This study identified and developed recommendations for addressing systemic and distress barriers faced by sexual assault patients in accessing and completing HIV preventative treatment.
Little is known about how the protocols of sexual assault forensic examiners (SAFE) programs influence sexual assault victims’ access to, acceptance of, and completion of non-occupational post-exposure prophylaxis (nPEP). This effort to obtain such information involved interviews with SAFEs from an urban program regarding systemic and distress barriers to completion of nPEPs for sexual assault patients. The interviews determined that these patients encounter both system-related and stress-related barriers to nPEP. Systemic barriers include the inconsistent offering of prescriptions for the correct medication, patient difficulty in locating a local pharmacy that stocks the necessary treatment, and uninsured patients who must complete additional steps to access treatment. Patient stress-related barriers to completing patient nPEP include fear of acquiring HIV, additional concern added to the emotional distress of the victimization, and the 28-day nPEP regimen that reminds a patient daily of the consequences of the sexual assault. Systemic barriers can be reduced by providing appropriate SAFE team personnel with written guidelines for when, what, and how to communicate with sexual assault victims about HIV risk and nPEP procedures, medications, and dosages. Stress-related barriers can be reduced by waiting to discuss HIV and nPEP until rapport has been established with the patient and the patient is less stressed by the victimization. The realistic risk of HIV should be addressed without exacerbating fear of exposure.