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. Massachusetts has 24/7 access points, and the ER is your fallback at any hour.
🚨 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 (Boston) | Fenway Health Urgent Care | Call (617) 927-6400. Fastest specialist route. Can start same-day. |
| Weekday Daytime (Statewide) | Nearest FQHC or sexual health clinic | Call ahead to confirm PEP is available. |
| Evenings / Weekends / Anytime | Nearest hospital Emergency Room | EMTALA ensures assessment regardless of insurance. |
| Anytime (Telehealth) | PlushCare / MISTR | Emergency telehealth PEP consultation available 24/7 in some cases. ⚠️ Note: Ensure the provider calls a 24-hour pharmacy to confirm the medication is physically in stock before you travel to pick it up. |
Do not wait for a convenient time. Every hour reduces PEP's effectiveness. The absolute legal maximum is 72 hours. Go directly to a clinic or ER.
🗣️ Navigating Triage
Whether at a clinic or ER, explain the situation clearly.
- 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. Massachusetts hospital ERs (Mass General, Brigham and Women's, BIDMC, etc.) have clinical protocols for PEP. Use precise language.
The Starter Pack: ERs typically provide a 3-to-5-day bridge supply. The follow-up is mandatory. You must follow up at Fenway Health or your FQHC the next business day to receive the full 28-day course and baseline bloodwork. Fenway Health has a dedicated PEP follow-up clinic and will often book your appointment when you get the starter pack at the ER.
💊 The Medication: What to Expect
The standard Massachusetts PEP regimen is typically Truvada (TDF/FTC) + dolutegravir (Tivicay), or the newer single-tablet combination Dovato.
- 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. Starting it and stopping early is worse than not starting it at all—it can drive drug-resistant HIV mutations if you were infected.
💵 Cost
- MassHealth: Free.
- ACA/Private Insurance: Covered; may have a copay. Gilead offers a co-pay card.
- Uninsured (ER): EMTALA law requires emergency care. Billing is resolved after. Do not delay over cost.
- Gilead Advancing Access: Free PEP medication for uninsured patients who meet income requirements.
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