Skip to main content

Advertisement

SpringerLink
Log in

The use of HIV post-exposure prophylaxis in forensic medicine following incidents of sexual violence in Hamburg, Germany: a retrospective study

  • Original Article
  • Published:
Forensic Science, Medicine and Pathology Aims and scope Submit manuscript

Abstract

In Hamburg, Germany, the initiation of HIV post-exposure prophylaxis (HIV PEP) in cases of sexual violence is often carried out by forensic medical specialists (FMS) using the city’s unique Hamburg Model. FMS-provided three-day HIV PEP starter packs include a combination of raltegravir and emtricitabine/tenofovir. This study aimed to investigate the practice of offering HIV PEP, reasons for discontinuing treatment, patient compliance, and whether or not potential perpetrators were tested for HIV. We conducted a retrospective study of forensic clinical examinations carried out by the Hamburg Department of Legal Medicine following incidents of sexual violence from 2009 to 2016. One thousand two hundred eighteen incidents of sexual violence were reviewed. In 18% of these cases, HIV PEP was initially prescribed by the FMS. HIV PEP indication depended on the examination occurring within 24 h after the incident, no/unknown condom use, the occurrence of ejaculation, the presence of any injury, and the perpetrator being from population at high risk for HIV. Half of the HIV PEP recipients returned for a reevaluation of the HIV PEP indication by an infectious disease specialist, and just 16% completed the full month of treatment. Only 131 potential perpetrators were tested for HIV, with one found to be HIV positive. No HIV seroconversion was registered among the study sample. Provision of HIV PEP by an FMS after sexual assault ensures appropriate and prompt care for victims. However, patient compliance and completion rates are low. HIV testing of perpetrators must be carried out much more rigorously.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organization. Guidelines for medico-legal care for victims of sexual violence. Geneva: World Health Organization; 2003.

    Google Scholar 

  2. Resnick H, Monnier J, Seals B, Holmes M, Nayak M, Walsh J, et al. Rape-related HIV risk concerns among recent rape victims. J Interpers Violence. 2002;17:746–59.

    Article  Google Scholar 

  3. Deutsche AIDS-Gesellschaft. Deutsch-Österreichische Leitlinien zur Postexpositionellen Prophylaxe der HIV Infektion. 2013. http://www.daignet.de/site-content/hiv-therapie/leitlinien-1/Deutsch_Osterreichische%20Leitlinien%20zur%20Postexpositionellen%20Prophylaxe%20der%20HIV_Infektion.pdf. Accessed 21 Jun 2017.

  4. Robert Koch Institut. HIV/AIDS in Deutschland – Eckdaten der Schätzung. Epidemiologische Kurzinformation des Robert Koch-Instituts Stand: Ende 2015. 2015. https://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Epidemiologie/Daten_und_Berichte/Eckdaten.html. Accessed 14 Jul 2017.

  5. Welch J, Mason F. Rape and sexual assault. BMJ. 2007;334:1154–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schröder AS, Hertling S. Medizinische Versorgung von Opfern sexualisierter Gewalt. In: Grassberger M, Yen K, Türk EE, editors. Klinisch-forensische Medizin. Vienna: Springer Vienna; 2013. p. 357–66.

    Chapter  Google Scholar 

  7. Landovitz RJ, Currier JS. Clinical practice: postexposure prophylaxis for HIV infection. N Engl J Med. 2009;361:1768–75.

    Article  PubMed  CAS  Google Scholar 

  8. Tsai CC, Emau P, Follis KE, Beck TW, Benveniste RE, Bischofberger N, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72:4265–73.

    PubMed  PubMed Central  CAS  Google Scholar 

  9. Schmiedel S, Hertling S, Degen O, van Lunzen J, Polywka S, Seifert D, et al. Postexpositionsprophylaxe bei Gewaltopfern. Hamb Ärztebl. 2009;63:35–6.

    Google Scholar 

  10. Seifert D, Anders S, Franke B, Schröder J, Gehl A, Heinemann A, et al. Modellprojekt zur Implementierung eines medizinischen Kompetenzzentrums für Gewaltopfer in Hamburg. Rechtsmedizin. 2004;14

  11. Müller ARE. HIV Postexpositionsprophylaxe in der Rechtsmedizin. Dissertation. Hamburg: Universität Hamburg; 2012.

  12. Hamburger Bürgerschaft. Gesetz zum Schutz der öffentlichen Sicherheit und Ordnung, SOG, §15(4). 1966.

  13. Draughon JE, Hauda WE, Price B, Rotolo S, Austin KW, Sheridan DJ. Factors associated with forensic nurses offering HIV nPEP status post sexual assault. West J Nurs Res. 2015;37:1194–213.

    Article  PubMed  Google Scholar 

  14. Draughon Moret JE, Hauda WE, Price B, Sheridan DJ. Nonoccupational postexposure human immunodeficiency virus prophylaxis: acceptance following sexual assault. Nurs Res. 2016;65:47–54.

    Article  PubMed  Google Scholar 

  15. Limb S, Kawsar M, Forster GE. HIV post-exposure prophylaxis after sexual assault: the experience of a sexual assault service in London. Int J STD AIDS. 2002;13:602–5.

