Gay men in London and Brighton are being targeted with an HIV-prevention campaign designed to increase their knowledge about the effectiveness and availability of treatment to prevent infection with HIV after possible sexual exposure to HIV.
Terrence Higgins Trust (THT) and its partner HIV prevention agencies in CHAPS will run a series of adverts in the gay press providing information about post-exposure prophylaxis (PEP). The ads will be supported by posters in gay venues and an assessment questionnaire to help gay men decide if they have taken a sexual risk which would justify seeking PEP. The campaign will also provide details of sexual health clinics which provide PEP.
Campaign ads explain that PEP is “treatment that may prevent HIV infection after the virus has entered the body.” They also explain that PEP must be started within 72 hours of possible exposure to HIV and involves a one month course of anti-HIV medication, which can have side-effects including diarrohea, nausea and headache.
It’s being stressed by the THT campaign that PEP is not a substitute for condoms, and a briefing paper accompanying the campaign emphasises that “it’s important to see PEP as just one possible HIV prevention tool.”
The PEP campaign is based upon the recently issued British Association for Sexual Health (BASHH) guidelines on the use of PEP after possible sexual exposure to HIV. These include guidance on the circumstances in which PEP should be considered, factors affecting the effectiveness of PEP, and prescribing recommendations.
The BASHH guidelines recommend that PEP should be provided to men who have had receptive or insertive unprotected anal sex with a man who is known to be HIV-positive. They also recommend that PEP be provided to gay men who have had unprotected receptive anal sex with a man whose HIV status they do not know. The guidelines also state that PEP should be considered if oral sex with ejaculation occurs with a man known to be HIV-positive or of unknown HIV status. PEP is not recommended for oral sex without ejaculation.
Providers of PEP are also recommended to consider the viral load of the HIV-positive individual, although the guidelines emphasise that viral load in semen can differ from that in blood, and that individuals with an undetectable viral load can still be infectious. Other factors which the guidelines recommend for consideration include those known to increase the risk of HIV transmission. These include infection with a sexually transmitted infection or trauma during sex (particularly during sexual assault).
Will Nutland of THT emphasised that “drug treatment to help prevent the onset of HIV infection is not new, and has been available for some time to healthcare workers and others who might have been accidentally exposed to HIV at work. Now for the first time there are prescribing guidelines for how PEP should be used for people exposed to HIV during sex.”
THT has also developed a training package to help HIV prevention workers establish the availability of PEP in their area. The training package includes possible answers to arguments frequently encountered against the availability of PEP for sexual HIV exposure, including the effectiveness of PEP, the cost of PEP, demand for PEP, and the possibility that PEP will undermine condom based HIV prevention campaigns.
The campaign also acknowledges the limitations of PEP. “It’s very important to emphasise that PEP is not a morning after pill treatment for HIV” said Nutland, adding “it’s a month-long course of anti-HIV medication. There’s no guarantee that PEP will work.”
Further information
The THT/CHAPS briefing papers on PEP can be downloaded from the CHAPS websitehere.