need for nPEP after condom breakage

Question

Dr. Frascino, I must say, the last 24 hours have been scary and frustrating. I had sex with my girlfriend yesterday, and during sex, the condom broke. She is HIV+, and is being treated, and her viral load is non-detectable. Being a health care worker (massage) I thought the most responsible thing to do was to seek advice on nPEP to prevent any possible seroconversion. I know that the risk is not considered high by probability standards, but I also was looking at the possibility of how this might effect my professional roles.

I am also a former social worker, and got to making phone calls to seek support. I phoned a couple of "HIV Specialists" but they were unresponsive in that they "did not treat anyone until they were HIV+." This did not make great sense to me, but they were uninterested, so I moved on to local resources. To circumvent the three additional layers of failure in services, I'll cut to the chase. No services exist in Tampa, Florida, nor it seems outside of San Francisco, for secondary prevention of non-occupational post exposure prophylaxis. I'm stupefied...and I'm even willing to pay for the service, I just can't find a physician who's willing to consider writing a prescription! Ultimately my question is this...I know I can't be the only person who has experienced this fear and frustration. How can we, as a society, put together protocols/letter campaigns to help educate "HIV experts" in the strength of nPEP as a method of preventing transmission? Are there foundations you can refer me to that have existing programs? Thanks for listening to me, and I hope we can strive to support our society more effectively.

Frustrated Consumer

Answer

Hello Frustrated Consumer,

I too am shocked and stupefied by your experience in Tampa! I can assure you access to non-occupational post-exposure prophylaxis is not limited to San Francisco. That you contacted "HIV specialists" in your area and they refused to help is particularly astounding and disheartening. I have contacted several HIV specialists in Florida who informed me nPEP is widely available, not only through their offices, but also in urgent care centers and all emergency rooms. (None of these physicians work in the Tampa area.) They too were shocked by your story. If you are still in need of nPEP I would advise you contact your girlfriend's HIV specialist first. He should be willing to treat you as an extension of services he's already providing to your partner. If for whatever reason that doesn't work out, go to the nearest emergency room. All hospital emergency rooms have protocols for treatment with PEP and nPEP. Once treatment is started, you can then be followed by an HIV specialist for the duration of your course of PEP. To locate certified HIV specialists in your area, check the American Academy of HIV Medicine's Web site at www.aahivm.org. They have a roster of certified HIV/AIDS specialists listed by location. I'm quite confident they would be more than willing to help.

As for your idea of making nPEP more readily available, I would suggest you contact your local AIDS Service Organizations (ASOs). Just Google AIDS Service Organizations and Tampa. A list will pop up. Discuss with them the experience you had and how best to get the word out locally. You might also share your experience with the American Academy of HIV Medicine and ask them for their assistance. Finally, the link to the recommendations from the U.S. Department of Health and Human Services titled "Antiretroviral Post-Exposure Prophylaxis after Sexual, Injection-Drug Use or Other Nonoccupational Exposure to HIV in the United States" is www.cdc.gov/mmwr/PDF/rr/rr5402.pdf (nPEP guidelines). This may be useful for you personally as well as your quest to make nPEP more readily available in your area. Hopefully your experience was just an unfortunate quirk and not really reflective of the general state of HIV knowledge and access to emergency HIV-prevention treatment in Tampa! Frustration and nonsensical roadblocks are not what one expects or needs when coping with an HIV exposure! Let me know after checking with your local ASOs, certified HIV specialists, and hospital emergency departments, etc. if indeed a serious lack of access to emergency HIV-prevention services exists in Tampa and the surrounding communities.

Dr. Bob