A Qualitative Exploration of Sexual Assault Patients' Barriers to Accessing and Completing HIV Prophylaxis

Sexual assault patients may encounter barriers when accessing, accepting, and completing nonoccupational postexposure prophylaxis (nPEP), such as lacking insurance or an understanding of nPEP. However, less is known about how sexual assault forensic examiner (SAFE) programs' protocols, approaches to discussing nPEP, and community resources may influence nPEP completion. Utilizing a qualitative case study framework, we conducted semistructured interviews with 10 SAFEs from an urban SAFE program in which emergency department physicians write prescriptions for nPEP before sending patients to the SAFE program. The participants identified barriers encountered by their patients, ranging from emergency department providers inconsistently offering prescriptions for the correct medication, to difficulty locating a local pharmacy stocking nPEP. The SAFEs also expressed concern that uninsured patients had to complete additional steps to access nPEP, while feeling overwhelmed by the immediacy of their assaults. Several participants raised concern that patients' emotional distress and fear of acquiring HIV may impede their ability to comprehend information and access nPEP. Participants also noted that the 28-day nPEP regimen might be a daily reminder for patients of the sexual assault. The SAFEs identified multiple strategies for discussing HIV and nPEP with these patients. Implications of the SAFE's role in reducing barriers are discussed.