Didn't use a condom? PEP 411

PEP 411 if you didn't use a condom

Was the condom MIA? PEP 411.

Get Your Game On, Play Smart

Rally the team
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PEP Talk

Play Smart trading cards were created by artists, commissioned by Visual AIDS and designed by John Chaich. It's an honest and straight-forward approach to promote harm reduction, HIV testing and post-exposure prophylaxis.

The back of each trading card features information you need to know to Get Your Game On and Play Smart.

So, you didn't use a condom - now what?

Postexposure Prophylaxis (PEP) for HIV Infection - Evaluation and Treatment

via The New England Journal of Medicine, by Raphael J. Landovitz, M.D., and Judith S. Currier, M.D.


This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.

A 24-year-old man presents to an outpatient clinic, reporting that 36 hours previously he had receptive anal intercourse without the use of a condom with an anonymous male partner who was known to have had sex with other men. The patient is known to the clinical practice and has had several negative tests for human immunodeficiency virus (HIV) infection, most recently 6 months previously. How should he be evaluated and treated?

Read the rest.

Learn more about PEP on LifeLube (less clinical, more keepin it real.)

A pivotal moment in HIV prevention

GLENDA GRAY AND MITCHELL WARREN
GUEST COLUMNISTS via seattlepi.com

Last week's announcement about the failure of the leading AIDS vaccine candidate developed by Merck & Co. is another in a series of disappointing setbacks in HIV prevention. How we as a global community choose to respond to this news, however, is the real test.

Historically, it has taken decades -- and more setbacks than advances -- from the discovery of a virus or bacteria until an effective vaccine is licensed. Typhoid was discovered in 1884, but there was no vaccine until 1989. Malaria, discovered in 1893, still has no vaccine. The measles vaccine took 42 years to develop.

In the 1930s, two experimental polio vaccines failed because they were determined to be unsafe, and polio vaccines were almost abandoned. At the time, we understood how to prevent infection by sanitation and avoiding public swimming areas, just as we know how to stop HIV infection today. We needed new tools then, and we need them now.

Today's question of how we deal with these setbacks will loom large in any reckoning of our response to the most severe epidemic of our time.

There are more than 4 million new infections every year. In South Africa, where three of this year's prevention trials have taken place, there are communities where nearly one-third of women between 25 and 29 are infected with HIV. For every one individual who starts on life-saving antiretroviral medications, there are six others who are newly diagnosed.

These are mind-numbing, tragic figures. They remind us that there is only one viable answer to the question -- "What do we do now?" -- that has been posed by many observers inside and outside of the HIV prevention field in recent weeks.

We do more of everything.

There is a drastic shortfall in funds for implementing proven prevention strategies, including male and female condoms, clean needles, prevention of mother-to-child transmission and risk-reduction counseling. In December 2006, we learned that male circumcision showed strong protective benefits for HIV-negative men. This strategy must also be made available in communities where it can have an impact.

We must do more to bring comprehensive care, treatment and support to people already living with HIV worldwide. Global targets have been set and missed and are in danger of being missed again.

And while we do those things, we must continue to search for additional prevention strategies, including vaccines, microbicides, oral prevention or pre-exposure prophylaxis and herpes treatment.

To pit proven prevention and treatment against research is a false and dangerous dichotomy. The range of tools that we have today is not reaching every person at risk. And even if it did, it is not enough. Women and men, adolescents, boys and girls and infants need more choices when it comes to HIV prevention.

The best approach to prevention is one that provides the most options. There will be no magic bullet, be it a condom or a clean needle today or a vaccine tomorrow. There is only the ethical and moral imperative to develop a multi-faceted response that is a match for the multiple drivers of the epidemic.

In the wake of the failure of the Merck vaccine, the AIDS vaccine field will need to make carefully considered decisions about whether to move forward with planned trials of other vaccine candidates, but the field will keep moving forward. It must, as the history of other epidemic diseases tells us that an essential tool to stopping epidemics is an effective vaccine.

As disappointing as recent failures are, donors and advocates, scientists and physicians, volunteers and their families must all guard against "failure fatigue." We must respond loudly and clearly to suggestions that enough money has been spent; that it would be easier and wiser to move on rather than to press on.

To do so would be to ignore the reality of the epidemic today, and to overlook the lessons from history about the long, slow process of vaccine discovery. We cannot afford to walk away from science, or from the generations to come. Rather than giving up hope, we must redouble our efforts in prevention research and stand firm in our commitment to scientific inquiry. Millions of lives -- today and tomorrow -- depend on it.

Glenda Gray is the co-director of the Perinatal HIV Research Unit in South Africa. Mitchell Warren is the executive director of the AIDS Vaccine Advocacy Coalition in New York.

The skinny on PEP [post-exposure prophylaxis]

[via aidsmap. info is delivered in a UK context, but instructive for all of us, wherever we live.]

Post-exposure prophylaxis

If a person is exposed to HIV they can reduce their chances of this leading to infection with the virus by taking anti-HIV treatment for a month. This kind of treatment with anti-HIV drugs is called post-exposure prophylaxis (PEP for short). It’s not a kind of ‘morning after pill’ for HIV, and although it’s not 100% effective very few people who receive PEP after exposure to HIV go on to become infected.

Recently efforts have been made by the Terrence Higgins Trust to inform gay men about the availability of PEP.

It’s crucial to get PEP as soon as possible after any exposure to HIV. To have the best chance of working it needs to be started within 24 hours. It might still have a chance of success if taken after 72 hours, but some experts think this is already too late.

PEP education campaigns have focused on HIV-negative gay men, but a new piece of British research shows that it’s also important that HIV-positive people know about PEP.

The research showed that some gay men who’d potentially been exposed to HIV only obtained PEP after their HIV-positive sexual partners told them it was available.

This raises some important issues.

There have recently been some prosecutions for the reckless sexual transmission of HIV. The cases involved people who didn’t tell their partners they were HIV-positive before having unprotected sex with them, leading to infection with HIV. Advising somebody to obtain PEP after unprotected sex or a condom accident will help reduce the risks of HIV infection occurring, and some lawyers think it might help a defence should transmission occur. But this hasn’t yet been test in court.

The second issue concerns sharing anti-HIV drugs. It can be very worrying thinking that you might have exposed somebody to infection with HIV. If you know somebody who needs PEP it might be tempting to give them your own anti-HIV drugs. But this could involve risks. For example, some anti-HIV drugs, most notably abacavir (Ziagen) and nevirapine (Viramune) can cause potentially dangerous allergic reactions.