Re: Post exposure prophylaxis: Where are we now?

April 10, 2006

Dear FORUM,

Indeed, I do not understand why such protection should not be made available to

sexually assaulted individuals! In fact WHO is advising such PEP for rape cases.

during all the training sessions of capacity building many resource persons are

emphasizing on the sensitization of the society so that the raped individual

immediately seeks for the PEP.

I have been working on this issue for many years, however, the response from the

society as well as HCP is discouraging.

Most of the raped individuals, particularly females are reluctant to lodge a

complaint as they are concerned about their defamation. This has lead to the

victim's silence. But if the society is made aware of the risk of HIV after rape

and the PEP victim should look for, victims will look for such treatment.

However, in this, the medical practitioners or officers should not insist on

police complaint.

Dr. Nishikant Shrotri

E-mail: <nishparna@...>

April 11, 2006

Dear Forum,

Access to Post exposure prophylaxis (PEP) for women who have survived sexal

violence, is an extremely critical issue demanding immediate action.

The possibility of being infected with the HIV virus is an added trauma for the

rape victim. So far, when media reports instances of rape, the links to HIV/AIDS

are hardly ever made. Public information messaging on HIV needs to link these

issues.

In addition to sensitization, the practical problems need to be addressed.

Ironically, from the legal point of view, the victim is told that s/he must not

wash, bathe or change clothes, in order to preserve evidence of rape.

However, for protection from possible HIV infection, the victim needs to wash

immediately and be administered PEP. Rape usually happens in violent, isolated

and unsafe situations where the victim is hardly in a position to access

immediate medical assistance or justice.

It is of prime importance to include information, sensitization and a set of

things that need to be done immediately (including availing of PEP) after rape

occurs, in all interactions with and resource material for law enforcement

agencies, women's groups, human rights groups, groups working with men...

NACO and the SACS need to work with public health care institutions and the

police to provide PEP for such cases.

Revathi Narayanan

E-mail: revathi@...

April 11, 2006

Dear Forum,

I somehow do not agree at all with the guidelines of NACO in terms of PEP only

to be provided to Health Care workers during occupational hazards for needle

stick injuries and sharp injuries. Instead I think PEP Kits should be made

available for general community at large and special focus needs to be given to

provide the PEP kits to rape victims esp. during the emergency/natural

calamities situations like Flood, Drought etc.

Also seeing the poor reporting status from SACS to NACO for PEP, we may conclude

that even the health care workers are not accessing these services.

We all understand that Health care workers like nurses, lab.technicians are more

at risk for PEP but this does not at all mean that services of PEP should be

limited to this particular population only.

Thanks and regards

Kavita Singh

E-mail: <kavitakirti@...>

April 13, 2006

Dear Forum members

I too agree that we should scale up to provide PEP to rape victims.

People or NGOs working on child sexual abuse or on child and women trafficking

are unaware that PEP is there for those who have expereinced penetrative sexual

abuse . But beofre that we must ensure that PEP is available for medial group

and PEP registers are used as a system among medical people. Still may private

practitioners are unaware of this.

Dr.Manorama

e-MAIL: <pmanorama@...>

April 13, 2006

Dear FORUM,

While PEP should be made available to those who have had a non occupational

exposure, I would like to sound a note of caution. I do not think " PEP kits "

should be made availabe for the general community.

This is because, PEP is not without its risks and toxicities. It needs to be

prescribed under supervision and monitored for compliance, side effects and

resistance.

It is pertinent to point out that a large number of hospital staff who have

been prescribed PEP for occupational exposure have defaulted on completing the

course of medication due to these factors.

Kits availabe to the community could see an upsurge in the emergence of

resistant strains of the virus and toxic side effects that would not be spotted

early.

Dr Deepak Batura

E-mail: <d_batura@...>

April 15, 2006

Dear Forum,

Theoretically, it looks to be a sound thought to make PEP kits available to

general population. However, while working in society, I have found curiosity

among the people to use PEP protections as a routine like using condom.

Just as we say abortion cannot be a substitute to contraception practices,

similarly PEP should not be used as a routine protection after promiscuous sex

or unprotected sex. PEP can never and should never replace ABC of safer sex.

Whenever I have discussed this issue of PEP for rape cases, which I strongly

advice and advocate, the response, interest and the curiosity of general public,

particularly those engaged in high risk sexual behavior was to explore its

possibility for routine use after unprotected 'Risky' sex.

To avoid this and such misuse of PEP, I strongly oppose its availability to the

general public. Still I fee, NACO should revise its scope and widen the