Offering HIV Prophylaxis to People Who Have Been Sexually Assaulted: 16 Months' Experience in a Sexual Assault Service
[ER Wiebe, et al. Canad Med Assoc J 2000;162:641]

The authors report their experience with a project completed in the Sexual Assault Service in the Vancouver General Hospital Emergency Department. The Service began offering HIV prophylaxis in November 1996 for victims of sexual assault. During the first 16 months there were a total of 258 patients seen. Of these, 71 accepted the HIV prophylaxis, 29 continued treatment after completing a five-day starter pack, and eight completed the four-week course of treatment. After this initial experience, the Service decided to offer HIV prophylaxis only to those with a high risk for HIV infection.
Comment: The use of HIV prophylaxis for victims of sexual assault is controversial. The CDC does not recommend this on the basis of mathematical modeling, which showed that it is not cost-effective. The obvious counter argument is that the benefit demonstrated in health care workers should be offered to sexual assault victims regardless of cost. This study tends to show a relatively low rate of compliance, with only 40% completing more than five days of treatment. By contrast, the experience in San Francisco with patients who actually sought prophylaxis in the context of an HIV exposure showed that over 80% completed the four-week course of treatment. JGB, 5/8/2000