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'Morning-After' HIV Pills: Godsend or Disaster?

They used to be given only to health workers, but now so-called "morning after" pills for preventing HIV are available to the general public through Beth Israel Medical Center.

The four-drug cocktail, or one like it, could potentially save lives and prevent HIV infection if taken within 3 days of being exposed to the virus.

Dr. Gabriel Torres, the Beth Israel Medical Center Emergency HIV Treatment program's co-director, describes target patients.

"It will be in those situations where people are practicing safe sex and they have an accident that can happen to anybody--a condom slips off and breaks," he explains.

The emergency treatment, formally known as postexposure prophylaxis, or PEP, involves taking an average of eight pills a day for a month to prevent the virus that causes AIDS from invading the body's cells.

Under the program, patients are carefully screened by phone. Those who fit the profile are given an HIV test to make sure they are not already positive. Then they are prescribed a drug cocktail within 72 hours of exposure--ideally, within 24 hours for the best result.

Patients must take the drugs for 30 days and continue to have HIV blood tests until 3 months after exposure, at which time they are considered in the clear, provided they abstain from high-risk sex or intravenous drug use.

Since the hotline opened about 2 weeks ago, program coordinator Joseph Kassous says he's been getting eight to ten calls a day.

"Their state of mind is usually hysterical," he says. "[They're] panicking, afraid."

The emergency regimen is believed to be effective at preventing the virus in about 80% of cases. But some advocates, including those from the group Body Positive, which describes itself as a nonprofit community service organization dedicated to providing a self-help model of HIV/AIDS education, information, and support, worry its availability might increase unsafe sex.

"This gives them the out where they don't have to go out and use protection," says member Brian McGrath, "because they have something to fall back on the morning after, and that's definitely not a good thing."

Hotline manager Kassous says that concern is not without merit.

"I have a phone call this morning of a patient asking me to send him medication 'just in case,' so that when he decided to party, he can have this medication for the morning after," Kassous says.

Hotline representatives call that line of thinking irresponsible and stress there is no substitution for safe behavior.

The other concern is side effects. Even for a 1-month period, these drugs can cause debilitating bouts of nausea, diarrhea, and even hallucinations. The one thing everyone can agree on is that this treatment is a last resort but an important safety net.

Treatment costs $2,500 and not all insurances cover it.

The hotline number for Emergency HIV Treatment at Beth Israel Medical Center is 212-420-5657.
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