The HIV Morning-After Pill
Introducing the best FDA-approved, commercially available lifesaver you've never heard of
One winter night in 2000, Danny, who was 21 at the time, went home with a guy he met at a crowded bar in San Francisco. Random hookups weren't out of the ordinary for Danny, but this one ended badly: As he was buttoning up to go home, his new friend mentioned he was hiv positive. Usually conscientious about safe sex, Danny hadn't been, and he panicked. "I was in shock," he says. "I just couldn't believe it." He vaguely remembered reading about an emergency treatment that could prevent infection, so when he got home he called the California aids hotline. Memory served. A monthlong regimen known as post-exposure prophylaxis treatment (pep)—usually given to health care workers who have been stuck with needles—was available at local clinics and emergency rooms to people who had recently been exposed to hiv. The side effects of debilitating nausea and fatigue were a small price to pay for its potential benefits: A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the virus.
Danny went to a city clinic, where after a consultation, he was given a prescription for two antiretroviral drugs—the same kind that hiv-positive patients have taken since the '80s. As preventative medicine, the drugs work with a one-two punch: The first intercepts the virus' initial attachment to dna, and the second stops infected cells from spreading the virus.
Danny was lucky that California is one of the few states (along with New York, Massachusetts, New Mexico, and Rhode Island) where policies ensure that the general public—not just hospital workers who have been exposed on the job—can access the drugs. Elsewhere, the decision is up to individual hospitals, clinics, and doctors. Surveying all 50 state health departments and more than 50 ERs nationwide, I encountered std clinicians and workers at aids hotlines and Planned Parenthoods who did not know pep could be prescribed to the public. An Alabama health department official told me, "It's not available." A nurse at a North Dakota clinic said he all but encouraged patients to fly to San Francisco.
Since the virus must be intercepted before it attaches to cells and reaches the lymph nodes, it is crucial that pep be administered immediately—each passing hour means decreased effectiveness.
"It needs to be treated like a gunshot wound or a stabbing," says Antonio Urbina, a medical director at St. Vincent Catholic Medical Center's hiv clinic in New York City. Yet of the largest hospitals in each state, only a quarter offer pep in their emergency rooms. In a 2005-06 cdc survey taken at gay pride parades around the country, less than 20 percent of hiv-negative respondents knew about pep. "When I tell people that I used it, they say they've never heard of it," says Danny. "You see signs about crystal meth or syphilis, but even in the gay publications, you never see ads for pep."
pep is fda approved, commercially available, and even often covered by insurance (though for the uninsured the drugs run upward of $1,000). In 2005, the cdc recommended that pep be administered to all patients on a case-by-case basis within 72 hours of a high-risk exposure, followed up by testing and counseling. But for reasons that are more political than scientific, there is no federal funding for the treatment. Some public health officials claim that public availability of pep will encourage risky behavior—the same argument used against RU-486, abortions, and condom distribution. Robert Janssen, director of the Division of hiv/aids Prevention at the cdc, explains, "Biomedical interventions raise concerns that people would feel, 'Oh, I have these pills, they will keep me from getting it.'"
Yet 73 percent of non-hospital-worker pep recipients in a San Francisco study decreased high-risk sex over the following year. And since pep drugs are so toxic, most doctors would be careful about overprescribing. "I'm concerned with two things," says Urbina. "Is the person that exposed them either hiv positive or at high risk for hiv, and is there potential contact with infectious body fluid? If both are yes, in my equation, you give pep." Peter Leone, medical director of North Carolina's hiv department, who hasn't received the necessary support to institute a public pep program in his state, believes the benefits of pep outweigh the risks. "Nationally, there is a 'Don't Ask, Don't Tell' policy," he says. "We're okay to say it's a good idea, as long as we don't know about it and don't do anything to support it. We don't deny care to smokers or people who didn't buckle their seat belts. It says a lot about the political climate around sexuality and homophobia." For the 40,000 people infected with hiv in the United States each year, the knowledge of a lost opportunity for prevention is devastating. In Britain, an hiv-positive couple has filed suit against the government for withholding lifesaving information.
Two months after he finished his treatment, Danny tested negative for hiv—whether because he hadn't contracted the virus from the encounter or because the pep worked, he'll never know. Since a randomized clinical trial is unethical, researchers have to rely on observational and tangential research. "At least if you test positive after pep, you'll know you did everything you could," says Danny. He keeps his medication label as a token of how a little bottle may have saved his life.
Find out if HIV morning-after therapy is available in your state.
