PEP is now available in British Columbia under a pilot project from the BC Centre for Excellence in HIV/AIDS. HIM has developed a Healthcare Provider Support Tool about PEP that you may find informative. The likelihood that a risk incident could result in HIV infection is much greater among gay men and other men who have sex with men. In Vancouver, 1 in 5 gay men is HIV positive. In 2010, this population made up 50.5% of new HIV infections in British Columbia. Risk incidents should be taken seriously. PEP must be started within 72 hours of exposure. Act quickly. Cultural Considerations For some, discussing sexual acts with a doctor or health care professional can be intimidating. They may feel judged. Not all men who have sex with men identify as gay. Also, men might not actively seek treatment after a risk incident because of embarrassment or shame about sexual behaviour. By focusing on risk incidents and behaviour, rather than on labels, you can help your patient feel more comfortable. PEP for sexual exposure involves much more than condomless anal sex and a four-week course of HIV meds. It requires admitting mistakes, failure, bad luck, losing control, disappointment for letting one’s standards drop, acting in spite of one’s better knowledge, and dealing with emotions of anger and anxiety. If your patient answers ‘yes’ to the following four questions, they are likely a candidate for PEP: • Are you a man who has sex with men (even once)? • Did you have condomless anal sex with a man (or experience a failed or broken condom)? • Was your partner HIV positive, or was his HIV status unknown to you? • Did this incident happen within the past 72 hours? Gay men are exposed to HIV in the following ways: • Insertive anal sex (“topping”) and receptive anal sex (“bottoming”) without a condom (“barebacking”) • A failed or broken condom during anal sex • A shared needle while injecting If you need more information, advice, or would like to consult further, the Immunodeficiency Clinic (IDC) at St. Paul’s Hospital operates a REACH Line (Rapid Expert Advice and Consultation in HIV). If you are a family physician, nurse, or pharmacist in BC and require consultation in HIV treatment and management from an infectious disease specialist, a family physician experienced in HIV management, or a pharmacist experienced in HIV management, please call the REACH Line at 604.681.5748 (Vancouver) or 1.800.665.7677 (outside Vancouver). For more information, you can visit them online. We are pleased to provide the following resources for you:
- Post-Exposure Prophylaxis for Consensual Sexual Activity in British Columbia – a Position Paper by Health Initiative for Men (published 2010)
- NPEP Pilot Project Guideines from the BC Centre for Excellence in HIV/AIDS
- HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS
- Advice for patients on speaking to healthcare providers, and a downloadable form for patients to take to their healthcare providers.