Human Immunodeficiency Virus (HIV)

  • Health care personnel should provide patients with information regarding the risks of HIV, the risk of contracting HIV from the sexual assault, and options for baseline and follow-up testing. The risks of contracting HIV from sexual assault are affected by similar factors to those described under Sexually Transmitted Infections.
  • If the assault is considered to be a high risk for HIV exposure, a baseline HIV status may be indicated and should be obtained as soon after the assault as possible. The patient should then be tested periodically as directed. HIV testing should be performed in settings where counseling can be offered to explain results and implications.
  • Written consent is not required for an HIV test. Patients can opt out of the test if it is offered.
  • Patients should be directed to testing services that are free, anonymous, and confidential. HIV testing should be performed in settings where counseling can be offered to explain results and implications. In some circumstances, HIV testing may be performed at the time of the initial sexual assault exam and evidence collection (see below for more information).
  • The need for HIV prophylaxis, a 28 day cycle of HIV medication that may help prevent the transmission of the virus, should be assessed by the examiner and discussed with the patient. When considering prophylaxis, clinicians and patients should assess how much time has passed since the exposure occurred, the probability that the assailant is HIV positive, the likelihood that transmission could occur from the assault, and the prevalence of HIV in the community in which the assault took place (e.g., a prison). The use of post-exposure therapy must balance the potential benefits of treatment with other factors including possible adverse side effects and toxicity, the need for frequent dosing and follow-up care, the importance of compliance with therapy, and the estimated costs of the medication and monitoring. If possible, an HIV specialist should be consulted. CDC recommendations should be utilized for medications and dosing.
  • If HIV prophylaxis is appropriate, the examiner may initiate a three-day course of medication until the patient is able to attend a follow-up appointment for further assessment for the continuation of the medication.
  • See Appendix J of the Guidelines for more information about how to help patient’s access nPEP.

 

Baseline Testing Recommendations

  • Baseline testing for HIV that is done at the time of the examination or within a few weeks of the assault only tells a patient if she or he was infected with HIV prior to the assault. HIV antibodies will not be evident for 3 – 6 months after the time of infection.
  • Following a possible exposure to HIV, testing is recommended at 6 weeks, 3 months, and 6 months. All sexual assault patients should be told about the need for follow-up testing and provided with referral information at the time of discharge.
  • The decision to test for HIV at the time of evidence collection should be made on an individual basis and is not appropriate for all patients. The following factors impact the appropriateness of immediate testing and should be discussed with sexual assault patients:
    • Sexual assault patients typically present to a health care facility in a state of crisis. This could impact a patient’s ability to provide informed consent to the HIV test.
    • If HIV testing is done at the time of evidence collection, results could end up in the patient’s medical records and be billed through the patient’s insurance company.
    • HIV tests administered in hospital emergency departments are typically expensive and will not be paid for as part of the costs of collecting forensic evidence.
    • Some patients who present at a health care facility for evidence collection may have limited interactions with health care systems. For these patients, the time of evidence collection could be the best opportunity for them to learn their HIV status. The Centers for Disease Control (CDC) recommends routine, annual testing for all individuals between the ages of 13 – 64.
    • If the patient is exhibiting symptoms of HIV or another STI, testing should be done to diagnose and provide treatment.
    • Most emergency departments are not set up to provide appropriate pre- and post-test counseling. HIV tests should be administered in accordance with Connecticut law [CGS § 19a-582(c)], which requires counseling or counseling referrals that include:

      • Coping with the emotional consequences of learning the results
      • Discussion of the discrimination that could accompany disclosure of results
      • Behavior change to prevent transmission or contraction of HIV infection
      • Information about available medical treatments and medical services
      • Information about local or community-based HIV/AIDS support services agencies
      • Working towards the goal of involving a minor’s parents or legal guardian in decisions related to medical treatment
      • Regarding the need of the test subject to notify his partners and, as appropriate, provide assistance or referrals for assistance in notifying partners
      • The issue of baseline testing at the time of evidence collection is complicated and should be carefully discussed with the patient. For all patients, efforts should be made to ensure testing within 120 hours of the assault. If prophylaxis is prescribed, testing should be done within 72 hours.