PEP (Post-Exposure Prophylaxis) is a 28-day course of emergency HIV medication that must be started within 72 hours of a high-risk exposure. The sooner you start, the more effective it is. In California, access points exist 24/7—you do not have to wait until a clinic opens.
🚨 Where to Go Right Now
Your route depends on the time of day and where you are.
| Time / Location | Where to Go | What to Expect |
|---|---|---|
| Weekday daytime (SF) | SF City Clinic or UCSF Ward 86 | Call ahead. Specialists on site. Full 28-day course available. |
| Weekday daytime (LA) | LA LGBT Center Clinic | Same-day urgent care slots. Call (323) 993-7500. |
| Evening / Weekend / Any time | Nearest hospital Emergency Room | State EMTALA law requires ER assessment regardless of insurance. Say "I need PEP for HIV exposure." |
| Anytime (statewide) | PlushCare / MISTR / Nurx (telehealth) | Emergency telehealth PEP consultation. Can start a bridge prescription within hours. |
Do not wait until Monday. Every hour reduces PEP's effectiveness. If it's a weekend and your clinic is closed, go directly to the nearest hospital ER.
🗣️ What to Say at the ER
ER triage staff are not always sexual health specialists. Be precise so you are assessed quickly.
- State the urgency: "I've had a potential HIV exposure and I need Post-Exposure Prophylaxis — PEP."
- Give the timeline: "The exposure was [X] hours ago. I know I have a 72-hour window."
- Describe the exposure: Receptive anal sex without a condom, partner of unknown or positive HIV status, condom failure. Be direct. The doctor needs the clinical facts to prescribe correctly.
The Starter Pack: ERs will typically give you a 3-to-5-day starter supply of PEP and instruct you to follow up with a specialist clinic (SF City Clinic, LA LGBT Center, or your primary care doctor) the next business day to receive the remainder of the 28-day course and baseline blood tests.
💊 The Medication
The standard California PEP regimen is typically Truvada (TDF/FTC) + dolutegravir (Tivicay), or the newer single-tablet combination Dovato. Your prescribing clinician will choose based on availability and your kidney function.
- PEP is not a morning-after pill. It requires strict daily dosing for a full 28 days.
- Missing doses significantly reduces effectiveness.
- Common side effects: nausea, fatigue, diarrhea (often worst in the first week). Your clinic can prescribe anti-nausea medication.
💲 Cost & Coverage
| Route | Cost |
|---|---|
| Medi-Cal | Free |
| ACA Insurance | Emergency PEP is covered; may have copay depending on plan |
| Uninsured (ER) | EMTALA ensures treatment; billing is handled after. Do not let fear of cost stop you. |
| Gilead Advancing Access | PEP assistance programme for uninsured patients — request at the clinic |
California law prohibits ERs from turning away PEP candidates based on inability to pay. If billing is a concern, a financial counselor at the hospital will work with you after treatment begins—not before.
📅 After PEP: The Follow-Up Protocol
After completing the 28-day course, you must return for a confirmatory HIV test:
- At 45 days post-exposure (4th generation test)
- At 90 days post-exposure (definitive negative)
A negative test at the end of PEP does not mean you are cleared. Your HIV testing window is not closed until 90 days post-exposure. Do not donate blood during this period.
After the follow-up, talk to your provider about starting PrEP to prevent needing PEP again.
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