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Post-Exposure Prophylaxis for HIV: What, When and How?

I picked up the call from one of our HIV testing staff, who told me that someone had come to the clinic and needed post-exposure prophylaxis, or PEP, for HIV. Think of PEP as the equivalent of “Plan B,” but instead of stopping pregnancies, it stops HIV infection. I called the young man’s name in the lobby, and when we sat down in my office, I asked him what had brought him in for PEP. He looked at me with a puzzled expression. “I just came in today to get tested, and I didn’t know this was even an option.”

[See: Which Practitioner Do I See, and When?]

The “this” he referred to is something that’s sadly still little-known among the general public. Non-occupational post-exposure prophylaxis is typically a 28-day course of HIV medications taken by someone who is HIV-negative after a known exposure with a partner(s) who is HIV-positive or a high-risk encounter with a partner of unknown status. When started within 72 hours of the exposure, it’s over 80 percent effective at reducing the risk of HIV infection, according to the WHO’s fact sheet on PEP. It helps keep the virus from taking root in your body.

The more widely known version of PEP is occupational and is recommended after a work- or environment-related exposure, like a needle stick in a hospital or other exposures to bodily fluids. But the Centers for Disease Control and Prevention also recommends PEP for persons who have had a known exposure to an HIV-positive partner’s blood, genital secretions or other infectious bodily fluids, and on a case-by-case basis when the exposure was high-risk and the HIV status of the partner was unknown.

The patient who recently came in for testing had condomless sex and only learned afterward that his partner was HIV-positive. He knew that the person was on treatment for their HIV, but didn’t know for how long or how consistently they’d been treated. That put him at higher risk for transmission, because he didn’t know if his partner had an undetectable, and therefore untransmittable, viral load. Someone living with HIV who is taking effective antiretroviral medication will eventually achieve an undetectable viral load — the lowest possible number of copies of HIV virus in their system. A recent study of more than 1,000 couples with one partner HIV-positive and the other negative found no cases of HIV transmission among couples where the HIV-positive partner had an undetectable viral load.

[See: 16 Health Screenings All Women Need.]

High-risk exposures include condomless (or if the condom broke/slipped) anal or vaginal sex, sexual assault and the sharing of injection drug needles/equipment. You can evaluate the risk of different acts with this tool from the CDC. Regardless of how the exposure occurred, it’s essential to prioritize medical care as soon as possible to be evaluated for the need for PEP or other sexually transmitted infection treatments. Those treatments should be taken completely to be effective. Unfortunately, figures from the World Health Organization noted that only 57 percent of people who started PEP completed the month (which is crucial to its success), and that only 40 percent of sexual assault victims were given PEP.

My recent patient appened to come to our clinic within the 72-hour window for accessing PEP, despite not having known about it. He met with a doctor that afternoon and left with a month’s worth of PEP medication. But for every patient who accesses PEP when medically needed, there are cases of HIV transmission that could have been prevented if only more people knew about PEP. So if you, a friend or family member finds themselves in a situation like my patient did, please contact your nearest medical facility about PEP.

[See: 10 Lessons From Empowered Patients.]

The best place to seek PEP is the emergency room at your local hospital. Some urgent care centers and walk-in clinics offer PEP, as well; many of these are in urban areas. If you’re in the greater District of Columbia area and in need of PEP, contact Whitman-Walker Health at 202-797-4439, or 1-800-465-9551 outside of normal business hours.

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Post-Exposure Prophylaxis for HIV: What, When and How? originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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