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This is SO utterly typical of the Bush-Administration style of governing. Replace Free AIDS and HIV testing with Abstinence flyers. I hope that British couple wins their lawsuit, and people stand up and Demand their right to life-saving drugs and treatments.
A "month of debilitating nausea and fatigue" following each bout of risky sex are going to encourage *more* risk behavior!? Who's smoking what out there?
As an American who had this happen to me in Britain I was surprised to find that the National heath Service in Britain offered this treatment immediately- They advertise its availability and encourage its use- It makes one feel more empowered to be able to fight when the unthinkable happens- Just another reason America will fail to be what we could be when politics not science rules the day
Your article is fascinating, however, I noted that Washington DC is not on your list of states in the "Find out if HIV morning-after therapy is available in your state," policy chart. This is a significant oversight, because, as the Washington Post reported in 2005, the rate of HIV/AIDS is probably worse in DC than any other major U.S. city. Please don't forget the the under-represented souls living in the plantation colony of the District of Colombia. Is PEP available in the District?
"Some public health officials claim that public availability of pep will encourage risky behavior—the same argument used against RU-486, abortions, and condom distribution."
Jeebus. I guess it's lucky we didn't just discover the female orgasm. Or the male penis for that matter. Because, after all, THEY can lead to risky behavior too.
If this young man wasn't practicing deviant behaviour by allowing himself to be sodomized, this never would have happened. That's all there is to say about the situation.
I am so astounded by this! On one hand I am overjoyed to discover this treatment exists. I mean, this is great for rape victims, not to mention "Oops" victims. I'm delighted and also horrified to know that it's not readily available- a standard treatment! The idea that any drug that causes a month of debilitating illness is going to encourage people to be less cautious is completely illogical.
I can't help but think PEP is just another uptick for big pharma.
Danny, and millions of others, are still 'believing' other people's self diagnosis based on the last time they tested for HIV.
It is this 'poz & neg' terminology that pharma and MD/associates want everyone to follow instead of what is clearly logical by now, 25 years after the fact; you do not share body fluids with others.
This needs to be made available everywhere in the world, but the conservatives and the evagelicals in the U.S. don't acknoledge these types of problems so it'll never get off the ground for another 10-15 years, and maybe only if there's money to be made. Otherwise it's population control for all they care.
"The first intercepts the virus' initial attachment to DNA."
Attachment to the cell surface?
this is a problem:
"A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the virus."
there's no way for anyone to ascertain that fact, to determine if one tests negative because of the PEP or because one never contracted the virus in the first place. there's no way to validate the efficacy of PEP. is it just a money-maker? yes. is it just a security blanket? yes.
"Danny tested negative for hiv—whether because he hadn't contracted the virus from the encounter or because the pep
worked, he'll never know. "
Right.
the whole PEP thing simply reinforces the subconscious drive to get infected that is present in all negative men who have sex with men in response to all the constant admonitions not to. it permits another step closer to the flame - not in this way: "Some public health officials claim that public availability of PEP will encourage risky behavior." - but rather does so subconsciously.
this language is so dangerous: "It needs to be treated like a gunshot wound or a stabbing,"
and then the final sentences of the article made my skin crawl:
"At least if you test positive after pep, you'll know you did everything you could," says Danny.
"Yes Danny did, didn't he?" they'll all say, with earnest frowns. "poor kid."
He keeps his medication label as a token of how a little bottle may have saved his life.
Oh the precious reminder of his brush with death and bad behavior. well guess what, he'll slip up again. and again until he gets infected. and that reminder sits there, probably on his nightstand.
It's getting to the point where I'll be advocating getting infected to relieve the homos of this burden of fear so they can move on and their lives can be lived more fully, not paralysed by fear, even if it appears to be "shortened."
I am an American doing human rights and public health work in South Africa, where it is policy that all rape survivors have the right to access PEP within 72 hours of their sexual assault. I am surprised and saddened that your article does not mention the use of PEP for rape survivors. This is a policy that civil society struggled for and won here in South Africa. Why, in the U.S., are we not making the links between unwanted sexual intercourse and potential HIV infection? PEP should be offered to all rape survivors within 72 hours after their assault. I wonder whether the author can supply us with info as to where PEP is available to rape survivors following sexual assault?
Really, Phil in Kentucky? That's ALL there is to say?
Thank god you're around to dictate the final word.
Why is the acts of Christians you hear most about and the Christians you hear the most from are the least Christ-like?
People at risk of AIDS/HIV are people too.
