Pharmac's decided to subsidise the expensive post-exposure prophylaxis (PEP) drug treatment programme, for people who have had accidental unsafe sex or shared a drug needle with a known HIV positive person. The decision is being greeted with "qualified optimism" by the New Zealand AIDS Foundation. PEP is a 28-day long, aggressive drug programme which, before the subsidy, had an actual cost of $1,300. It can significantly reduce the risk of becoming HIV positive after exposure. Treatment is most effective when started within an hour of exposure to HIV and no longer than 72 hours. Until now it was only formally available to medical professionals exposed to possible HIV infection through accidents such as hypodermic needle pricks. However, on rare occasions the partner of a person known to have HIV has been put on the treatment when incidents of accidental unsafe sex or shared drug needle have occurred. NZAF executive director Rachael Le Mesurier says the foundation lobbied for the subsidy because accidents can, and do, happen. She says while people who have been exposed to HIV in the workplace have had access to subsidised PEP for some time, when exposure has occurred outside of a work setting it has been extremely difficult to access. Le Mesurier says in particular, the number of gay and bisexual men exposed to HIV in relationships where one partner is living with HIV and one is not, is likely to be higher than the number of workplace injuries that expose people to HIV. "So this is a pragmatic decision for emergencies like a broken condom," she says. There has been some concern from groups such as HIV peer support and advocacy organisation Body Positive, that a subsidy could encourage PEP to be used in a 'morning after pill' fashion, although the group believes making the treatment more readily available for couples where only one partner has the virus could have serious benefits. Le Mesurier points out scientific evidence does not support PEP being used as an alternative to tried and true methods of HIV prevention like using condoms and lube for sex. "There is some data that suggests PEP will work, but there have also been cases where it has failed. The efficacy of PEP varies depending on issues such as the delay between exposure and treatment and the viral load of the person who has HIV at the time of exposure." Other concerns about PEP are the strict compliance to a treatment regime it requires to work. It also has unpleasant side effects including diarrhoea, headaches, nausea, vomiting and fatigue. There is also a risk of false negatives in subsequent HIV tests because the PEP can slow the development of the antibodies that produce a diagnosis. Le Mesurier says anyone taking the treatment is unable to be certain about whether it has been effective or not until they have a second HIV test at the six month mark, as well as the standard three month test. "Side effects are common and can be horrid which, compounded with six months of uncertainty and stress while waiting to see if the PEP has worked, mean that PEP is in no way an easy option. PEP is a necessary alternative in an emergency," she says. "We welcome this announcement but encourage people not to have to take PEP at all by using condoms and lube every time they have sex.” To apply for PEP either partner should consult their GP or HIV specialist as soon as possible. The PHARMAC announcement does not provide subsidised PEP in the event of exposure to HIV through vaginal sex or where HIV status is unknown.
Credit: GayNZ.com Daily News staff
First published: Wednesday, 9th June 2010 - 11:42am