Medical Care Services for HIV Negative, but at Risk

Who Should Be Tested for HIV?

People who engage in activities that put them at a high risk for HIV or whose partners engage in such activities should be tested for HIV on a regular basis.

Those who should get tested for HIV include:

  • Pregnant women
  • People who have sex without a condom
  • Men who have sex with men
  • People whose partners have HIV
  • People who use drugs with needles
  • People who have sex with more than one partner
  • People who have sex with people they don’t know

Pre-exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is a preventative option for people who do not have HIV, but are at a high risk of contracting HIV. PrEP is a pill taken daily and should be paired with other prevention methods such as using a condom.

The word “prophylaxis” means to prevent or control the spread of an infection or disease. PrEP is a pill that contains two medicines that are also used to treat HIV. If someone is taking PrEP and are exposed to HIV, PrEP will work to keep the virus from taking hold in the body.

PrEP is not a vaccine and does not work like a vaccine; it is a pill that is taken daily. The FDA-approved pill is called Truvada®, which uses a combination of the HIV medications tenofovir and emtricitabine to block the pathways that HIV uses to set up an infection.

People who should consider PrEP include anyone who:

  • Is in an ongoing relationship with an HIV-infected partner
  • Anyone having anal receptive sex without a condom (Gay, Bisexual, Transgender and Women)
  • Anyone having unprotected sexual activity (anal and vaginal)
  • Have injected illicit drugs and shared needles and paraphernalia within the last six months

Despite the effectiveness of PrEP, people who take PrEP should also use other HIV prevention strategies such as:

  • Using condoms consistently and correctly
  • Frequent HIV/STI testing
  • Encouraging sexual partners to have frequent HIV/STI testing
  • Choosing less risky sexual behaviors
  • Participating in a drug treatment program or Using sterile needles when injecting illicit IV drugs.

What is Post Exposure Prophylaxis (PEP)?

PEP is any prophylactic (preventive) treatment started immediately after exposure to blood or bodily fluid contaminated with a pathogen (such as a disease-causing virus), in order to prevent infection and the development of disease.

Although multiple diseases can be transmitted from exposure to blood, the most serious infections are hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. Fortunately, the risk of acquiring any of these infections is low.

In order to be exposed to a bloodborne pathogen, you must have contact with blood, a visibly bloody fluid (i.e., phlegm or urine containing blood), or another bodily fluid (i.e., semen or vaginal secretions) that contain an infectious organism (virus or bacteria). The blood or fluid must come in direct contact with some part of your body. A virus can enter your body through the bloodstream, open skin, or mucous membranes, which include the eye, mouth, or genitals. Contact with skin that is intact (without new cuts, scrapes, or rashes) poses no risk of infection.

Thus, exposure to a bloodborne pathogen is possible after:

  • A skin injury such as a needlestick or cut with a sharp object
  • Contact with a mucous membrane (including exposure through sexual intercourse, especially if an ulcer is present or vaginal/rectal tissues are injured)
  • Non-intact skin

Infected Blood and/or Bodily Fluid

Anyone who is exposed to potentially infected blood or bodily fluids should be tested for HIV at the time of exposure (baseline) and at six weeks, three months, and six months after exposure.

The baseline HIV test is necessary (and required) to document that the HIV infection was not already present at the time of the incident.  Experts from the United States Center for Disease Control recommend use of medications to reduce the risk of HIV infection if all of the following criteria are met:

  • Exposure occurred less than 72 hours previously
  • One or more of the following areas were exposed: the vagina, rectum, eye, mouth, or other mucous membrane, open skin, through the skin (i.e., from a sharp object or needle)
  • One or more of the following bodily fluids were involved in the exposure: blood, semen, vaginal secretions, rectal secretions, breast milk, or any body fluid that is visibly contaminated with blood.

However, the CDC also recommends that each situation be considered on an individual basis; preventive treatment may be recommended to people who do not meet these criteria in some situations.

The CDC recommends NOT using preventive treatment when:

  • The exposure occurred more than 72 hours prior
  • Intact skin was exposed
  • The bodily fluid is urine, nasal secretions, saliva, sweat, or tears, and is not visibly contaminated with blood
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FAQs

Wash the area. The first and most important step after being exposed to blood or bodily fluids is to wash the area well with soap and water. You can clean small wounds and punctures with an antiseptic such as an alcohol-based hand gel, since alcohol kills HIV, hepatitis B virus, and hepatitis C virus. However, the alcohol may sting. For mucosal surfaces (mouth, nose), the area should be flushed with copious amounts of water. Eyes should be flushed with saline or water. There is no evidence that expressing fluid by squeezing the wound will further reduce the risk of bloodborne infection.
Treatments are available to reduce the risk of becoming infected with HIV after exposure. Previous studies have suggested that the use of an anti-HIV medication, reduced the already low risk of healthcare workers becoming infected with HIV by about 81% (but perhaps a higher rate of prevention with the new anti-HIV agents available). The risk of becoming infected with HIV as a result of other types of exposure (i.e., trauma, rape) is probably even lower than the risk of infection after a needlestick.
Pre-exposure prophylaxis (PrEP) is recommended by the CDC to those who are HIV negative but are at a high-risk of being exposed to and contracting HIV.
Pre-exposure prophylaxis (PrEP) lowers the risk of contracting HIV by up to 92 percent for those who take the medicine consistently.

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