PEP is not new. The drugs have been available for HIV prevention since the early to mid 1990s for health workers who have had ‘needle-stick’ or similar injuries – being pricked with a needle used on someone with, or thought to have, HIV - during a routine medical procedure.

More recently, PEP has been available, under strict prescribing guidelines, to people who might have been exposed to HIV during sex. PEP has been more widely available for sexual exposure to HIV in many other parts of the world – including Australia, France and the USA.

Until recently, there have been no prescribing guidelines to make it clear under what circumstances PEP should be given. The first British guidelines, published by the British Association for Sexual Health and HIV [BASHH], for how PEP might be prescribed were released in February 2006.
There is also now more consensus than ever amongst HIV organisations and gay men's health projects that PEP is a useful and effective HIV prevention tool.
In addition, new research undertaken in 2003 as part of the CHAPS research and development programme found that only a fifth of gay men knew about PEP but over 70% of gay men would consider trying to get it if they thought they had been exposed to HIV.
The organisations that make up the CHAPS partnership believe that it is right to provide clear information to gay men about PEP, how it is available and under what circumstances.

Very few people are aware that PEP is potentially available. Generally, it has mostly been available to people in key population groups where rates of HIV are highest, and telling the general population about PEP has not been seen as a priority.

Work has been undertaken over the last five years to increase availability of PEP and to raise awareness about its availability to professionals who might come into contact with key groups of people who might need it, including work with the police to ensure that people who have sexually assaulted could be told about PEP.

In 1998 the CHAPS partnership published a booklet – The Whole Picture – that told gay men about PEP and where it’s available. It’s not that information has been withheld – the new prescribing guidelines, the consensus amongst gay health projects and the increasing availability of PEP, makes it the right time to increase the amount of information available to key population groups.

Absolutely not. PEP is a course of anti-HIV medication that needs to be taken daily over a course of a month. This is being made clear in the mass media and small media interventions within the programme. Pre-testing of the mass media campaign with gay men has shaped the final campaign message – that PEP is a month long course of anti-HIV medication that can have serious side effects.

No. It’s important to see PEP as just one possible HIV prevention tool. Although PEP can be useful at an individual level to prevent HIV infection, at a population level it is not going to significantly drive down HIV incidence. Many people who become exposed to HIV do not realise or imagine that they have done so – often because the person they had sex with did not know themselves that they have HIV. The fact that PEP needs to be taken very soon after exposure to HIV [within 72 hours] means that many people will not know or realise they have been potentially exposed to HIV until after this time. Additionally, it is important to realise the potential that PEP has for people who are in known sero-discordant relationships or partnerships [where one partner is known to be HIV positive and one known to be HIV uninfected] – it can be in such circumstances where PEP might be most beneficial.

Research contradicts the assumption that PEP increases sexual risk taking – especially when it is reinforced that PEP is not a ‘morning-after-pill’. No study shows an overall increase in risk-taking amongst those who have had PEP. Someone enquiring about having PEP [regardless of whether they are subsequently prescribed it] is then offered opportunities for counselling, information and interventions with potential to reduce their future sexual risk-taking. Many men who have taken PEP say their experience of being on a month-long course of anti-HIV drugs means they are less likely to take risks in the future.

No. There are strict prescribing criteria around who can get PEP. The new BASHH guidelines provide guidance for doctors on the circumstances when PEP might be given – these include the type of sex someone has had, whether they knew the HIV status of their partner and if the partner is from a population group or area with high HIV prevalence.

It’s important to draw a distinction between 1) PEP not being made available to an individual and 2) PEP not being available to anyone in an area.

1. Whether or not PEP is prescribed to an individual will up to the judgement of the prescribing doctor. Given the potential side effects of PEP and the need to ensure that it is given in circumstances when HIV exposure is likely to have occurred, doctors have to make a decision based on the evidence before them and the circumstances of the potential risk. PEP is not, and should not be, available ‘on demand’ under any circumstances. It is also worth noting that the new BASHH guidelines are just that – guidelines and recommendations – not rules or standards.
   
2. The organisations making up the CHAPS partnership believe there should be an increase in NHS services where PEP is available to gay men who have been sexually exposed to HIV. When PEP is currently not available, the CHAPS partnership is encouraging gay men’s projects and sexual health centres to develop local referral pathways [including availability at Accident and Emergency departments] and protocols to ensure local availability of PEP. Examples of how this has been done in other parts of England are included in the PEP Programme Implementation Pack.