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27 Mar 2003

very worried about transmission
last saturday while on a sexual encounter for the first time with a hooker in a brothel,the condom broke after i ejaculated.i didnt realise it could break so i carried on.however,after about a minute or so when i pulled out,i saw it was i am very worried that i might have caught far,there are no signs.but the lady thoroughly assured me that she was i safe,or should i be worried.i know by law,'these' prostitutes have to go for testing regularly,but i'm still concerned.PLEASE DOC,HELP ME OUT HERE BY GIVING SOME ADVICE.IM REALLY DESPERATE.
Answer 422 views

01 Jan 0001

I'm not sure in which country you live, but there are no such "law" in South Africa that Sexworkers have to go and be tested regularly. In fact brothels are still illegal, under the Sexual offences Act of 1959. So forget about the "I am safe, because I tested last week.

Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking antiviral medications as soon as possible after exposure to HIV, so that the exposure will not result in HIV infection. These medications are only available with a prescription.

Workplace exposure: PEP has been standard procedure since 1996 for healthcare workers exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the exposure is from a "needle stick", when a health care worker accidentally gets jabbed with a needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace exposures by 79%. However, some health care workers who take PEP still get HIV infection.

Other exposure: In the last few years, community activists and researchers began asking why PEP shouldn't be used after HIV exposures that are not work-related. People can be exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they share needles for injecting drugs. Infants can be exposed if they drink breast milk from an infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one person became infected with HIV.

HIV exposure at work is usually a one-time accident. Other HIV exposures may be due to unsafe behaviors that can occur many times. Some people think that PEP might encourage this unsafe behavior if people think that PEP is an easy way to avoid HIV infection.
There are other reasons why PEP might not be a good idea for non-occupational exposure:

There is no research to show that PEP works for non-occupational exposure. We don't know how soon after exposure to HIV someone has to start PEP.
PEP is not a "morning-after pill". It is a program of several drugs, several times each day, for at least 30 days. PEP costs between R1500-00 and R3000-00.
For best results, you have to take every dose of every PEP medication. Missing doses could mean that you develop HIV infection. It could also allow the virus to develop resistance to the medications. If that happens they would no longer work for you.
The medications have serious side effects. About 40% of health care workers did not complete PEP because of the side effects.
Despite these concerns, a few cities are starting to offer PEP for non-occupational exposure. These programs include counseling to inform and encourage people to avoid exposure to HIV.

PEP should be started as soon as possible after exposure to HIV. The medications used in PEP depend on the exposure to HIV. The following situations are considered serious exposure:

Exposure to a large amount of blood
Blood came in contact with cuts or open sores on the skin
Blood was visible on a needle that stuck someone
Exposure to blood from someone who has a high viral load (a large amount of virus in the blood).
For serious exposures, the U.S. Public Health Service recommends using a combination of three approved antiviral drugs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC.

The most common side effects from PEP medications are nausea and generally not feeling well. Other possible side effects include headaches, fatigue, vomiting and diarrhea.

Post-exposure prophylaxis (PEP) is the use of antiviral drugs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79%.

The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviors.

PEP is a four-week program of two or three antiviral medications, several times a day. The medications have serious side effects that can make it difficult to finish the program. PEP is not 100% effective; it can not guarantee that exposure to HIV will not become a case of HIV infection.

CDC guidelines on PEP are on the Internet.

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