The Morning After... Let’s talk About PEP

Post-Exposure Prophylaxis - usually called PEP- is an emergency method of preventing HIV that can be used after a potential risk for HIV. Taking PEP after a potentially risky sexual encounter can stop HIV from taking hold in your body. Taking ‘PEP’ is different to taking ‘PrEP’ (see below). PEP is a 28-day course of anti-HIV medication. The sooner after a possible exposure you start taking PEP the better, but it must be started within 72 hours (3 days). PEP is available from most hospital Emergency Departments and some sexual health clinics.

Understanding your vulnerability to HIV

Statistically, gay and bisexual men and transgender people who have sex with men have a higher vulnerability to HIV. If you don’t always use condoms and you are not taking PrEP (Pre-Exposure Prophylaxis) consistently, PEP is another prevention option to keep in mind in case you are concerned about a possible exposure to HIV.

Getting access to PEP

You can get PEP from many Emergency Departments and STI clinics in Ireland as well as Sexual Assault Treatment Units. You can find a list of places where you can get PEP at www.getPrEP.online/pep.

PEP is prescribed only when there’s a fairly high possibility of HIV transmission. When you go to get PEP, you will be asked about the sort of sex (or other activity) you are concerned about to assess the risk of HIV transmission.

If PEP is prescribed, you’ll get a HIV test to check you don’t already have HIV, and another one when you have finished the 28-day course of PEP. You may also be offered an STI screening

Some people who use PEP decide to start using PrEP to protect themselves in the future. If you do want to start PrEP, there’s no need to wait, you can start PrEP when you finish PEP. Talk to the medical staff about continuing on PrEP when you’ve finished the 28-day course of PEP.

PEP is provided for free in Ireland. This includes the medication and any medical tests that are performed. However, if you access PEP in an Emergency Department you may have to pay a fee of €100. Hospitals are required to charge that fee to anyone using an Emergency Department who doesn’t have a medical card or a referral from a GP. The HSE is currently looking into whether that fee can be waived for people accessing PEP, but for now the fee remains in place.

The difference between PEP and PrEP

PEP; Post-Exposure Prophylaxis is a 28-day course of emergency anti-HIV medication taken immediately after a possible exposure.

PrEP; Pre-Exposure Prophylaxis is HIV prevention medication taken before and after sex by HIV negative people on a daily or on-demand basis.

When should I think about PEP?

The HSE has created guidelines to help doctors decide when to prescribe PEP and when it is not needed. The guidelines evaluate the relative risk of transmission in different situations and also take into account the viral load of the person with HIV, if that information is available. If someone living with HIV is on effective treatment and their viral load suppressed to an undetectable level, there is zero risk of passing HIV on during sex. PEP won’t be prescribed if your partner is HIV-positive and has been on effective treatment for at least 6 months, or if your are using PrEP consistently. PEP is not considered if oral sex is the only risk.

According to the HSE guidelines:

Receptive anal sex:

PEP is recommended if you’ve had receptive anal sex without a condom (you were the ‘bottom’) in the past 72 hours with a gay or bisexual man or a trans person whose HIV status you do not know or who is HIV-positive and not on treatment.

Insertive anal sex:

PEP is recommended if you’ve had insertive anal sex without a condom (you were the ‘top’) in the past 72 hours with a gay or bisexual man or a trans person who is known to be HIV-positive and not on effective treatment.

Vaginal sex:

PEP is recommended if you’re the receptive partner and the insertive partner is HIV-positive and not on effective treatment. It may also be considered if you’re the receptive partner and the insertive partner’s status isn’t known or if you’re the insertive partner and have had vaginal sex without a condom in the past 72 hours with a gay or bisexual man or trans person whose HIV status you do not know.

Sharing injecting equipment:

PEP is recommended if you have shared injecting equipment in the past 72 hours with someone who is HIV positive and not on effective treatment. It may be considered if the other person’s status isn’t known.

You can find more information and a list of places where you can get PEP at www.getPrEP.online/pep