This week, PositiveLite.com is focusing on Post-exposure Prophylaxis, or PEP — medication that can help prevent HIV after a possible exposure. Today, in our final piece in the series, we talk with Daniel, who took PEP three years ago, as he thought he might have been exposed to HIV when a condom broke.
John McCullagh: Thank you, Daniel, for agreeing to talk with PositiveLite.com about your experience using post exposure prophylaxis. I’d like to start by asking you to tell us a little bit about yourself.
Daniel: I’m a 42 year old gay man, happily partnered since 2005. I was born in Mexico and I came to Toronto to live, work and study. I finished my master’s degree here and work for a multinational engineering company. I love my life with my partner, like cooking, working out, reading biographies of famous women in power and love to learn languages.
When did you get PEP?
I went on PEP in June 2011.
I had sex with a guy who was wearing a PA [Prince Albert, a relatively common male genital piercing — Ed.]. He penetrated me, and although he used a condom, it broke and he came inside of me. He disclosed that he was HIV-positive after realizing what had happened.
Did you already know about PEP as a means to protect you from getting HIV after a potential exposure such as this?
Yes, I had heard about PEP through my partner and decided to ask him what to do a couple of hours after the incident.
So what did you do?
I called our family doctor. He prescribed the medication right away. I got it and took it four hours after the event.
That’s excellent timing! Did your doctor prescribe your meds over the phone?
Yes, thankfully. Because I don’t think I would have had the courage back then to go to the emergency department at a hospital or to a sexual health clinic.
So you were more comfortable talking with your family doctor about this than you might have been discussing it with a doctor you didn’t know.
Yes, because I discuss my sexual health with him on a regular basis. He’s knowledgeable about these things and treated me with respect and sympathy when I told him what had happened. The support I got both from him and my partner was crucial. It’s not easy for me to share my problems with friends and so I might not have sought help had my partner not given me his support.
You said your doctor prescribed PEP over the phone. So did you go straight away to the pharmacy to pick up the meds?
Well, my doctor told me to take a dose of my partner’s medication right away (my partner is HIV-positive) while I was waiting for the prescription to be filled.
Perfect! But PEP is expensive and, for non-occupational exposure, is not usually covered by public or private insurance plans, in Ontario at least. Given that a month’s supply of PEP can cost between $900 and $1,300, depending on the medications prescribed, was it financially difficult for you to pay out-of-pocket for the meds?
No, because to my surprise, it was covered by my employment insurance.
That’s wonderful. Daniel, I’d now like to ask you about your actual experience of taking PEP. As with all medications, there can sometimes be side effects. Did you experience any?
I was worried about potential side effects, but, in the event, I didn’t experience any at all, not not even stomach problems. I did have some fatigue but I don’t know if that was due to the medication or the stress I was experiencing at that time.
Apart from your partner and the doctor, did you talk with anyone else about being on PEP and, if so, how did they react?
I talked with three friends about being on PEP. They were interested about my experience and asked me about side effects and how quickly I had to take the meds after exposure.
What happened once you finished taking PEP?
Well, there were a couple of subsequent HIV tests.
How did they turn out?
I tested HIV-negative on both occasions.
That’s great to hear. Was it difficult, though, waiting for the final post-PEP test results confirming that you were still HIV-negative?
Yes, it was difficult to wait but I had prepared myself for whatever the result might have been.
How confident were you that taking PEP would prevent you from becoming HIV-positive, following your potential exposure to the virus?
I was pretty confident.
Daniel, what thoughts do you have about the way in which you believed you had been exposed to HIV? Who do you think bears the responsibility for what happened to you?
Something in my mind told me that being penetrated by a penis with a PA was not a good idea, even when wearing a condom. I should have said no to that. So I was partly responsible for what happened.
In hindsight, when we all have 20/20 vision, what do you think would have made a difference to prevent you being exposed to HIV in the way you were?
Being more assertive. At the time, though, I was going through a depression and assertiveness and self-responsibility were at a low level for me. I’m sure our mental health plays an important role in our decisions, sometimes more so than the knowledge we have in our heads. Also, John, I think that there’s a danger that depression can be a factor that can prevent us from looking for help, even if we have all the necessary information about any given situation. That’s why I think that it’s of the utmost importance to find people in a clinic or at a hospital that show some sympathy and understanding towards their patients.
I agree. Our mental health is an important consideration and something we and our health care providers always need to be aware of. Daniel, what do you do now, having had this experience, to reduce your risks so that you don’t need PEP again?
I always use condoms during sexual intercourse, with lots of lubricant.
In the event that you did have another potential exposure, and I hope you don’t, would you take PEP a second time?
Yes, I would. And if I did have another exposure, I hope I’d still have someone to support and help me, like my family doctor, who is friendly, professional and not judgmental.
And would you recommend to a friend, if he were in a situation similar to the one you found yourself in, that he access PEP?
Thank you, Daniel, so much for sharing your PEP experience with PositiveLite.com.
It’s my pleasure, John.