Drug treatment which may be taken after sex to prevent a woman from getting the human immunodeficiency virus (HIV), are available in Jamaica. For HIV prevention after sex, the drug cost is between $1,000 and $8,000.

This HIV treatment is called HIV post exposure prophylaxis or prevention (P.E.P.). It is prescribed by a doctor for persons who have had potential exposure to HIV. The treatment involves giving a course of the regular HIV medication to the person who had a potential exposure to HIV (for example, someone who had been raped).

The regular HIV medications are called antiretrovirals (ARVs) and come in various combinations, for example, efavirenz plus lamivudine plus stavudine or zidovudine plus lamivudine plus indinavir. The medication must be given immediately after the potential exposure or within 24 to 72 hours, which is about the time it takes for HIV to integrate itself into human cell DNA. The treatment is given for one month.

The condom breaks

There are persons who do not have HIV, but have partners whom they know are HIV-positive. The P.E.P. is also useful for these persons if the condom breaks while they are having sex with their known HIV-infected partners. However, these clients may be exposed to HIV on a regular basis (the condom may break from time to time) and the recurrent, on-and-off use of P.E.P. is not recommended, due to possibly serious side effects and toxicities. Health professionals such as dentists, doctors, nurses and phlebotomists who accidentally stick themselves with a needle which was used to stick a client, also benefit from this treatment.

Although there is compelling data that suggests that P.E.P. after HIV exposure is very effective, there have been cases where it has failed. The regimen may be very demanding and may have unpleasant side effects including blurred vision, anaemia, abnormal dreams, fatigue, headaches, nausea, vomiting and diarrhoea.

P.E.P. not a replacement

The P.E.P. cannot replace preventive behaviours such as using a condom consistently. Medical treatment after sexual or other HIV exposure is less effective than preventing HIV infection by avoiding exposure in the first place. The HIV P.E.P. is prescribed for rape survivors, persons who have had accidental needle-stick injuries, and the HIV-negative partner of a HIV-positive/HIV-negative (discordant) couple.

Survivors of rape should make every effort to seek medical care as soon as possible after the event, and certainly within 72 hours, to prevent HIV transmission.

Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.

Use within 72 hours

The medical doctor is required to evaluate the situation presented, and is more likely to recommend HIV P.E.P. if:

the source person is known to be HIV infected.

the type of exposure event poses a huge risk for transmission.

the client presents within 72 hours after the exposure event.

the benefits of the client taking HIV P.E.P. outweigh the risks.

HIV P.E.P. is prescribed for rape survivors, persons who have had accidental needle-stick injuries, and the HIV-negative partner of a HIV-positive or HIV-negative (discordant) couple.