Sexual Assault Survivors' Barriers to Accessing and Completing HIV Prophylaxis

Purpose: The risk of human immunodeficiency virus (HIV) transmission increases from a penetrative sexual assault by an HIV infected person or someone whose HIV status is unknown (CDC, 2016; WHO, 2007). nPEP is a series of antiretroviral medications that must commence within 72 hours of a potential exposure to reduce the likelihood of HIV transmission, thus, widely recommended for sexual assault survivors (CDC, 2016; WHO, 2014). However, studies report low rates of medication (nPEP) adherence. Sexual assault forensic examiner (SAFE) programs provide specialized care for sexual assault survivors, which sometimes include HIV preventative care such as HIV risk assessment and nPEP education and referral (Draughon et al., 2014). Focusing on an urban SAFE program, the current study examines potential barriers that survivors may encounter while accessing and completing the 28-day nPEP regimen.

Method: Using a qualitative case study framework, ten semi-structured interviews were conducted with SAFEs about the barriers encountered by their patients with accessing, accepting, and completing nPep. Utilizing Creswell’s (2017) method of case analysis, two analysts developed initial codes, then identified patterns and relationships among the codes, which led to thematic formation. The analysts compared and discussed the meaning of the thematic codes, and revised the coding framework until consensus was reached. Next, the researchers utilized analytic induction to finalize the results by returning to the data to assemble confirming evidence of the themes (Patton, 2015).

Results: This study identified multiple potential barriers. The SAFEs reported that their patients do not always receive a prescription by a physician and have difficulty locating a local pharmacy which stocks nPEP. Several participants pointed out that survivors are coping with a recent assault and worried that they might become emotionally overwhelmed while trying to access nPEP and forego the medication. Survivors without insurance must complete additional steps to access nPEP and may be at higher risk of becoming overwhelmed and subsequently cease their efforts. Finally, participants noted concern that the 28-day nPEP regimen might serve as daily reminders of the assault, which, in turn, might serve as triggers whereby a survivor experiences unwanted emotions associated with the assault.

Implications: This study highlights that medication adherence is a complex process for sexual assault survivors and may involve multiple potential barriers of nPEP completion. The current study suggests emotional distress may serve as a significant barrier. Social workers are well-suited to help survivors navigate the steps to obtain nPEP while also helping them manage their acute distress while completing the 28-day nPEP regimen and beyond. However, most services for survivors are limited to crisis intervention during a medical forensic exam, legal advocacy, and counseling. Thus, health-related advocacy and intervention is often a gap in services. The authors will discuss these implications for social workers filling this service gap.