Postexposure Prophylaxis

• Pages: 31-33

Contenidos

• The Issue.
• Legal and Policy Considerations.
• Practice Examples.
• References.

Page 31

The Issue

Postexposure prophylaxis (PEP) can be an important tool to prevent HIV transmission. Available evidence suggests that prophylaxis given immediately after exposure to HIV reduces transmission rates. PEP is most commonly employed for occupational HIV exposures in health care settings (health care workers or patients exposed to HIV during treatment or while handling bodily materials) and victims of sexual assault who may be exposed to HIV by their attackers. The anti-retroviral medicines used for prophylaxis can have a range of side effects of varying seriousness. Since there is urgency in the administration of PEP, the law should be clear on the rights of exposed persons and on who may be subjected to HIV testing and under what circumstances.

Legal and Policy Considerations

Laws and policies should facilitate rapid and targeted PEP for those who may have been exposed to HIV. A standard approach is to guarantee access to PEP for certain categories of possibly exposed persons, including health care workers and rape victims. Joint WHO/ILO guidelines on HIV suggest that medications for PEP (as well as voluntary, confidential counseling and testing) should be available at health service workplaces for immediate administration in the event of an exposure. Policies typically do not guarantee access to post exposure prophylaxis to other potentially exposed persons outside of these designated categories.

The debate surrounding prophylaxis policies focuses on whether PEP should be offered to all persons who potentially have been exposed to HIV, or whether PEP should only be provided if certain risk factors have been met. Since PEP should be administered very soon after the exposure, many laws and policies encourage access to PEP without first requiring HIV testing of the person or sample implicated as the source of the potential exposure. Indeed, many health experts have strongly supported the provision of universal PEP as a precautionary approach in cases where there is a high likelihood of HIV transmission and the identity-and HIV status-of the perpetrator is not known. Proposals that recommend universal PEP access for all potential HIV exposures must counsel potentially exposed persons on the side effects of the treatment, explain the risks of foregoing treatment, and account for the costs associated with post exposure prophylaxis...