PEP (Post-Exposure Prophylaxis) must be started within 72 hours of a high-risk HIV exposure. In Texas, where LGBTQ+ specialist clinics are only in the major cities, knowing every access point is critical. The ER is your 24/7 safety net regardless of where you are in the state.
🚨 Where to Go Right Now
| Time / Location | Where to Go | What to Expect |
|---|---|---|
| Weekday daytime (Austin/San Antonio) | Kind Clinic | Same-day urgent PEP assessment. Call ahead: kindclinic.org |
| Weekday daytime (Houston) | Legacy Community Health | Call your nearest Legacy location. PEP-experienced clinical team. |
| Weekday daytime (Dallas) | Nelson-Tebedo / Resource Center | Call (214) 540-4455. PEP available same day for urgent exposures. |
| Evening / Weekend / Anywhere in Texas | Nearest hospital Emergency Room | EMTALA law mandates emergency assessment regardless of insurance. Say: "I need PEP for HIV exposure." |
| Remote / rural / no nearby ER | Telehealth (PlushCare / MISTR) | Some platforms can issue emergency PEP bridge prescriptions within hours. |
The clock is running from the moment of exposure, not from when the clinic opens. If it's a Sunday night in a rural area, drive to the nearest ER. Do not wait.
🗣️ What to Say at the ER
Texas ERs can be inconsistent with sexual health expertise. Be direct and specific so you get triaged correctly.
- "I've had a potential HIV exposure and I need Post-Exposure Prophylaxis — PEP."
- State the timeline: "The exposure was [X] hours ago. The window is 72 hours."
- Be explicit about the exposure: type of sex, condom status, partner's HIV status. The doctor needs these clinical facts.
Under EMTALA (federal law), ERs must provide emergency medical assessment regardless of your insurance status or ability to pay. PEP for HIV exposure qualifies. Do not let fear of a bill stop you from going. Billing is resolved after the fact—your life is not.
💊 The Medication & What to Expect
Standard Texas PEP regimen: Truvada (TDF/FTC) + dolutegravir (Tivicay) or combined tablet Dovato.
- ERs will issue a 3-to-5-day starter pack. You must follow up at Kind Clinic, Legacy, or Nelson-Tebedo the next business day for the full 28-day course.
- PEP is a strict daily 28-day regimen. Do not stop early.
- Side effects (nausea, fatigue, diarrhea) peak in week 1. Ask for anti-nausea medication.
💲 Cost & Coverage
| Route | Cost |
|---|---|
| ACA Insurance | Covered; check your copay |
| Uninsured (ER) | EMTALA mandates emergency care. Bill is resolved after. Do not let cost deter you. |
| Gilead Advancing Access | Free PEP medication for uninsured patients; Kind Clinic and Legacy can enrol you |
| Texas ADAP | Covers HIV treatment for eligible patients (not PEP directly, but can bridge to ongoing care) |
Kind Clinic has a PEP financial assistance programme. If you're uninsured and can get to Kind Clinic, call ahead and specifically ask about PEP assistance—they have experience navigating this for patients in the Medicaid gap.
📅 After PEP: Follow-Up
After the 28-day course, return for confirmatory HIV testing:
- 45 days post-exposure
- 90 days post-exposure (definitive)
After PEP, discuss starting PrEP to prevent the next emergency.
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