Offering HIV prophylaxis to people who have been sexually assaulted: 16 months' experience in a sexual assault service

THE SEXUAL ASSAULT SERVICE, OPERATED BY THE CHILDREN'S & Women's Health Cen tre of British Columbia in partnership with the Vancouver General Hospital Emergency Department, started offering HIV prophylaxis in November 1996 to patients presenting to the emergency department after a sexual assault. In the first 16 months of the program a total of 258 people were seen by the s ervice, of whom 71 accepted the offer of HIV prophylaxis. Only 29 continued with the drug treatment after receiving the initial 5-day starter pack, an d only 8 compteteid the full 4-week treatment regmen and returned for their final follow-up visit. Patients at highest risk for HIV infection (those w ho had penetration by an assailant known to be HIV positive or at high risk for HIV infection [men who have sex with men, injection drug users]) were more likely to accept prophylaxis and more likely to complete the treatment than those at lower risk. Compliance and follow-up were the main problems with implementing this service. Service providers found it difficult to giv e the information about HIV prophylaxis to traumatized patients. After this program evaluation, the service changed its policy to offer HIV prophylaxi s only to people at high risk of HIV infection. This targeting of services is expected to make the service providers' jobs easier and to make the prog ram more cost-effective while still protecting sexual assault victims again st HIV infection.