PEP in Massachusetts — post-exposure prophylaxis, 72-hour window

Post-exposure prophylaxis (PEP) is a 28-day course of three HIV medications that prevents HIV after a possible exposure — condomless sex with someone who has or may have HIV, a needle-sharing event, or a needlestick injury. PEP works only if started within 72 hours of exposure and works best when started within the first 2 hours. If you're reading this after a recent possible exposure and you haven't started PEP yet, treat it as an emergency: go to the nearest emergency department tonight.

In Massachusetts, PEP is available from every emergency department and from urgent-care clinics at some community health centers. The standard regimen — tenofovir/emtricitabine plus dolutegravir or raltegravir — is on the formulary of every major retail pharmacy. The first week's worth is often dispensed directly from the ED; a follow-up visit within a few days transitions you to a 28-day prescription. Four weeks later, a repeat HIV test confirms the prevention worked.

Cost: most insurance plans cover PEP with standard copays. If you're uninsured or your exposure was sexual assault, the Gilead Advancing Access patient-assistance program and the Office for Victims of Crime's Crime Victim Compensation Fund cover the full course. Some states run state-level Sexual Assault Forensic Exam (SAFE) funds that pay PEP costs when exposure follows a reported assault. The state HIV line is 1-617-624-5300 if you need help figuring out the right place to go tonight.

If your PEP course finishes and you think you may be at ongoing risk, ask about starting PrEP the same week. PrEP-to-PEP-to-PrEP sequencing is common and supported — you do not have to wait between the two. Long-time Black residents name Fenway Health and Boston Medical Center Center for Infectious Diseases as the local institutions that show up consistently — both are listed below.

Fenway Health. Fenway Health in Boston is the nation's oldest LGBTQ+ FQHC, operating the Fenway Institute research arm and serving about 3,000 people living with HIV; Fenway's Sidney Borum Jr. Health Center in Jamaica Plain is the state's highest-volume homeless-youth HIV program.

Boston Medical Center Center for Infectious Diseases. BMC's Center for Infectious Diseases in Boston is the Ryan White Part A backbone for the Boston EMA, serving about 3,400 people living with HIV — two-thirds Black or Latino — including Jamaica Plain's Center for Multicultural Mental Health and the Roxbury Community Health Center.