PEP (Post-Exposure Prophylaxis) is a 28-day course of emergency HIV medication. It must be started within 72 hours of a high-risk exposure (e.g., a condom break with a partner of unknown status), but the sooner you start it, the more effective it is. In Texas, where LGBTQ+ specialist clinics are only in the major cities, the ER is your 24/7 safety net regardless of where you are in the state.
🚨 Where to Go Right Now
Your route depends entirely on the time of day and where you are.
| Time / Day | 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. |
| Evenings / Weekends / Anywhere | Nearest hospital Emergency Room | EMTALA law mandates emergency assessment regardless of insurance. |
| Remote / Rural / No 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.
🗣️ Navigating Triage
Whether at a clinic or ER, explain the situation clearly. Texas ERs can be inconsistent with sexual health expertise, so be direct.
- At the ER Triage: "I've had a potential HIV exposure and I need PEP — Post-Exposure Prophylaxis."
- State the timeline: "The exposure was [X] hours ago. I know I have a 72-hour window."
- Be direct about the exposure: Explain exactly what happened (e.g., receptive anal sex without a condom) to help the doctor assess the risk. The doctor needs these clinical facts.
The Starter Pack: ERs will typically give you a 3-to-5-day starter supply of PEP. The follow-up is mandatory. You must follow up at Kind Clinic, Legacy, or Nelson-Tebedo the next business day for the full 28-day course. Do not miss doses or stop early.
💊 The Medication: What to Expect
The standard Texas PEP regimen is strictly a three-drug combination. This is typically Truvada (TDF/FTC) paired with dolutegravir (Tivicay), or the single-tablet combination Biktarvy.
- 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, particularly in the first week. The clinic can prescribe anti-sickness medication.
- Do not stop: Never stop taking PEP without speaking to a doctor first. An incomplete course does not protect you.
💵 Cost
- ACA Insurance: Covered; check your copay.
- Uninsured (ER): Under EMTALA (federal law), ERs must provide emergency medical assessment regardless of your insurance status or ability to pay. Billing is resolved after the fact.
- Gilead Advancing Access: Free PEP medication for uninsured patients; Kind Clinic and Legacy can enrol you.
- Texas ADAP: Covers HIV treatment for eligible patients (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.
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