HIV Basics
- According to the CDC, “HIV stands for human immunodeficiency virus. It weakens a person’s immune system by destroying important cells that fight disease and infection. There is currently no effective cure for HIV. But with proper medical care, HIV can be controlled.”
Stigma
- Today, there is still a fair amount of stigma around HIV. There is stigma in who is most likely to acquire the virus, which affects people’s likelihood of being tested or getting treated.
PEP
- PEP, post-exposure prophylaxis, is a combination of medications used to help prevent the acquisition of HIV, after a potential exposure. The medications work best when taken as soon as possible after the possible exposure, but must be taken within 72 hours. PEP must be taken daily for 28 days. While the likelihood of acquiring HIV is low, PEP is highly effective in preventing HIV. nPEP refers to a possible non-occupational exposure. The medications and treatment are the same as someone who had a possible exposure at work. In order for the medication to be prescribed, the survivor will need to have an HIV test to ensure the person doesn’t already have the virus. There are occasions when the medication will be prescribed without a test, so be sure to discuss this with the SANE or Emergency Department (ED).
PrEP
- PrEP, pre-exposure prophylaxis, is a combination of medications taken before an exposure to help prevent acquisition. It is prescribed to people who are at a higher risk of acquiring HIV. The medication is taken daily, and is highly effective in preventing HIV.
Hotlines
- There are national hotlines available to answer questions providers may have in accessing nPEP, as well as any questions on HIV.
- National PEP hotline: PEP:Post-Exposure Prophylaxis | National Clinician Consultation Center (ucsf.edu) : Non-occupational PEP: 9 am to 8 pm EST, Monday through Friday; 11 am to 8 pm EST, weekends and holidays
- HIV Consultation and Referral Services | Resource Library | HIV/AIDS | CDC
Access to Care/Payment
- The medications that make up nPEP are expensive. If the survivor does not have insurance, or their insurance doesn’t cover the medications, there are payment assistance programs available.
- Sexual Assault Forensic Exam | Wisconsin Department of Justice (state.wi.us) (SAFE Fund will assist in covering the costs of nPEP)
- Pharmaceutical Company Patient Assistance Programs and Cost-Sharing Assistance Programs for Pre-exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP) | NASTAD
- Paying for PEP | PEP | HIV Basics | HIV/AIDS | CDC
- Gilead Advancing
- Access® Medication Co-pay Coupon Card
- Home - Patient Advocate Foundation
- Homepage - PAN Foundation (currently closed, but keep on radar)
- Good Days | Effective Compassion | Copay Assistance (mygooddays.org) (Medicare/military only)
- NeedyMeds
Access to HIV Testing
- There are many places across the state where you can get an HIV test.
- Find an HIV Test | Testing | HIV Basics | HIV/AIDS | CDC (for condoms, PEP, PrEP, and HIV testing)
- Embed the widget on the website: (<divdata-cdc-widget="DynCombinedWidgets" data-component-name="Blue-EN"></div><script src="//tools.cdc.gov/1M1B"></script>)
- Find an HIV Test | Testing | HIV Basics | HIV/AIDS | CDC (for condoms, PEP, PrEP, and HIV testing)
HIV/nPEP Information for Advocates
Positive result counseling -
- If the HIV test result comes back positive, it means the person was exposed to HIV before the assault. The SANE should help with the next steps. However, here is some information to help inform the survivor of the possible next steps.
Provider Bias -
- We know there are stigmas and biases in the sexual violence field, and accessing medical care is no exception. There may be stigma around asking the survivor if they would like to be tested for HIV. There may be a need to suggest to the SANE that the survivor would like to be tested, or know the option is available.
- To Provide Patient-Centered HIV Care, Train on Implicit Bias (medscape.com)
- HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review (nih.gov)
- Provider Bias May Impact Patient Access to Care, HIV Prevention (patientengagementhit.com)
Side Effects and Misinformation -
- As with any medication, people may experience side effects while taking PEP. The SANE can discuss any concerns around potential side effects. It may be important to note that PEP is generally tolerated well by most people, and side effects may be temporary. Ask the SANE about a prescription to help with nausea, as well as other ways to mitigate other possible side effects.
SANE/Emergency Department (ED) –
- It is important to work with the SANE as much as possible to assist with medication payment, medication adherence and follow-up, advocate for the patient to get tested, and assist with access to medication. Be sure to ask about payment assistance programs and if they are familiar with the forms and the processes. Check to see if the hospitals in your area give out a “starter pack” for PEP, as some locations may give out a few days worth, giving the survivor time to access a pharmacy for the rest of the prescription. It is best to connect with your local SANE and/or ED to inquire about their protocol for HIV and PEP for forensic exams before you are called in to work with a survivor.
Medication adherence -
- Medication adherence is important when taking PEP as the medication is only effective at preventing HIV if the survivor takes the full 28 day course. Your role as an advocate can be helpful with this. We need to appreciate the effect that trauma has on memory and mental health. If your agency has a policy of checking in with survivors, add medication adherence to that check-in, along with helpful reminders.
Resources and Further Learning -
- WCASA hosted a three part webinar series on HIV, nPEP, and the Advocate’s role.
- Part One: HIV 101 webinar: HIV Basics Training for Sexual Assault Advocates - YouTube
- Part Two: PEP webinar: Biomedical Interventions for HIV Prevention Before and After Exposure - YouTube
- Part Three: Advocates webinar: HIV/PEP Advocate Webinar Series / PART 3: HIV and nPEP: An Advocate’s Role - YouTube
- Vivent Health: Serving all affected by HIV AIDS (viventhealth.org)
- WI Department of Health Services: Wisconsin HIV Program | Wisconsin Department of Health Services
- NSVRC Guide: Sexual Violence and HIV: A Technical Assistance Guide for Victim Service Providers
- National Protocol Examination Process -HIV Concerns - Sexual Assault Forensic Examiners
- Post-exposure prophylaxis for HIV infection in sexual assault victims (nih.gov)
- The First 72 Hours after a Sexual Assault are Critical for HIV Prevention | HIV.gov