HIV PEP on Koh Phangan: What to Do in the First 72 Hours

What is PEP, and when do you need it ?

PEP, post-exposure prophylaxis, is a short course of antiretroviral medication taken after a possible exposure to HIV. It works by stopping the virus from establishing itself in the body during the first few days, before infection becomes permanent. It is an emergency treatment, and like most emergency treatments, it is most effective when it is started early.

You should be assessed for PEP if, in the last 72 hours, any of these happened:

• vaginal or anal sex without a condom, or with one that broke or came off, with a partner whose HIV status you do not know
• sex with a partner who is HIV-positive and not known to be on effective treatment
• sharing needles or other injecting equipment
• a needlestick or sharps injury from an unknown source
• sexual assault

If you are not sure whether what happened counts, come in anyway. The doctor can work out the risk with you in a few minutes, and an assessment you did not need costs far less than the treatment you missed.

Why the 72-hour limit is real

The 72-hour limit is not a bureaucratic rule. HIV takes some time to establish a permanent infection, and PEP works by interrupting it during that window. After 72 hours, the evidence that PEP helps falls away, so it is generally no longer offered. Within the 72 hours, earlier is better: a dose started at hour four does more than one started at hour sixty. That is why the advice is to come in today, not to wait and see.

Where can you get PEP on Koh Phangan ?

At our Haad Rin · Ban Tai clinic, 202/3 Moo 6, Ban Tai, 84280. We offer PEP and PrEP at all three island clinics, and the Koh Phangan clinic is open every day from 09:00 to midnight with no appointment needed. Call 077-374-668, or message on WhatsApp at wa.me/66836065265.

If it is after midnight, do not let the hour talk you out of it. Come in as soon as we open at 09:00, or go to a government hospital emergency department sooner if you can. On Full Moon Party night the Koh Phangan clinic stays open around the clock. A few hours' delay within the 72-hour window is far better than not starting at all.

What happens at the PEP visit ?

The visit is quick, private and practical. You will not be judged, and you will not be asked anything the doctor does not need to know.

1. Tell reception it is urgent and the exposure was recent. You will be seen promptly.
2. The doctor assesses the risk: what happened, when, and anything known about the other person.
3. A baseline HIV test is taken, to confirm you were negative before starting.
4. Other tests are taken as needed, often kidney function, hepatitis B and a pregnancy test where relevant.
5. The first dose is usually started at the visit, and you leave with your medication and clear instructions. The doctor explains the course and its cost before you start.
6. Follow-up is arranged, including HIV testing after the course ends.

Side effects, and how to finish the course

Modern PEP regimens are much easier to take than older ones. Some people feel mild nausea, tiredness or headache in the first days, and these usually settle. Finishing all 28 days is what matters most: stopping early can leave you unprotected. Set a daily alarm, keep the tablets with you, and if side effects bother you, come back rather than stopping on your own. Tell the doctor about any other medication you take, and if you are diving, mention it too.

After the course: the tests that confirm it worked

Finishing the 28 days is not quite the end. An HIV test about six weeks after the exposure, and sometimes again later as the doctor advises, confirms that PEP did its job. Until that result is back, use condoms with any partner. If you develop a fever, sore throat, rash or swollen glands during or soon after the course, come back and say so, because these can occasionally be early signs of infection and need prompt testing. Take your written records home, so a doctor there can carry on your follow-up if you have left the island.

What does PEP not cover ?

PEP only prevents HIV. The same exposure can carry a risk of other infections, and of pregnancy, which need their own steps.

• Pregnancy: emergency contraception works best when taken as early as possible, so mention it at the same visit
• Gonorrhoea and chlamydia: test from one to two weeks after the exposure
• Syphilis and hepatitis: test from three to six weeks after
• Hepatitis B: ask whether vaccination is needed if you are not already protected

If you find you need PEP more than once, ask about PrEP, which prevents HIV before an exposure happens.

If the exposure was not consensual

If you have been sexually assaulted, you can come to the clinic for care, privately and without being asked to report anything. The doctor can assess you for HIV PEP, emergency contraception, and treatment to prevent other infections, and can look after any injuries. Whether to involve the police is entirely your decision; the doctor can explain the options, including how evidence can be kept, without pressure. You can bring a friend with you. Above all, the same time limit applies to PEP, so please come in as soon as you can.

What to do right now — a quick decision guide

• Exposure in the last few hours → come to the clinic today
• Exposure 24 to 72 hours ago → still come today; PEP can still help
• After midnight → come in at 09:00, or go to a government hospital emergency department sooner
• More than 72 hours ago → PEP is no longer offered; plan testing and STI checks instead
• Needle or sharps injury → wash the area, then come in for assessment
• Already on PEP with side effects → come back to the clinic rather than stopping

For independent guidance, the World Health Organization HIV fact sheet covers PEP alongside testing and treatment.