I had heard about something like this years ago on the tv show "ER". Not knowing whether it was fact or fiction, months later when I experienced a needle stick injury at my job as a healthcare professional, I asked the exposure nurse who was giving me emergency hepatitis vaccines and such if there was anything available like that. She said no. Now this was in Michigan, and she could have been uninformed, but as a hospital worker, I had heard of nurses where I worked getting this treatment. I was left unsure if the knowledge of the existence of PEP was restricted to healthcare workers further up the totem pole, (as I was not a nurse but still had to administer injections to sometimes very high-risk patients) or if it was determined on a case by case basis of the severity of the exposure. I was petrififed, and my exposure wasn't even all that bad, considering what it could have been. It ended up that the patient had been negative at the time of exposure, but I was traumatized and am still dealing with some residual PTSD over the ordeal. It makes me livid to know that there is a product out there that can help the spreading of such a deadly disease, and can potentially help to erase the stigma about this illness in some estimation, and if the argument for not making its existence widely known or available to the public is that it will encourage people to take part in more risky behavior, then that is just irrational, illogical, and sociopathic. People will engage in irresponsible behavior if the climate is right. Teenagers will have sex whether or not condom machines are allowed in schools. However, the most effective protection any of us ever have against the spread of infectious disease is prevention, and to have successful prevention, we need to have a combination of education and availability of risk-reducing devices at our disposal. The benefits of a drug treatment like this could alter the face of the HIV/AIDS crisis and contribute enormously to the perpetuation of a higher degree of public health and awareness, and it seems to me that in any case when political "reasoning" steps in and intercepts vital information from the public (and in this case the deception seems broad and far-reaching) then the questions that come to my mind are, who is making money off of this travesty of social welfare? What are the motivations behind such a heinous act? and also, How can we as a public work to remove ourselves from the all-encompassing net of disinformation effectively enough to reverse the tide of greed in the top economic echelon of our society that is intent on keeping us down in all ways possible? At this moment, the fact that this article was researched, written, and published is a hell of a start. Hooray for a publication that facilitates journalism with a spine. Our side of the fight for a healthier (in all ways) community as the populous of this country and others lay in re-establishing effective dissemination of accurate and germane information, treating each other as family, and as much as we can, removing ourselves from the corrupt power structure that has permeated our culture and society. Health is not a commodity; it is a fundmamental right.
The spider web of manipulation, lies, deceit, stupidity, fear, ignorance. This is what we are as a species. People do not always learn from the beginning, sometimes we learn in the middle or closer to the end. Where ever knowledge/learning occurs is a huge benefit to society. WE need to get out information that is life saving. If it effects change, all the better. Giving clean needles to addicts does not invite addiction, it prevents disease. Giving profilactics or medication to people who participate in dangerous behavior will not encourage anymore than would happen otherwise. It will save lives and prevent the spread of disease.
With all due respect, Danny is an idiot. I certainly think this sort of thing should be available and legal, but there's not a lot of sympathy here for someone who gets hammered and has unsafe sex, then expects a bail-out.
Really! Not to mention the fact that it's only 81% effective! That makes me wanna risk my health....let me tell you!
My initial response was to Ouch's posting. Also, the idea that this is a ploy by "big-pharma" is absurd. If that were the case, there would be clinics on every block in every city in every state offering PEP.
I wonder if the author could explore the consequences of repeated PEP use. I think one of the arguments against mass availability of PEP is the possibility of drug resistance; which could mean that if an individual were to become infected, then they might be certain regimens/therapies that s/he might no longer have available as options. What little I understand suggests that to even call this a"morning after pill" is a misnomer. The other issue I am curious about is whether there is greater consideration for accessibility of PEP to couples who are sero-discordant (1 HIV positive partner; 1 HIV negative partner)? Maybe the author could do a follow up in these respects?
The New England Journal of Medicine study (Cardo et al) actually says "By univariate analysis, there was no significant difference between case patients and controls in the use of zidovudine after exposure (9 of 33 case patients, or 27 %, vs. 247 of 679 controls, or 36 %)", i.e. there was no benefit to Zidovudine/AZT usage. However, through highly unusual statistical manipulations (elimination of all the significant variables) they were able to tease out a positive benefit. It's also interesting to note that out of about one million total AIDS cases in the United States, two groups most likely to have an uncontrolled transmission of HIV, surgeons and paramedics, have no had a single case of occupational transmission, despite hundreds of thousands of estimate puncture wounds every year many of which, according to a Brazilian study of plastic surgeons, are unknown to the medical workers.
MJ- great article. Spreading the word about this is MANDATORY. I am not gay, but I will tell both gay and straight friends just in case.
