Decision-making in HIV post-exposure prophylaxis: insights from sexual assault survivors

Sexual assault is a pervasive issue, with an estimated 463,634 victims (age 12 years or older) each year. Sexual assault is directly linked to STIs and HIV transmission. The research team conducted a qualitative thematic analysis of 42 adult sexual assault survivors who had previously been recommended HIV Post-exposure prophylaxis (PEP). The qualitative analysis centered on exploring survivors' experiences with HIV PEP decision-making during the initial post-sexual assault healthcare visit. The sample included 35 females, 4 males, 1 transgender and 2 participants who did not report gender. Among the sample, 57% completed the full 28-day PEP prescription, 19% declined to initiate PEP and 24% discontinued. Analysis identified one central theme, patient-perceived provider education and communication practices, comprising three sub-themes: 1. provider communication and influence, 2. internalized shame, and 3. patient risk assessment and HIV risk assumptions. These findings demonstrate an urgent need to standardize and implement trauma-informed care to ensure supportive and effective communication between service providers and survivors seeking post-sexual assault care. Feeling supported, heard, and valued after experiencing a sexual assault can potentially improve healthcare visits and increase HIV PEP acceptance and subsequent adherence.