'This Is a Public Health Failure': New York City's Troubling Silence on Morning-After HIV Meds

Published: July 22, 2013

Last Wednesday, in scorching midday heat, about twenty members of the longtime HIV/AIDS activist group ACT UP held a protest in front of Mt. Sinai Medical Center’s entrance at Madison Avenue and 100th St., their shirts soaked in sweat. They carried posters reading “Why Didn’t Your E.R. Know About HIV Morning-After Drugs?” and “How Many More Infected Before You Get It Right?" Walking in a circle, they chanted: “What do we want? PEP on demand. When do we want it? Now!”
 
 Passersby, when I asked them, generally had no idea what PEP was. Nearby, Mt. Sinai staffers on their lunch break watched the protest impassively. “There was a mix-up that night,” said a female employee who asked not to be named. “We’ve never had a problem with this before.”
 
 Well, what is PEP? Short for "post-exposure prophylaxis," it is the practice of starting a month-long course of HIV meds within 72 hours of possible exposure to the virus to prevent permanent infection. In 2005, the U.S. Centers for Disease Control issued evidence of PEP’s effectiveness plus guidelines for PEP usage, and the New York State health department did the same in 2008 – and again as recently as this year – for ERs throughout the state, requiring them to administer PEP to medically qualified patients who request it.
 

The protest last week was a response to an incident involving a gay man who, according to ACT UP, went to the Mount Sinai Medical Center emergency room earlier this month after fearing he had been exposed to HIV during sex, asked for PEP, and had difficulty obtaining his starter dose. (The man wants to remain anonymous and ACT UP would not put me in touch with him.) As many as three Mt. Sinai ER staffers told the man there was no such treatment, says ACT UP, and it was only after the man called up the activist group, which then got in touch with a doctor with admitting privileges at Mt. Sinai, that the man was given PEP medication.
 
 Mt. Sinai, for its part, has issued a statement claiming that the man “promptly received his initial dose of medication. The patient has returned to Mount Sinai for follow-up care to ensure the treatment’s success.” Mt. Sinai also included portions of an email it said the patient later sent them: “At the ER after the initial confusion over talking to the right person, at one point I may have spoken to a janitor on accident, I was checked in I was given the medicine within 20 minutes and then referred to [your] clinic so I think they will handle my costs without a problem.”

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