Here's why this isn't that common:
80% reduction in risk sounds great, until you consider that without protection, your chance of getting infected after a one-night stand is less than 1 in 1000, so now maybe you cut that risk to 1 in 5000. The point is that either you or you're insurance company would be paying at least $1,000,000 for every case of HIV they prevent with these drugs, and in doing so, they've given 1000 extra people an increased risk of being resistant to the drugs if they ever do contract HIV. So, if you're that 1000th guy, this is great stuff, but for the vast majority, all you're paying for is the side effects. Now, if the guy he hooked with got infected in the past month or so, then there's a much higher risk, and PEP is probably worthwhile.
I agree with Renee. If Big Pharma were making tons of money off of this, the advertising budget alone would be astronomical...maybe not on TV, but certainly in periodicals addressing the needs of men's and women's health.
It also astounds me that some über-moralistic "Christians" (as one who at least tries to follow the teachings of Christ, I cannot seriously consider Phil in Kentucky as one who would reach out to the dispossessed the way Jesus did) are more into the letter of the Law than the Spirit of God's love. I believe that if Jesus were on this earth right now, he would not deny the health and safety needs of the GLBT population. After all, he prevented the execution of a woman caught in the very act of adultery. One thing he did say comes to mind regarding this Biblical story: "Let he who is without sin cast the first stone."
Phil had better be completely without sin if he's going to make comments such as the one he posted here.
The Fenway Institute in NYC and the S.F. Department of Public Health will be launching a study in a couple of months testing whether it would be safe and effective for HIV negative people to take the current AIDS meds, like Truvada, as a Pre-Exposure Prophylaxis.
Of course, if not used in conjuction with condoms this will increase the spread of other STDs and increase the likelihood of them becoming more drug resistant. And what about the cost of the drugs and the side-effects? They believe that this will drive down the cost of the meds and help stop the spread of AIDS throughout the world. But, I believe that if there is more demand for the AIDS drugs, the drug companies will say that they need to increase the price to build new factories and to market the drugs. Also, with our government's abstinence-only policy, widespread use of Pre-Exposure Prophylaxis, wouldn't be likely even if the price of the meds went down.
I'm all for other options, but I still believe that condoms and low-risk sexual activity are the most sensible and responsible options.
More than anything, this is just another way of remarketing and expanding the drug's target market and finding a way of holding on to the drug's patent.
I fear the day when I see a commercial on mainstream TV, telling me to "ask my doctor"
Okay, Danny, seriously you might want to ask about someone's HIV status BEFORE you have unprotected sex with them. Just a thought.
But it is interesting to know that the PEP treatment exists. I'd never heard of it.
Really, in this day and age should we really waste resources on fundamentally stupid people who refuse to carry condoms?
This stuff should me available everywhere in the world just think how many lives it could save
Why is there no policy listing for Washington, DC?
I haven't seen anyone mention the vulture who nailed Danny knowing he was HIV positive. This should be classified as assault with a deadly weapon, and the animal should be locked up. Jail should be reserved for the truly deranged, and this man fits the bill.
The 5th Comment down posts statistics that make NO SENSE. How could you possibly know the chance of "getting infected after a one-night stand is less than 1 in 1000". Be specific. Are you saying that the chance of getting infected by a person who is positive, not on medication, through receptive anal intercourse, is 1 in 1000? I'd have to say "absolutely not".
AIDS drug resistance? So far there is no "super-virus", all strands can be treated with the medications currently available. And, was the man that Danny had sex with been on AIDS meds regularly and been tested as undetectable for 6 months or more? The chance of the virus being transmitted may be slight. Please checkout this link: http://www.chinapost.com.tw/health/sexual%20health%20/2008/02/01/141510/...
Why aren't we going after the HIV positive individual who refused to disclose until AFTER. He should be punished!
What's with David Corn? Does he really believe that people who "did" the trade center left their names in a bag at the airport or let their passport survive the crash to be found on the street? Dave sounds like Rush and also paid by the CIA. You cannot support the Constitution and allow Corn to speak for you. Mother Jones is surely "puking".
Your biological warfare will be shut down
i have exdedent whit broken condom , whent to clinic right after excident , doctor refuse to give me pep for low chances to be infectet and assure me i not recomended beacose of side effects , i was stupid and leessen to her ,and now i expiriensed all simptoms of ARS end have all chances to test positive ,belive me i feel like my life was taken from me by doctor hu make call to give or not to give me chance for life , and for people hus critics somebody behaiving belive me before thise exedent i never think somethink like thise can happen to me belive me life can surprise you very badly,PEP is must be more open and more promoute for people, its people choice to have sex , but its people choise to have at list chance to save life . How people can feel to now thay have chance not to diy if thay been given those pills ,iven one life what can be be save dont have equal in money world Sory for engl. i am foreiner
Emo, your ARS symptoms could actually be the flu or anxiety symptoms. Go to a different doctor and discuss what you are going through now and what you have went through. Unfortunately, they say you should wait a few months before you get tested for HIV.
