HIV-positive individuals need to know of the existence of post-exposure prophylaxis (PEP), an investigator from the UK writes in an article published in the online edition of Sexually Transmitted Infections.
Dr Catherine Dodds of Sigma Research, University of Portsmouth found that many gay men who sought PEP after unprotected sex did so after their sexual partner disclosed their HIV-positive status before or after a risky sexual encounter.
In 2005, the annual UK Gay Men’s Sex Survey, men were asked if they had ever accessed PEP. Of the 16,500 gay men who completed the survey, only 1.4% said they had ever tried to obtain PEP after a possible sexual exposure to HIV. Dr Dodds writes, “this indicates that PEP seeking is not a common behaviour among homosexually active men in the UK.”
Dr Dodds was surprised that so few men had sought PEP given the high rates of potentially risky sexual activity revealed by the 2005 survey. In all, 48% of HIV-negative or untested men reported unprotected anal sex in the twelve months before completing the questionnaire. Furthermore 28% of HIV-negative and untested men said that they’d had unprotected sex in the past year with a man who was either HIV-positive or of unknown HIV status.
To gain a better understanding of the PEP seeking experiences of gay men, Sigma Research conducted in-depth interviews with 30 men who completed the questionnaire and said they’d sought PEP.
Half of these men (15) said that they’d sought PEP following unprotected sex with a man they knew was HIV-positive. Only five men knew that their partner was HIV-infected before the sexual encounter. In the other ten cases the men sought PEP because the men disclosed their HIV-positive status after unprotected sex.
In some cases disclosure occurred after a mutual friend expressed concern or because the HIV-positive man was directly asked about his status after sex.
But just as many men independently raised their HIV-positive status after the unanticipated or accidental exposure to HIV. In some instances disclosure was accompanied by information about the availability of PEP.
Dr Dodds quotes one man whose partner revealed he had HIV after unprotected sex. Disclosure was “followed by a comment that I ought to go see a doctor.” This led to a conversion about PEP, the existence of which the man was previously unaware.
In another instance the HIV-positive man’s attempts to disclosure before and during sex were misinterpreted. After unprotected sex the two men recognised their miscommunication. At this point the HIV-positive man said, “well, you can do something about it, there is PEP…you start taking antiretrovirals and it's like a preventative thing if you get exposed.”
Dr Dodds had not expected to find post-hoc disclosure, particularly as “most of these disclosures occurred following the emergence of criminal prosecutions for the transmission of HIV in the UK. Alongside the risk of moral and social censure by their sexual partners, the men who revealed their HIV-positive diagnosis following a potential sexual exposure also ran the risk of police involvement as a result of their attempt to prevent seroconversion in a man they were unlikely to see again.”
She adds, “some might infer that these men’s concern to prevent transmission could have over-ridden their desire to shield themselves from the personal consequences of disclosure following sex that carried a risk of transmission.”
Men who sought PEP had learnt about it from friends, sexual partners and health officials. Dr Dodds believes that there is a “particular role that some people with HIV can play in supporting their casual partners to access PEP when sexual exposure to HIV might have occurred.” She concludes, “it is important for HIV and sexual health specialists to ensure PEP information is not only targeted at those who tested negative for HIV or are untested, but also to people with diagnosed HIV.”
Dodds C. Positive benefits: preventative impact of PEP awareness among those with diagnosed HIV. Sex Transm Infect, online first, published October 30th, 2007.