think I'd become a bit slack. But after thinking about the possibility of becoming positive, I'm sure I won't take a chance like that again ... Peter

The facts about P.E.P.

• P.E.P. is a four-week course of anti-H.I.V. drugs that may prevent you becoming H.I.V. positive after an exposure to the virus.
• It is an important option to consider if you think you may have been exposed to H.I.V..
• You don't have long to act! If you think you've been exposed to H.I.V., you should see a doctor urgently, and definitely within seventy-two hours.
• P.E.P. can have some unpleasant side effects, and may well react with other drugs you are taking.
• There is no conclusive evidence that P.E.P. will work in every case.
• P.E.P. is not a vaccine or a cure for H.I.V. / AIDS. The best way to avoid being infected with H.I.V. is through safe sex and safe injecting practice

Polare is published in Australia by The Gender Centre Inc. which is funded by the Department of Community Services under the S.A.A.P. Program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act. Unsolicited contributions are welcome, though no guarantee is made by the Editor that they will be published, nor any discussion entered into. The editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc.I, the Department of Community Services or the N.S.W. Department of Health.