Risk of undiagnosed infection in men attending a sexual assault referral centre

Abstract

Objectives: To investigate men undergoing forensic examination at the Haven, a specialist centre for the management of sexual assault in south London. Methods: Forensic notes of 92 men attending the Haven from May 2000 to August 2003 were identified and a detailed review performed. Results: Males ranged in age from 12 to 51 years, with 83% within the range 12-35 years. 78% were white. Of those who were sexually active (n = 82) 30% were heterosexual, 34% were homosexual, and the remainder provided no information regarding sexual orientation. Most clients were referred by the police (n = 79) and attended within 3 days of the alleged assault (n = 73). Many of the victims had increased vulnerability to assault-for example, through alcohol or drug consumption or mental health difficulties. One assailant was reported in 61 cases but two or more assailants in 26. Women were reported as assailants in four cases. The sexual assault was frequently accompanied by other physical assault (n = 45). Use/threat of a weapon was reported in 18 cases. Rape or attempted rape was reported in 59 cases and was the most common assault. Non-genital injuries were documented in 37 men (40%). Anal injuries were seen in 31 (34%). The non-attendance rate at follow up was 41%. Post-exposure prophylaxis (PEP) against HIV was commenced in 31 men (34%). 23 of the 54 men (43%) reporting rape and 14 of the 31 (45%) with anal injuries initiated PEP. Conclusions: The number of men presenting after sexual assault is likely to increase but despite significant risk many do not engage with medical care. This carries an unknown risk of HIV and other STI transmission. 1 The Home Office concedes that these trends are ''unlikely to reflect the real experiences of such crimes.'' Although the true prevalence of sexual assault of men in the wider community is not known, one study in a general practice sample reported a 5% lifetime prevalence with 3% in adulthood.2 The Haven is a sexual assault referral centre (SARC) based within the sexual health directorate of a south London teaching hospital, providing forensic and medical services to victims of sexual assault. The aim of this study was to describe male clients attending the Haven for forensic examination and to investigate their subsequent medical follow up, as this patient population is poorly represented in the medical literature. Forensic examination occurs within 7 days of the assault in order to collect DNA evidence and to document injuries accurately. Clients may be referred by the police or by other medical services; they may also self refer. METHODSThe forensic notes of male clients aged 12 years or more attending the Haven from May 2000 to August 2003 were reviewed, focusing on their demographic characteristics, alleged assault, examination findings, and further management-data are missing where clients were unable to give this information. Where possible, comparisons have been made with unpublished data for women clients, using x 2 as a test of significance. RESULTS ClientsBetween May 2000 and Aug...

Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: A review

“…Internationally, two single-site studies found less than 10% of patients accepted the nPEP offer (Kerr, Cottee, Chowdhury, Jawad, & Welch, 2003;Templeton, Davies, Garvin, & Garsia, 2005). Acceptance by 20-60% of patients offered nPEP was found in three additional single-site studies (Diniz, Almeida, Ribeiro, & Macedo, 2007;Reeves, Jawad, & Welch, 2004;Wiebe, Comay, McGregor, & Ducceschi, 2000). And acceptance greater than 80% was found in the remaining four studies; two conducted at single sites (Garcia et al, 2005;Limb, Kawsar, & Forster, 2002), one inclusive of city-wide data (Sonder et al, 2007), and one regional (Carrieri, Bendiane, Moatti, & Rey, 2006).…”

