Frequently Asked Questions 

What is PEP?
PEP stands for Post Exposure Prophylaxis for HIV. It is a combination of medicines taken if you suspect you may have been exposed to HIV through unsafe sex or sexual assault, and want to reduce the chances of getting infected.

PEP is the only medication that can reduce the risk of your becoming HIV positive. You will need to take these medicines within 72 hours after exposure, for a total of 28 days.

Is PEP available in India?
Yes. It may be easier to obtain from private doctors or pharmacies. The government-run HIV programs also provide PEP, though on a limited scale. [See government guidelines]

When should I take PEP?
If you suspect that your sexual encounter was unsafe, immediately seek PEP. You must start PEP within 72 hours from the time of possible exposure, for it to be effective.  The sooner the better: every hour counts.

Take PEP if:

  • You had unprotected (without condom) vaginal or anal sex (whether as a top or bottom)
  • The condom broke or slipped while having sex
  • You/your sexual partner was dry humping but you suspect that pre-cum or cum entered the anus or vagina.
  • You/your sexual partner had bleeding gums when performing oral sex without a condom or dental dam, and or if you/they had cuts or sores on the genitals
  • You/your sexual partner were deep kissing and one/both of you had cuts or sores in the mouth
  • You were sexually assaulted or raped

PEP will help prevent the HIV virus from spreading in your body, and you becoming HIV positive.  [Click here for directory of doctors and facilities that may offer PEP, or click here to submit an entry]

I had unprotected sex, but I have no symptoms of HIV like fever or diarrhea or night chills. Should I still seek PEP?

Yes you should. Symptoms typically associated with HIV such as fever, diarrhea, weight loss, or feeling persistently tired may take 3-6 weeks or longer to show up, and some people may not have these symptoms at all.  So, if you suspect your sexual encounter was risky, seek PEP without waiting for symptoms.

Do I need to test for HIV before starting PEP?
Meet the doctor to discuss the course of action. The doctor may ask you to carry out some tests, but will not hold back PEP if you are close to crossing the 72-hour window.

Most common HIV tests will be able to diagnose whether you had a previously established HIV infection. A HIV positive result at this point may require a different set of medicines. It will also allow you to alert your partner, so that they may start PEP if they are HIV negative. 

Must I see a doctor?
Yes. Ideally, you should meet a doctor who is experienced in treating HIV, many of whom are specialists in STI/venereology. Your family physician may not be trained in treating HIV infection and may be biased against treating possible HIV infections.


However, if you are unable to meet a doctor immediately (i.e. you had unsafe sex, or were sexually assaulted, on a weekend when doctors were not available, or the nearest doctor is quite a distance away), get the medicines from pharmacy directly and take your pill(s) until you get to a doctor. These pharmacies will most probably give you the medicines without a prescription.


What medicines should I get?
We recommend first seeing a doctor who will assess the risk of your exposure and then recommend PEP.  Only if it is impossible for you to meet a doctor within 72 hours should you consider starting on PEP first.

If you must start PEP before seeing a doctor, take one that contains Tenofovir+Emtricitabine or Tenofovir+Lamivudine. See Footnotes [iv] and [v].


 It is one tablet once a day for 28 days.  However, please be sure to consult a doctor as soon as you can: they will review your case and may suggest a change or addition of a third ARV, depending on the nature and severity of the exposure.

What should I discuss with the doctor when you are seeking PEP?
Be open with your doctor. Doctors specializing in sexual health and sexually transmitted infections (STIs) typically do not make moral judgments. Clearly state the time of exposure, mode of exposure, etc. In addition, disclose any past instances of STIs that you were treated for.

Provide full information on any medication that you are currently taking, even food supplements such as mineral/vitamin tablets, protein supplements, or antibiotics.

Your doctor will use this information to determine the most suitable course of medication (PEP) based on your health, any pre-existing conditions and medication.

What important points must I note from the discussion with the doctor?
Your doctor will guide you on the treatment option. You may note down these:

  • Any changes in medicines that you are currently taking (for example, some vitamin/mineral supplements may affect the PEP medication)
  • Time of taking the medicines
  • Any changes in food and sleeping habits that you may need to make
  • Any additional tests such as liver- and kidney- function
  • Next test date
  • Next consultation with the doctor

What if I miss a day’s medication?
You MUST NOT. Make sure that you take the medicines every day at the same time.

