Éditorial / Editorial

Research indicates that the medications used to treat an HIV infection can also be used to prevent a person who has been exposed to HIV from seroconverting, i.e., from becoming HIVpositive.Because it takes 48 to 72 hours before HIV is detectable in a person's regional lymph nodes, the immediate period after HIV exposure constitutes an important window when these medications can be used for HIV post-exposure prophylaxis (henceforth referred to as HIV PEP).While the evidence about this prevention strategy is far from perfect, research involving occupational exposures to HIV (e.g., needle-stick injuries), animal model studies for sexual exposure to HIV, and case reports indicate that HIV PEP induces an 80% reduction in HIV seroconversion after exposure to HIV.Accordingly, international recommendations suggest the use of HIV PEP in all cases of exposure to HIV, whether the exposure occurred through sexual contact or otherwise.Guidelines to structure this intervention exist in the United States, the United Kingdom, and Austalia.In Canada, however, no such guidelines for HIV PEP exist.Of even greater concern in the Canadian context is that HIV PEP is expensive, totalling approximately $1650CAD for the required 28-days of treatment.For individuals with private medical insurance that partially or completely covers pharmaceuticals, such costs are diminished.For example, a private insurance plan that covers 90% of medication costs still leaves a person paying $165CAD out-of-pocket.While this new figure is greatly improved, it may still constitute a significant enough barrier to prevent some persons who require HIV PEP from accessing a prevention strategy that will reduce their subsequent potential for HIV seroconversion.To alleviate such financial barriers to HIV PEP, in some jurisdictions, these medications are publicly funded; e.g., after occupational exposures.Another situation where HIV PEP is often dispensed without charge is sexual assault.In these situations, the person who was sexually assaulted is typically offered and provided with HIV PEP medications at no cost to them.However, unless it relates to a sexual assault, opportunities to obtain publicly funded HIV PEP are not afforded to gay, bisexual, and other men who have sex with men, notwithstanding the fact that, in Canada, nearly 50% of all new and previous HIV diagnoses involve a man who has sex with men.This situation constitutes not only an outright mismanagement of an effective HIV prevention strategy, but also it constitutes a blatant disregard for the health and wellbeing Éditorial/

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