My apologies if everyone knows about this already!

At my GUM clinic the other day and the lovely woman who worked there chatted to me about being an escort at length. She was delighted to hear about this site. She asked me to put this on a little information about medication called Post Exposure Prophylaxis (PEP), which is available upon request at many A&E departments in the UK, as well as GUM clinics. In its most basic terms, (and forgive my non-technical description) it is medication that flushes the human immune system with a huge dose of anti-HIV, and is available to those who believe they have come into contact with the virus in the past few hours.

The woman at the GUM said it is a priority of the NHS to give it to medical workers who have accidents with used needles in hospitals.  However, she said that should sex-workers have an accident at work with condoms or other barrier contraception, and have reason to believe that their client may have exposed them to the HIV virus (heaven forbid, but I suppose there are some people out there who may go around deliberately doing such a thing to sex-workers etc) then we should also be treated as priority cases if we go to our A&E departments or GUM clinics as soon as the accident occurs, and specifically request this PEP medication. She said that a sex-worker should be offered PEP without judgement, although I cannot vouch for the staff over the whole country, and have myself been unfortunate enough to meet judgmental people in the NHS as a sex worker, but nevertheless.....

The PEP medication works in a similar way to emergency contraception, in that the sooner after the event you take it, the more effective it is. She also asked me to make a point of saying that it was not a cure, but merely a very good preventative in any unfortunate event where we may need it, and has a good success rate (bearing in mind that there is no way of creating a control group with which to compare those who take it after an accident and those who don't, so take all of this into account.)

I am not wanting to preach, or indeed talk of wonder drugs which can cure HIV etc, but the woman at my GUM said that this PEP drug is not as well known as it should be, and that if there was one group of people she would want to know about it it would be sex-workers. Feel free to correct/expand upon what I have said if you know more about it, but hopefully it is a good start in knowing that there is something there to consider, should we ever be in such an unfortunate situation as to need it.

Blimey, that sounds awful- knew nothing about the false positives side of things, thanks for pointing this out Evie. Wow, trauma 

I don't know about the side effects etc, so I hope my post didn't seem like it was all "this is what can save you from HIV!" It is certainly not The Wonder Drug as far as I can tell.

The lady at the clinic made a point of saying it was definitely as case of only asking for PEP if you have strong reason to believe you have been in contact with HIV.  I guess the chance of PEP being needed in the first place is hopefully slim, and one would have a talk about the side-effects with the nurse/doctor before taking any.

But just thought it was something people could at least educate themselves about- I was shocked to even hear of its existence and thought my specialist subject on mastermind could have been "STIs and going to GUM clinics"!!

As has been said, this is a month's worth of anti-HIV drugs with significant side-effects for many. These are one of the reasons people tend not to have it more than once (one of the worries was that people would indeed do the sex, then get the drugs, then do the sex and.. but in this case 'ad nauseum' would be a cruel pun.)

Partly because of the cost, it is not handed out willy-nilly and there are guidelines that say whether doctors should prescribe it, consider doing so, or decline to do so. You won't get it for CIM, for example, unless you know the man is HIV+ (and even then, the chance of transmission is minimal) or from a high prevalence group (this usually translates as gay/bisexual or African) when it's a 'consider'.

Increasing awareness of the existence of this amongst gay and bisexual men is one of the undoubted successes of the CHAPS programme of work aimed at reducing HIV amongst that target group. Annoyingly the main otherwise useful 'microsite' on it, which has a 'what happened - here's the guidance' bit, doesn't deal with things like vaginal sex. (As far as the makers of the site are concerned, the sex gay and bisexual men have with women doesn't count.)

But for vaginal sex, it's 'recommended' if you know he's HIV+, 'considered' if he's from a high prevalence group, and 'no' if you know neither of these. I'd be surprised if some worried people don't fib about knowing more than they do, but even if he is HIV+, your chance of catching HIV is about one or two in a thousand, and given a general prevalence of about five in a thousand, that's about one in a hundred thousand chance in the latter case.

For anal sex, the risks are higher (if he's HIV+, it's about 1-3% chance of being infected) and it's 'recommended' if you know he's HIV+ or from a high prevalence group, and 'considered' if you know neither of these. Given that there's evidence that bisexual men have more anal sex with women than straight men, if I were female in this situation and wanted PEP, I'd be tempted to fib.

Like the 'morning after pill', the sooner you take it, the better, so if you've got cum in your bum, don't wait for an appointment, head off to A&E whatever the hour.

You have to be getting rammed in the ass with no lubrication; being bareback to increase your chances. However, it still isnt worth the risk to do it without condom any event.

Looking at 'receiving', there are other factors which increase the risk, primarily how much HIV is in his semen. This is particularly high just after he's caught it and before his body develops the antibodies most tests look for.

(Hence the rapid original spread in the gay scene in places like San Francisco and New York, given a culture of casual sex, and the opportunities for multiple partners in an evening, once a few people had it, lots were going to get it. One of the reasons UK infections were lower is that there weren't the 'on the premises' venues there are now.)

I may be misreading your meaning, but I also wonder if there's an aspect of being male looking at this, where the risk of anal sex is sooo much greater than oral (the argument goes on, but is still plausibly so near nil that anyone unlucky enough to catch it via CIM is probably already dead.) If you had a vagina, you might not see the risks of vaginal sex as so small, especially in this context.

Going with a 2% chance of infection for receptive anal sex, that's a one in three chance of infection after twenty times with someone who's HIV+. With a 0.2% chance for receptive vaginal sex, it goes up to two hundred times, but that's not that many weeks working...