The HIV Morning-After Pill

Introducing the best FDA-approved, commercially available lifesaver you’ve never heard of

Illustration: Thom Sevalrud

Fight disinformation: Sign up for the free Mother Jones Daily newsletter and follow the news that matters.


One winter night in 2000, Danny, who was 21 at the time, went home with a guy he met at a crowded bar in San Francisco. Random hookups weren’t out of the ordinary for Danny, but this one ended badly: As he was buttoning up to go home, his new friend mentioned he was hiv positive. Usually conscientious about safe sex, Danny hadn’t been, and he panicked. “I was in shock,” he says. “I just couldn’t believe it.” He vaguely remembered reading about an emergency treatment that could prevent infection, so when he got home he called the California aids hotline. Memory served. A monthlong regimen known as post-exposure prophylaxis treatment (pep)—usually given to health care workers who have been stuck with needles—was available at local clinics and emergency rooms to people who had recently been exposed to hiv. The side effects of debilitating nausea and fatigue were a small price to pay for its potential benefits: A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the virus.

Danny went to a city clinic, where after a consultation, he was given a prescription for two antiretroviral drugs—the same kind that hiv-positive patients have taken since the ’80s. As preventative medicine, the drugs work with a one-two punch: The first intercepts the virus’ initial attachment to dna, and the second stops infected cells from spreading the virus.

Danny was lucky that California is one of the few states (along with New York, Massachusetts, New Mexico, and Rhode Island) where policies ensure that the general public—not just hospital workers who have been exposed on the job—can access the drugs. Elsewhere, the decision is up to individual hospitals, clinics, and doctors. Surveying all 50 state health departments and more than 50 ERs nationwide, I encountered std clinicians and workers at aids hotlines and Planned Parenthoods who did not know pep could be prescribed to the public. An Alabama health department official told me, “It’s not available.” A nurse at a North Dakota clinic said he all but encouraged patients to fly to San Francisco.

Since the virus must be intercepted before it attaches to cells and reaches the lymph nodes, it is crucial that pep be administered immediately—each passing hour means decreased effectiveness.

“It needs to be treated like a gunshot wound or a stabbing,” says Antonio Urbina, a medical director at St. Vincent Catholic Medical Center’s hiv clinic in New York City. Yet of the largest hospitals in each state, only a quarter offer pep in their emergency rooms. In a 2005-06 cdc survey taken at gay pride parades around the country, less than 20 percent of hiv-negative respondents knew about pep. “When I tell people that I used it, they say they’ve never heard of it,” says Danny. “You see signs about crystal meth or syphilis, but even in the gay publications, you never see ads for pep.”

pep is fda approved, commercially available, and even often covered by insurance (though for the uninsured the drugs run upward of $1,000). In 2005, the cdc recommended that pep be administered to all patients on a case-by-case basis within 72 hours of a high-risk exposure, followed up by testing and counseling. But for reasons that are more political than scientific, there is no federal funding for the treatment. Some public health officials claim that public availability of pep will encourage risky behavior—the same argument used against RU-486, abortions, and condom distribution. Robert Janssen, director of the Division of hiv/aids Prevention at the cdc, explains, “Biomedical interventions raise concerns that people would feel, ‘Oh, I have these pills, they will keep me from getting it.'”

Yet 73 percent of non-hospital-worker pep recipients in a San Francisco study decreased high-risk sex over the following year. And since pep drugs are so toxic, most doctors would be careful about overprescribing. “I’m concerned with two things,” says Urbina. “Is the person that exposed them either hiv positive or at high risk for hiv, and is there potential contact with infectious body fluid? If both are yes, in my equation, you give pep.” Peter Leone, medical director of North Carolina’s hiv department, who hasn’t received the necessary support to institute a public pep program in his state, believes the benefits of pep outweigh the risks. “Nationally, there is a ‘Don’t Ask, Don’t Tell’ policy,” he says. “We’re okay to say it’s a good idea, as long as we don’t know about it and don’t do anything to support it. We don’t deny care to smokers or people who didn’t buckle their seat belts. It says a lot about the political climate around sexuality and homophobia.” For the 40,000 people infected with hiv in the United States each year, the knowledge of a lost opportunity for prevention is devastating. In Britain, an hiv-positive couple has filed suit against the government for withholding lifesaving information.

Two months after he finished his treatment, Danny tested negative for hiv—whether because he hadn’t contracted the virus from the encounter or because the pep worked, he’ll never know. Since a randomized clinical trial is unethical, researchers have to rely on observational and tangential research. “At least if you test positive after pep, you’ll know you did everything you could,” says Danny. He keeps his medication label as a token of how a little bottle may have saved his life.

Find out if HIV morning-after therapy is available in your state.

or


AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with The Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with The Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate