THE HIV MORNING-AFTER PILL?

Many of us have had at least one risky sexual experience that we feared might have exposed us to HIV. It could have been a drunken one night stand or a burst condom but the next morning, in the stark light of day, is usually an emotional nightmare. Wouldn’t it be great if we could simply pop a pill or two to solve all our problems? Well today, we can. Well, sort of…

Jeffery (36), a publicity executive, has had three frightening experiences he won’t soon forget. “The condom burst three times, three years in a row, almost to the day,” he says. “The first time I was completely freaked out. The fact that the guy never asked me what my status was when it happened made me think that he was positive because he didn’t seem to care.”

Kenneth (25) a fashion student, insists that he’s never had unsafe sex, but he was disturbed when he discovered that a guy he had a long kissing session with at a club was HIV positive. “I know you can’t really get HIV from kissing, but I didn’t know if he had sores in his mouth or if his gums were bleeding, so I was scared,” he says. “I was very stressed but I did nothing and hoped for the best. Eventually I did get tested and I was fine.”

Dinesh (23) a personal assistant, remembers that he had unsafe sex when he first met his now long-term boyfriend. ” We got very drunk and we didn’t use a condom, which I normally always do. The next day was horrible,” he says.

It’s an experience echoed by Jed, (28) an office clerk – except that, for him, risky sex was something that happened relatively often. “I was crazy when I was younger and I used to drink a lot. Drinking was a way of me becoming comfortable with myself and meeting other gay guys and feeling confident.”

He often didn’t use condoms and he’s grateful that today he remains HIV negative. The risk he was taking only hit home one day when “I suddenly became very paranoid and got tested and I’ve been careful ever since”.

Until relatively recently there’s wasn’t much any of these guys could have done after their risky encounters – other than to simply hope for the best. Today, however, a course of PEP might have been the best way to handle at least some of these experiences.

PEP stands for Post Exposure Prophylaxis and consists of a course of medication begun within 72 hours of the sexual encounter that will, in most cases, stop the virus in its tracks before it can take hold in the body.

“People think it’s just one tablet. They don’t know that it actually involves being tested, taking anti-retroviral tablets for 28 days, and then being tested again…”

PEP is undoubtedly a groundbreaking development and is a solid and effective line of defence against the HIV virus. But it’s also extremely controversial.

Dr Oscar Radebe, medical advisor at the Simon Nkoli Health4Men clinic in Soweto and the Health4Men clinic at OUT in Pretoria, is one of many who are concerned that some might see PEP as a sort of ‘morning-after pill’ for HIV, along the lines of the morning after pill women can take after having unprotected sex to ensure that they won’t get pregnant.

“It’s not a morning after pill. It’s completely different,” insists Radebe passionately. “It’s HIV we’re dealing with. It’s a virus. HIV can determine your life. The morning after pill prevents pregnancy – not a disease.”

He admits, however, that “people have got condom fatigue” and that the abuse of PEP is already a reality among some of his patients: “Some clients keep coming back to you to use PEP as regular prevention – it’s almost a constant thing for them – even knowing that their behaviour puts them at risk.”

Radebe says that this is a real concern for him: “They are misusing the drugs and you never know when someone might develop resistance to the drugs. We don’t have enough information at this point on that and we don’t know the long terms effects on the body – especially when you use it in an abusive manner.”

He notes that while more and more people are becoming aware of PEP, thanks to exposure in the media and on the internet, they often “don’t know the facts”.

His observation is borne out by Jeffery, Kenneth, Dinesh and Jed. Of the four, only Jeffery has used PEP and so knows all the details of what it entails. The other three are aware of PEP, but they admit that their knowledge is pretty fuzzy when it comes to the details.

“People think it’s just one tablet. They don’t know that it actually involves being tested, taking anti-retroviral tablets for 28 days, and then being tested again. And they also don’t know that there are side effects.”

For Jeffery, the side effects were luckily minimal and included “sleeping like a baby and having very weird dreams,” but other side effects can include nausea, abdominal cramps, diarrhoea, dizziness, weakness and loss of appetite.

And, PEP is also not full-proof. Dr Radebe explains that studies indicate that it is at least 80% effective in preventing infection if used correctly and in time. That means that there is a 20% possibility that it might not work. That won’t be all that comforting for someone who relies on PEP as their primary means to stay negative.

The good news in all this is that PEP is a undoubtedly another powerful weapon in disarming the HI virus – and of great benefit to sexually active guys who might occasionally slip up (hey, who’s perfect). If you need it, contact OUT in Pretoria, a Health4Men clinic in Soweto or Cape Town or your doctor within 72 hours of having risky sex. As for it being an AIDS ‘morning after pill’… Well, we’re not quite there yet.

For free access to PEP, contact one of the OUT or Health4Men offices or clinics. They provide non-judgemental advice, counselling, testing, free ARVs and other services to men who have sex with men and can be contacted in Pretoria: 012 430 3272, Soweto: 011 989 9756, Green Point Cape Town: 021 421 6127 or Woodstock Cape Town: 021 447 2844.

*Names of some of those interviewed have been changed.

**This article first appeared in the October 2011 issue of The Pink Tongue.