“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault

Abstract

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients ( N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.

Psychosocial Health Factors Among Men Reporting Recent Sexual Assault

“…The overall high rate of side effects is consistent with other work on HIV PEP (Abrahams & Jewkes, 2010; Garcia et al, 2005; Inciarte et al, 2020; Krause et al, 2014; Leal et al, 2016; Sonder et al, 2010; Vetten & Haffejee, 2005, 2008). Although the U.S. Centers for Disease Control and Prevention (CDC) updated their HIV PEP Guidelines in 2016 (CDC, 2016) to include medication regimens with more tolerable side-effect profiles before data collection for this study, it is apparent that PEP and associated side effects still interfere with sexual assault survivors' daily life (Abrahams & Jewkes, 2010; Draughon Moret et al, 2021).…”

“…The parent-study survey included several measures to assess factors known in the literature to be associated with HIV PEP acceptance and adherence or HIV medication adherence more broadly (Draughon, 2013;Draughon et al, 2014Draughon et al, , 2015Draughon & Sheridan, 2012;Draughon Moret et al, 2016, 2021. These were organized in domains adapted from the theory of reasoned action/theory of planned behavior: personal factors, cognitive factors, mental health, barriers, and facilitators-all of which contribute to behavioral intentions (decision to initiate HIV PEP) and downstream to ultimate behaviors (completion of HIV PEP; Draughon, 2013;Montaño & Kasprzyk, 2008).…”

“…a n = 68 questions only asked for participants who initiated HIV PEP. b Original Article is apparent that PEP and associated side effects still interfere with sexual assault survivors' daily life (Abrahams & Jewkes, 2010;Draughon Moret et al, 2021).…”

Postexposure prophylaxis (PEP) of HIV among adults

“…In a qualitative interpretive study, 11 participants who were sexually assaulted were interviewed to explore their understanding of HIV PEP and to uncover the barriers and facilitators of HIV PEP acceptance and adherence in this population. Decision-making was affected by elements of losing and reclaiming control 18. Adherence to PEP regimens has been found to be markedly lower among sexual assault victims 13,18.…”

“…18 Adherence to PEP regimens has been found to be markedly lower among sexual assault victims. 13,18 NPs are pivotal in improving adherence to PEP through education and follow up. Patients are more likely to adhere when they understand the indications and mechanism of the medications they are prescribed.…”