Post Exposure Prophylaxis

I recieved an urgent call a few days ago from a friend I haven’t spoken to in a while. It was around 11:30PM, and I was comfortable in bed, so I was startled and concerned when I saw his number pop up. He explained to me that he was out with a friend at a bar two nights before and he got drunk, something he doesn’t normally do, and he took a guy home with him, something else he doesn’t normally do. He informed me that he and this guy had oral sex, but he was afraid that this guy ejaculated in his mouth. He is terrified about getting HIV, but apparently not enough to get on PrEP. Ugg.

So I told him that any emergency room can provide him with Post Exposure Prophylaxis(PEP). For those who don’t know, Post Exposure Prophylaxis is medication that must be taken with 72 hours of exposure to HIV, a full 28 day course of medication that drastically reduces the risk of HIV infection. The medication can be very expensive, however there are a number of copays cards and programs to help cover the cost or even eliminate it entirely. If someone thinks they have been exposed to HIV, you must first be tested for HIV to make certain you are not already HIV positive.

With my friend, I provided him with a number of locations throughout the city where he can access PEP. I also informed him that if he has a regular PCP he can see if he is able to do a same day appointment. I tried to explain to him that his risk of HIV transmission was on the lower side, and he should not be too worried. My friend however, is a worrier and will not be swayed. I told him to let me know how it goes the following day.

The next day he called me asking for help on deciding to wait an hour at a doctors office or to go to an urgent care. I told him it’s his choice, and that an urgent care could take just as long. I also told him whichever would cost less is always a better option. So he went to the regent care to see how long the wait was but found out the cost would be much more than to see his doctor. So he returned to his doctors office, and was finally seen. He called me about thirty minutes later asking for help with a copays card. Some drug companies make copay cards to help cover the cost of medications. Gilead does this for their PrEP and PEP medications, so if you have insurance and a copay for the drugs, this card should cover the full amount so the out of pocket cost is $0. I got the card set up for him in 2 minutes and gave him the information. He told me that he got the medication and just took the first pill. I told him I was glad and reminded him not to miss any doses.

The following day I called to check in with him, to see if he was experiencing any side effects or had any questions. He told me that he decided to not take the medication because he felt fine. I explained to him that the medication must be taken as prescribed to be effective. I also reminded him that someone can look and feel healthy even though they may be sick. I also reminded him about the time frame of HIV infection and how he wouldn’t deteriorate immediately if he was positive. He said he doesn’t like taking pills so that’s why he is stopping.

I had to calm myself down before calling him a selfish idiot. He calls me in the middle of the night, then needs my help the following day for no reason. He knew the medication is a 28 day regimen, as he has been on PEP twice in the past. Starting PEP is completely his decision, but when he plays a helpless victim unable to do anything himself, asking for my help, but then dismisses all I have done to help, it bothers me.

Now, I know I should just let it go and not think about it. This doesn’t effect me, and it’s not my decision. However, this just adds to the mental frustration and capacity overload that my brain is feeling. I need a vacation now more than ever.

If you know of someone who might need Post Exposure Prophylaxis(PEP) or Pre-Exposure Prophylaxis(PrEP) there are many resources available and I am happy to assist if needed.

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