HIV continues to be pandemic with an estimated 56,000 new HIV infections in the United States (US) in 2006. The number of new HIV infections due to sexual assault is unknown, but young women, especially of color, are among the fastest growing groups contracting HIV. Sexual assault affects both men and women. Sexual assault presents several factors making transmission of HIV more likely such as: lack of condom use;infliction of genital and/or anal trauma;concurrent sexually transmitted infections (STIs);and multiple and/or unknown assailants. Non-occupational post-exposure prophylaxis (nPEP) for sexual assault remains controversial in the US. However, nPEP is recommended as standard practice internationally, especially in areas of high sexual assault with greater rates of HIV such as in South Africa. The proposed mixed methods study will address the following specific aims, hypotheses and research questions:
Aim 1 : To compare the frequency and factors related to offering nPEP to sexual assault patients by Sexual Assault Nurse Examiners (SANE) in urban settings.
Aim 2 : To identify predictors of acceptance and adherence to nPEP post- sexual assault. Hypothesis 2.1: Survivors with depression and/or trauma symptoms will be less likely to complete nPEP than those with lower levels of these symptoms. Research Question: Does intention mediate the relationship between cognitive/personal factors and the behavior - completion of nPEP? Hypothesis 2.2: Survivors who have higher perceptions of HIV risk will be more likely to accept and complete nPEP than those with lower perceptions of HIV risk. Hypothesis 2.3: Survivors with higher levels of social support will be more likely to complete nPEP than those with low levels of social support.
Aim 3 : To explore the perceptions of a sub-sample of sexual assault survivors of the experience in SANE clinics after assault care, including: reactions to discussion of nPEP;attitudes and understanding related to HIV and nPEP as well as barriers and facilitators to nPEP acceptance and adherence.
The intersection of HIV and gender based violence requires greater understanding and scrutiny as young men and women of color are among the fastest growing groups infected by HIV;these same groups are also at highest risk for sexual assault, which may increase HIV transmission. This study aims to determine factors and predictors of sexual assault survivor acceptance and adherence to HIV nPEP in an effort to determine the current utility of nPEP as a public health intervention through surveys and in-depth interviews. A greater understanding of sexual assault survivor's perceptions of nPEP will influence development of future interventions to decrease HIV.
