Sexual assaults may put the victim at risk for contracting HIV. There is a medication available that acts as a prophylaxis after potential exposure to the virus. This medication is commonly referred to as nPEP (Nonoccupational Postexposure Prophylaxis). While this medication is available, it is not always accessible to every victim.
The most common barrier is that most victims do not immediately seek help after a sexual assault. Because of fear, feelings of shame or doubt, or not knowing where to turn, few people will reach out to a medical provider right away. nPEP needs to be started very soon after the assault for the drug to take effect. This does not mean that victims should not seek medical attention if they waited. It may mean that nPEP will not be recommended.
Another barrier to getting nPEP is that healthcare providers do not always assess for risk of contracting HIV. Having a SANE exam does not even guarantee it. This is true even though assessing for risk of HIV is a standard for sexual assault forensic exams. Advocates must work to educate healthcare providers on this standard to ensure that victims have access to nPEP. Providers should also train on how to assess for risk and counsel victims on testing and the side effects of the drug.
Unless the identity and HIV status of the alleged assailant has been clearly established to assist with the decision-making, PEP should be promptly initiated and should not be delayed while awaiting test results from the alleged assailant. (HIVGuidelines.org)
The cost of nPEP is another major barrier. The medication is very expensive and victims who do not have the financial resources to pay for it or information on alternative payment options may simply opt out. nPEP is also a very difficult regimen on the body and has many side effects. Victims who have access to social support are more likely to complete the entire nPEP regimen.
In some settings victims are told that they need to cooperate with police before they can have the drug. This is not true. People who can benefit from nPEP should be able to take it even if they do not want a rape kit. In some cases this barrier is also tied to having the cost of nPEP covered by victim’s compensation. Addressing these types of barriers will require increased cross-system collaboration and major systems advocacy.
Although many mainstream health organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend access to the drug, many barriers exist. A group of national victim advocacy organizations recently released a position statement on this issue discussing these barriers and the research on nPEP in more depth. Increasing access to the best possible care for victims of sexual assault will require advocacy around HIV assessment and medication. To learn more, read the position statement and the Applied Research paper on sexual violence and reproductive health.
What barriers to obtaining nPEP have you encountered in your advocacy work? Please share your experiences in overcoming or addressing those barriers.