Here are some tips:

  • Keep a small box/container with medicines for one or two days with you always, including if you go on travel
  • Set yourself alarms at two or three intervals so that you don’t miss out on your meds.
  • To protect your privacy, you may remove the labels from the container to prevent others from finding out what medicines you are taking.

Does PEP have any side effects?
You may experience side effects including nausea (feeling like vomiting), interrupted sleep, extreme tiredness, etc. Whatever the side effects, DO NOT STOP taking medicines. Speak to your doctor. They may choose to change the medication.

Is it safe to take PEP if I have any other illnesses, or if I am taking other medicines or if I am on hormone therapy?
Check with your doctor. PEP medicines may have interactions with other medicines that you take, and can cause side effects on your liver and kidney. However none of these should prevent you from being able to take PEP.

How much does it cost?
A month’s dosage will cost between Rs. 2000 and Rs. 4000.

What should I do after completing PEP for 28 days?
Meet the doctor again. Your doctor may suggest further tests for HIV as well as for other viruses such as Hepatitis B and C.

I am worried I may become HIV positive even after PEP. What do I do?
PEP, if taken within the 72-hour window, significantly reduces your chances of becoming HIV positive. Do meet your doctor and discuss your concerns. Also, consider speaking with a counselor. Vinay Chandran and Mahesh Natarajan in Bangalore, and Magdalene Jeyarathnam in Chennai, are among those you can contact. The directory of LGBTIQA+ friendly healthcare providers will have more listings.

Can I speak to someone about PEP?
You can talk anonymously to a few volunteers who may help you choose the right steps. At present we have volunteers in Bangalore and Chennai.

Google chat/email: Contact orinam.net@gmail.com or peptalk.chn@gmail.com

I missed the 72-hour window. What do I do now?
Meet the doctor and discuss your options. Your doctor may ask you to do a few tests and suggest the best course of action.

How often can I take PEP?
PEP is intended for use after accidental exposure to someone who is known to have HIV or if you don’t know their HIV status. It is a 28-day course. If you anticipate that you may frequently be at risk, then perhaps you should consider Pre-Exposure Prophylaxis (PrEP). [link for PrEP]

Can I take PEP instead of using condoms?
We do not recommend this. Condoms, if used consistently and correctly, can protect against a wide range of STIs including HIV. PEP (and PrEP) are intended for use against HIV but will not prevent you from getting other STIs.

I am HIV negative, but in a relationship with a partner who is living with HIV. Should I use PEP?
If you regularly engage in penetrative sex with a partner living with HIV, then PreP may be more appropriate for you than PEP. Click here [link will be up soon] to learn about PrEP.


Disclaimer: The contents of this page have been compiled by a group of volunteers who have been on PEP or are on ART. While the contents have been reviewed by a medical professional, they are not intended to be a substitute for direct medical advice. Please see a doctor. Orinam is not legally responsible for the accuracy of the information provided.

Footnotes:

[i] The Tenofovir-Emtricitabine and Tenofovir-Lamivudine combinations for PEP are recommended based on discussions with HIV experts, guidelines from CDC (2016), and a systematic review of the literature on PEP (WHO 2014).

[ii] If you are an LGBTIQA+ community member and want to learn about other HIV and STI topics (including safer sex, PrEP, etc.) please visit thebody.com

[iii] If you are a doctor and want to learn more about PEP and PreP, stay tuned for a link.

[iv] Tenofovir + Emtricitabine combinations
Brand NameManufacturerMRP (30 tablets)Discounted Price
Tavin-EMEmcure22001100
Tenof-EMHetero HC2000
Tenvir-EMCipla2200
Recovir-EMMylan
[v] Tenofovir + Lamivudine combinations
Brand NameManufacturerMRP (30 tablets)Discounted Price
Tavin-LEmcure1900
TenolamHetero HC1500

Discounted price is the price reported from multiple users, usually obtained from individual medicine suppliers.

Summary
Article Name
PEP talk
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Description
I had unsafe sex and am worried about HIV: what do I do?