I find it hard to believe that a doctor would refuse to prescribe PEP. For the most part, doctors are scared of getting sued. It seems like you ultimately made the choice to not get on the drugs.
Sorry, I don't believe giving PEP to everyone whom believes they may have been exposed to the virus is justified just because maybe one person will not get infected.
HIV is not a death sentence and you do not have to get on medication right away. Often people are infected for 10 or more years before they have any symptoms. All drugs have side-effects. Please keep in mind that if you have sex, you are more infectious by not being on these drugs. And, be compationate and responsible by protecting your partner by engaging in safer sex. I don't believe that you have a responsibility to inform your partner if they don't ask. A person whom has sex with someone whom hasn't asked if they have an STD, is taking that risk.
Best of Luck!
hiv it is death sentence ,but very slow and depend on yor health and how lucky you whit doctor and treatment work for you or not it stupid beacose piople keep says chances ur 1 to 1000 ,no i think it can bee only once and you got infectet , many people just diy beacose of kidney falure ,iven doctors dont now the side effects from thise mrds becose it just not enafe data to study thise drugs ,hiv became 2 or 3 cose of death in in usa ,i not schure i see comerschial vich say evry 1 hour sombody get infectet whit hiv in us and evry day 161 people diy in usa beacose of hiv, i not schure about numbers but is was schok.If anybody whant to see what kind of chalenge have people hiv inf. look on aidsmeds.com living whit hiv
Emo,
AIDS is not a Death Sentence! Although I suppose that you could say that we are ALL living under a Death Sentence, none of us gets out of here alive.
Kidney Failure? Maybe from Crixivan. Not sure where you are getting your information? The Internet is full of outdated information. For example, you can't get HIV from your Dentist if he is using proper precautionary measures. An unborn child does not get HIV until the mother goes into labor. And, you can't get HIV from someone spitting on you. Etc.
Please, realize that it is your responsibility to keep educated about current treatments, find a good doctor and find organizations to help out. Don't depend on "luck".
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Hey Chuck from PA, The Fenway Institute is in Boston. :-)
I found that PEP is only available in my state for juvenile rape victims. What about adult rape victims? We are just allowed to die? Thanks for the info, this is an eye opener.
I've heard of this medicine from the "Feed the children" infomercials. They talked once about a baby who had been cured of HIV through that medicine. But what's weird is that the article says it has to be treated within the first 72 hours. I think it's safe to assume the child they were talking about on FTC had been infected since she was born. And she was nearly two when she got the meds. Hmm, unless they were hiding some kind of molestation, the meds don't have to be administered within 72 hours.
I Also Believe This Should Be Available What About Raped Victims Who Get The Virus What About The People Who Get Get It From Cheating Partners. I Really Hope That This Medication IS Released
I am 40 yrs old, I'm gay, and I have been sexually active since the age of 18- I am most comfortable in a monogomous relationship but happen to be single now - I recently had sex with a lover from 10yrs ago and was unknowingly exposed to HIV - we engaged in high risk activity and I was horrified after a lifetime of being careful and getting tested constantly that I was careless and trusting - this happened on my birthday early in the morning and spent my entire day crying and worrying when one of my positive friends mentioned (pep) to me - words cannot express my gratitude that these drugs exist - and deeply saddened and disgusted that they are not talked about - I'm sure if the people "in charge" were somehow exposed, they would certainly change their minds about telling people about the treatment - I hope this will prevent me from contracting HIV and I know this experience has altered my views and trust - we are all on this rock together and no amount of money should matter more than human life and well being - pray for me and I will pray for all of you -
Hi my last period was 9/27/08 and usually last 4 days, I had unprotected sex the morning of 10/27/08 around
9:20 am and took the first plan B tablet on 10/30/08 around 6:30 pm and the second on 10/31/08 around 5:45 pm; I have not seen my period, should I be worried that I am pregnant or did the plan B delay my period?
Concerned - You should visit your doctor or community health clinic. Do not wait for helpful feedback here.
Thanks Mojo it's all good it came today
You can own the web address www.TheHIVpill.com. Buy it at that address.