    Article  PubMed  CAS  Google Scholar 

  16. Linden JA, Oldeg P, Mehta SD, McCabe KK, LaBelle C. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med. 2005;12:640–6.

    Article  PubMed  Google Scholar 

  17. Loutfy MR, Macdonald S, Myhr T, Husson H, Du Mont J, Balla S, et al. Prospective cohort study of HIV post-exposure prophylaxis for sexual assault survivors. Antivir Ther. 2008;13:87–95.

    PubMed  Google Scholar 

  18. Olshen E, Hsu K, Woods ER, Harper M, Harnisch B, Samples CL. Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims. Arch Pediatr Adolesc Med. 2006;160:674–80.

    Article  PubMed  Google Scholar 

  19. Templeton DJ, Davies SC, Garvin AL, Garsia RJ. The uptake of HIV post-exposure prophylaxis within a sexual assault setting in Sydney, Australia. Int J STD AIDS. 2005;16:108–11.

    Article  PubMed  Google Scholar 

  20. Wiebe ER, Comay SE, McGregor M, Ducceschi S. Offering HIV prophylaxis to people who have been sexually assaulted: 16 months’ experience in a sexual assault service. Can Med Assoc J. 2000;162:641–5.

    CAS  Google Scholar 

  21. Krause KH, Lewis-O’Connor A, Berger A, Votto T, Yawetz S, Pallin DJ, et al. Current practice of HIV postexposure prophylaxis treatment for sexual assault patients in an emergency department. Womens Health Issues. 2014;24:e407–12.

    Article  PubMed  Google Scholar 

  22. Chacko L, Ford N, Sbaiti M, Siddiqui R. Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis. Sex Transm Infect. 2012;88:335–41.

    Article  PubMed  Google Scholar 

  23. UNAIDS. Regional factsheets: Western and Central Europe and North America 2016. HIV and AIDS estimates. 2016. http://aidsinfo.unaids.org/. Accessed 25 Oct 2017.

  24. Bundeskriminalamt. PKS 2015 - Vergewaltigung und sexuelle Nötigung. Hamburg. 2015. https://www.bka.de/DE/AktuelleInformationen/StatistikenLagebilder/PolizeilicheKriminalstatistik/PKS2015/InteraktiveKarten/04VergewaltigungSexNoetigung/04_VergewaltigungSexNoetigung_node.html. Accessed 21 Jul 2017.

  25. British Association for Sexual Health and HIV. UK Guidelines for the use of HIV post-exposure prophylaxis following sexual exposure (PEPSE) 2015. 2015. https://www.bashh.org/documents/PEPSE%202015%20guideline%20final_NICE.pdf. Accessed 21 Jul 2017.

  26. Centers for Disease Control and Prevention. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. CDC Stacks. 2016. https://stacks.cdc.gov/view/cdc/38856. Accessed 21 Jul 2017.

  27. Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005;54:1–20.

    PubMed  Google Scholar 

  28. Vernazza PL, Kashuba ADM, Cohen MS. Biological correlates of sexual transmission of HIV: practical consequences and potential targets for public health. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2002;45:277–85.

    Article  PubMed  CAS  Google Scholar 

  29. Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;1:CD003255.

    Google Scholar 

  30. Jin F, Jansson J, Law M, Prestage GP, Zablotska I, Imrie JCG, et al. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS. 2010;24:907–13.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Royce RA, Seña A, Cates W, Cohen MS. Sexual transmission of HIV. N Engl J Med. 1997;336:1072–8.

    Article  PubMed  CAS  Google Scholar 

  32. Kersh EN, Henning T, Vishwanathan SA, Morris M, Butler K, Adams DR, et al. SHIV susceptibility changes during the menstrual cycle of pigtail macaques. J Med Primatol. 2014;43:310–6.

    Article  PubMed  PubMed Central  Google Scholar 

  33. UNAIDS. HIV prevalence in men who have sex with men. AIDSinfo. 2016. http://aidsinfo.unaids.org/. Accessed 20 Jul 2017.

  34. Hösl J. Rechtliche Rahmenbedingungen der HIV-Postexpositionsprophylaxe in Deutschland. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2000;43:S26–30.

    Article  Google Scholar 

  35. Ford N, Mayer KH. World Health Organization guidelines on postexposure prophylaxis for HIV: recommendations for a public health approach. Clin Infect Dis. 2015;60:S161–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Jennifer Barrett, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Legal Medicine, University Medical Center Hamburg–Eppendorf, Butenfeld 34, 22529, Hamburg, Germany

    Julia Ebert, Jan Peter Sperhake & Ann Sophie Schröder

  2. Outpatient Center, Department Infectiology, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Olaf Degen

Authors
  1. Julia Ebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Peter Sperhake
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olaf Degen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann Sophie Schröder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann Sophie Schröder.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ebert, J., Sperhake, J.P., Degen, O. et al. The use of HIV post-exposure prophylaxis in forensic medicine following incidents of sexual violence in Hamburg, Germany: a retrospective study. Forensic Sci Med Pathol 14, 332–341 (2018). https://doi.org/10.1007/s12024-018-9985-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-018-9985-7

Keywords

Search

Navigation