Dear Dr Little

A recent report in a South African newspaper states that a clinic in Johannesburg has incontrovertibly demonstrated that anti-retroviral drugs prevent the transmission of HIV in rape victims. Would it not then be considered "safer" sex if people (both male and female) who engage in promiscuous sexual activities (with protection) also take anti-retrovivals after engaging in such activities as an added form of insurance ????. If so, why is this not encouraged i.e. taking anti-retrovivals after a risky sexual activity ?

Sachin Durban, South Africa

This is an extremely complicated topic. First, the issue of getting the drugs to the exposed individual in a timely fashion - many feel that emergency rooms are not the best place for this form of counseling and triage - but we have no obvious alternative in the U.S. Second, the issue of cost - there is insufficient data at present on efficacy and insurance companies do not typically reimburse this cost. Third, it is not clear who will follow these individuals after they start therapy. Fourth, it is not clear how different mucosal exposure (ie sexual) and needle stick exposures (ie health care workers) are in terms of risk/benefit related to antiretroviral medications.

I agree that the prevention of HIV after high risk sex is extremely worthy of study - but I do not feel that we have the answers to enough questions to determine yet in what circumstance and where some form of widespread intervention should be practiced.