“…Rates of nPEP acceptance for the remaining four US adult populations ranged from moderate (20-40%) in one state-wide, and one single-site study (Merchant et al, 2008;Myles, Hirozawa, Katz, Kimmerling, & Bamberger, 2000) to greater than 75% in two other single-site studies (Linden et al, 2005;Merchant et al, 2003). In the four studies concurrent to CDC (2005) guideline publication (see Table 5), Diniz et al (2007) 92 52 (57%) Garcia et al (2005) 278 169 (60%) Kerr et al (2003) 34 14 (41%) Limb et al (2002) 8 5 (63%) Reeves et al (2004) 31 3 (9%) Rey et al (2008) -53 (54%) Sonder et al (2007) 23 - Templeton et al (2005) 9 3 (30%) Wiebe et al (2000) 71 8 (11%) Studies with US populations conducted pre-CDC guidelines Linden et al (2005) 82 18 (22%) Merchant et al (2008) 35 - Merchant et al (2003) 34 - Moe and Grau (2001) 2 - Myles et al (2000) 69 26 (28%) Completed 1 week Pesola et al (1999) 2 - Straight and Heaton (2007) 846 -Note: xUnless otherwise noted. *Percentage reflects the number completing nPEP out of those who accepted nPEP.…”

“…Only three studies Myles et al, 2000;Olshen et al, 2006) were able to examine differences by race and/or ethnicity. Furthermore, only two studies were specific to male populations (Pesola et al, 1999;Reeves et al, 2004).…”

“…All data were retrospective except for the Canadian study Loutfy et al, 2008). In person, self-report 2-4 days, then at 2, 3, & 4 weeks 34% Forbes et al (2008) In person, self-report -50% Loutfy et al (2008) In person, self-report 2-4 days, then at 2, 3, & 4 weeks 31% Studies with pediatric specific populations conducted pre-CDC guidelines Babl et al (2000) In person, self-report 2 & 4 weeks, 3, 6, & 12 months 20% Girardet et al (2009) In person, self-report 2, 4, & 24 weeks 0% Merchant et al (2004) --- Neu et al (2007) Pill counts, self-report 1, 2, 4, 6, 12, & 24 weeks 27% Olshen et al (2006) In person, self-report 2 & 6 weeks, 3 & 6 months 11% Schremmer et al (2005) In person, self-report 4 appointments 24% Studies with international populations conducted pre-CDC guidelines Carrieri et al (2006) In person, self-report Range: 48 h to 3 months 51% Diniz et al (2007) --- Garcia et al (2005) -45 days, then 3 & 6 months 60% Kerr et al (2003) In person, self-report 3 days, further f/up implied 41% Limb et al (2002) In person, self-report 0, 3, & 6 months 62% Reeves et al (2004) In person, self-report -9% Rey et al (2008) In person, self-report 1 month 54% Sonder et al (2007) In person, self-report 3 days, then 2 & 4 weeks - Templeton et al (2005) In person, self-report -30% Wiebe et al (2000) In person, self-report 5 days, then at 2 & 4 weeks 11% Studies with US populations conducted pre-CDC guidelines Linden et al (2005) In person, self-report -22% Merchant et al (2008) --- Merchant et al (2003) --- Moe and Grau (2001) In person, self-report 1 visit - Myles et al (2000) In person, self-report 1 week 28% Pesola et al (1999) ---Straight and Heaton (2007) -3 months, 6 months 0.5% …”

“…Four studies reported the frequency of baseline HIV testing (Bechtel, Ryan, & Gallagher, 2008;Campbell et al, 2006;Merchant, Phillips, Delong, Mayer, & (2007) 172 - Garcia et al (2005) 347 278 (80%) Kerr et al (2003) 676 - Limb et al (2002) 150 10 (6%) Reeves et al (2004) 92 - Rey et al (2008) 98 -Sonder et al (2007) 29 - Templeton et al (2005) 146 117 (80%) Wiebe et al (2000) 258 -Studies with US populations conducted pre-CDC guidelines Linden et al (2005) 181 167 (92%) Merchant et al (2008) 780 610 (78%) Merchant et al (2003) 461 286 (62%) Moe and Grau (2001) 58 48 (82%) Myles et al (2000) 376 354 (94%) Pesola et al (1999) 27 - Straight and Heaton (2007) 179,149 -Note: *The percentage reflects the number of patients eligible out of the total sample size. Becker, 2008;Straight & Heaton, 2007).…”