Comprehensive care and HIV prevention for survivors of sexual violence

Uptake to HIV Post-Exposure Prophylaxis in Haiti: Opportunities to Align Sexual Violence, HIV PEP and Mental Health.

Marc L, Honoré JG, Néjuste P, Setaruddin M, Lamothe NN, Thimothé G, Cornely JR. Am J Reprod Immunol. 2012 Dec 28. doi: 10.1111/aji.12053. [Epub ahead of print]

Sexual violence is a public health problem in Haiti, potentially augmenting HIV transmission. Reports from L'Hôpital de l'Université d'État d'Haiti (HUEH) suggest severe underutilization of antiretroviral post-exposure prophylaxis (ARV-PEP) among rape survivors. With a cross-sectional design using mixed methods, informational interviews were conducted with HUEH personnel to learn about post-rape service offerings. HUEH surveillance data were used to estimate the sexual assault reporting rate/100,000 and to examine the proportion of survivors receiving ARV-PEP within 72 hr, stratified by age (<18 years, ≥18 years). Informational interviews revealed that survivors were navigated through two hospital algorithms to receive post-rape care; however, <5% of victims sought mental health services. Surveillance data show that 2193 sexual assault survivors (adult and pediatric) reported a rape to HUEH personnel between 2004 through first quarter of 2010. Annual estimates suggest a twofold increase comparing cases in 2004 versus 2009. Between 2008 and 2009, uptake to ARV-PEP within 72 hr was lower for pediatric (38.4%; N = 131/341) compared with adult survivors (60.1%; N = 83/138) (χ(2)  = 18.8, P < 0.001). The prioritization of funding and comprehensive interventions that align sexual violence, HIV, and mental health is crucial to support the timely uptake to ARV-PEP.

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Editor’s notes: Survivors of sexual and gender based violence require biomedical interventions such as post-exposure prophylaxis of HIV (ARV-PEP) and other sexually transmitted infections. Sensitization and training of police and emergency room workers has increased the availability of ARV-PEP, though it is of concern that in a large urban hospital in Haiti PEP was not more widely utilized, and that the uptake was so low (38%) among children. Comprehensive services for survivors of sexual assault should include mental health services, both for immediate interventions as well as for long-term follow up. Hospital based surveys may be methodologically limited, but it is of concern that fewer than 5% of sexual assault survivors sought mental health services. The psychosocial service needs of such survivors should not be underestimated and planners need to take these needs seriously.

Latin America
Haiti
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