Post-Exposure Prophylaxis (PEP) is an emergency course of HIV medication that must be started within 72 hours of a potential exposure. The sooner you start, the more effective it is. Do not wait for Monday morning if the clock is ticking.
🚨 Where to Go Right Now
Your route depends on the day of the week and the time of day.
| Time / Day | Where to go | What to expect |
|---|---|---|
| Weekday business hours | NYC DOHMH Sexual Health Clinics, Callen-Lorde, or Evergreen (Upstate) | Fastest, most competent care. They understand PEP protocols intimately and will help with financial assistance if needed. |
| Nights & Weekends | Hospital Emergency Room (NYC Health + Hospitals) | ER doctors must provide PEP if indicated. NYC public hospitals are accustomed to these requests. Be prepared to wait behind acute trauma cases. |
| Any time | Telehealth (e.g., Mistr, PlushCare) | Only use telehealth if they guarantee same-day pharmacy dispatch. If they must mail it, the 72-hour window may close. |
Avoid standard urgent care clinics (like CityMD) for PEP if possible. They often lack the required baseline HIV tests, may not stock a starter pack, and frequently send patients to the ER anyway, wasting critical hours.
🗣️ Navigating ER Triage
If you go to a hospital ER, you are entering a high-pressure, general emergency environment. To ensure you are triaged correctly and efficiently, you need to use clear, explicit language. Do not downplay the risk out of embarrassment.
- Use the terminology: Say, "I have had a high-risk exposure to HIV and I need an emergency assessment for PEP."
- State the timeline: "The exposure was [X] hours ago. I know I have a 72-hour window."
- Be direct about the exposure: State exactly what happened (e.g., receptive anal sex without a condom, partner of unknown HIV status).
The provider will run a rapid HIV test (PEP is only for HIV-negative people) and check your kidney function.
The Starter Pack: ERs and clinics will often give you a "starter pack" containing the first 3 to 7 days of medication directly from their pharmacy before you leave. Regardless of how many pills you receive, you must follow up with a clinic to get the rest of your 28-day prescription.
💊 The Medication: What to Expect
PEP requires a full 28-day course of medication. The standard US PEP regimen usually consists of Truvada (or Descovy) taken alongside either raltegravir (Isentress) or dolutegravir (Tivicay).
- It is a strict regimen: PEP is not a morning-after pill. It is a mandatory 28-day course, and you cannot miss doses.
- Side effects are manageable: You may experience nausea, fatigue, or diarrhea, though not everyone does. The clinic will often prescribe anti-sickness medication alongside your PEP.
- Do not stop: Never stop taking PEP without speaking to a doctor first.
💵 Cost
A full 28-day course of PEP can cost over $2,000 out-of-pocket without coverage.
- Medicaid / Essential Plan: Covers PEP entirely.
- Private Insurance: Typically covers PEP, subject to your standard pharmacy copay.
- Uninsured: Ask the clinic or hospital to help you apply for emergency assistance. The manufacturer programs (like Gilead's Advancing Access) offer emergency PEP vouchers that can cover the cost entirely if you have no coverage. The social worker or clinical navigator at an LGBTQ+ center or public hospital is best equipped to process this rapidly.
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