Are we being punished for irresponsible sex?

If 28 days of pills could prevent you from getting HIV after possible exposure, would you take the meds?

The meds exist. They’re called post-exposure prophylaxis (PEP) and they could significantly reduce your risk of contracting HIV. So why isn’t everyone demanding access to this treatment?

The Health Initiative for Men (HIM) has written a position paper on PEP. In it, three cases are briefly described:

Case 1
A gay guy says he went to emergency at St Paul’s Hospital and told them he had relapsed on cocaine after four years of abstinence. He had been in a monogamous relationship with an HIV-negative partner for 18 months — until he went to a bathhouse and had unprotected receptive anal sex with multiple anonymous partners.

Twenty-four hours later he went to the hospital. He was advised not to take PEP, as the risks of taking them outweighed the risk of getting HIV. He was told his chances of getting HIV were less than one in 5,000.

Two months later, he tested positive.

Case 2
A gay guy went to a clinic for HIV testing. He had tested negative six months earlier. He said he was having consensual anal sex with a partner of unknown status when that partner, despite being asked to use a condom for penetrative anal sex, removed the condom during sex and ejaculated.

The guy went to St Paul’s emergency 36 hours later. He was refused a prescription for PEP and told the risk of seroconversion was not high enough.

The guy’s HIV test came back positive three months later.

Case 3
After having unprotected receptive anal sex with a partner he had met online, a guy found HIV meds in the man’s bathroom. He went to emergency at St Paul’s 12 hours later and asked for PEP.

He was told he didn’t meet the criteria.

Like the others, he was not given the option to pay for the meds himself, even though he wanted PEP and could afford to buy it.

He later tested positive for HIV.

The paper’s conclusion: PEP should be available to gay men.

It’s great that HIM has started a push for PEP. Let’s hope they push hard enough to make BC a safer place for gay men.

So why isn’t PEP available?

Simple. I’d say the medical profession is reluctant to give people, and especially gay guys, too many opportunities to behave recklessly. And our community’s silence is letting them get away with it.

I don’t expect a change in policy until someone stands up to demand it. So far, no community group or agency has directly taken on the BC government for its shameful policy on PEP.

How PEP works

If you are exposed to HIV and are concerned about getting infected, you need to start on medication as soon as possible. The treatment has to begin within 72 hours to be effective; some local doctors suggest within 24 hours is best.

How effective is PEP? One study showed that persons who did not take PEP were seven times more likely to get HIV (Roeding et al, 2008).

But accessing PEP is not easy. You need a doctor to prescribe it, which can be tricky at the best of times, and even harder at 6am on a Saturday morning.

One more hurdle: in BC you have to cover the $1,500 price tag yourself, unlike in Quebec and Australia where the medication is free.

If the BC government can prevent infection in even one person in 20 by providing access to effective medication, the investment is worth it. From a purely financial point of view, paying $1,500 for PEP is much cheaper than providing a lifetime of HIV treatment.

But maybe it’s not simply about saving money; maybe gay guys are not important enough for the government to prioritize. Or maybe this policy is punishment for irresponsible sexual behaviour. Or maybe it reflects an ongoing squeamishness around gay sex.

Bottom line: our government won’t care about us unless we make them care.

So talk to your community organizations and ask them to take action to make PEP available to everyone in need. Write to the health minister. And find yourself a doctor who knows about HIV and PEP, and talk to them about how you might access it quickly if you need it.