Key recommendations
- PEP risk assessment following an acute sexual assault should not generally differ from that of a consensual sexual exposure.
- Most victims presenting to Australian sexual assault services have suffered receptive penile-vaginal intercourse by a sole, presumed heterosexual man, the risk of which is estimated to be 1:3,000,000.
- An assessment for PEP should occur in situations where there is likely to be a risk of HIV acquisition from the assault, including:
- penile-anal assaults
- penile-vaginal assault when assailant is known or suspected to be from a high-prevalence country or an MSM
- assailants known to be HIV positive and known or suspected not to be either on antiretroviral therapy or viraemic.
- Consider referral for a forensic examination if less than seven days since the assault, but do not delay initiation of PEP if indicated.
- If victim raises concerns regarding HIV, they should be informed of the estimated risk. If low risk and victim still requests PEP, provide starter pack and arrange specialist follow-up.
- Offer emergency contraception to those with the potential to conceive.
Most sexual assault victims who present to medical-forensic services in Australia are women who have experienced vaginal penetration only by the penis of a sole, presumed heterosexual, male.110 The risk of HIV acquisition in such a situation is estimated to be 1: 3,000,000 (Appendix A: Table 7) and thus would not be an indication for PEP. In such situations, raising the possibility of HIV acquisition may have adverse psychological consequences for the already traumatised victim. A PEP risk assessment following an acute sexual assault should generally not differ from that following the same type of consensual sexual exposure.
Concerns have also been raised that anogenital or oral injuries from a sexual assault may further increase the risk of HIV acquisition. Given the very low risk of acquiring HIV from a receptive penile-vaginal assault, any additional increase in risk from anogenital injuries or other co-factors in a low HIV-prevalence and low viraemic population would not raise the risk estimate to that in which PEP would be considered.
An assessment for PEP should occur in situations where there may be a risk of HIV acquisition from the assault, including penile-anal assaults, penile-vaginal assaults when the assailant is known or suspected to be from a high-prevalence country or an MSM, and assailants known to be HIV positive and known or suspected not to be either on antiretroviral therapy or viraemic.
If a victim raises concerns regarding HIV, they should be informed of the estimated risk (Appendix A). If they are still anxious after being informed of an estimated (low) risk of transmission and still requesting PEP, the clinician should provide a starter pack and arrange specialist follow-up. People with the potential to conceive should be offered emergency contraception (refer to RACGP Australian Family Physician. Emergency contraception: oral and intrauterine options).87
People who present to a non-forensic healthcare facility seeking PEP following sexual assault should immediately be offered a referral for a forensic examination if within the forensic timeframe of no more than seven days.111,112 A healthcare worker with knowledge of the forensic examination should explain the reasons and benefits of a timely forensic assessment to the victim. However, PEP, if indicated, should not be delayed pending referral.
If the victim is under 16 years of age, refer to section: Children younger than 16 years of age.
