sorry everybody
I have been sent a number of emails containing the word 'rape', these were
filtered out by the IT security service and returned as potentially
offensive. They have now been cleared and sent on to me.

On the subject of counselling for HIV prophylaxis we are going through the
process of negotiating a new protocol and we have insisted that a expert in
HIV be on call to offer advice as we recognise that this is outside our
field of experience.
paul

-----Original Message-----
From: Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR
[mailto:[log in to unmask]]
Sent: Tuesday, August 27, 2002 09:32
To: [log in to unmask]
Subject: Re: HIV and rape


> Where I work in Central London the virologists are telling us
> to give prophylaxis. If the patient requests it, and you
> refuse, and they subsequently sero-convert the law suit isnt
> worth thinking about. Its a risk benefit ratio, and after
> careful counseling, if the patient still insists you would be
> silly to refuse.

The trouble is that to counsel you have to be aware of the risks and
benefits- the likely prevalence of HIV in the population studied, the
likelihood of transmission, the likelihood of side effects of the drugs in
this particular patient.
There may be a few A and E consultants with sufficient experience of HIV
care (I'd imagine in parts of London and maybe Edinburgh or Dundee- although
I could be well out of date on this one) to counsel, but in general advising
a patient on a use of a combination of drugs that is not based on any
reasonable evidence, is unlicensed, and is a fast moving field should not be
done by someone with no previous experience of that drug. Refer to GU
medicine or ID. If there is no GUM on call covering your  hospital, raise
this issue with your managers- it's analogous to say cardiothoracic surgery
where a lot of us work in hospitals without the speciality on site, but if a
patient needs it and they can wait an hour (even if it's not ideal to do so)
we transfer them or bring the people in rather than opening the chest
ourselves.

In answer to the original question, my own view would be that the risks of
prophylaxis probably  outweigh the benefits. This is based on a previous
discussion with my local pox doc. However, as you say an individual patient
might view the risks and benefits differently. Of course, the patient needs
appropriate screening and treatment for other STDs (again, outside my
field).

Matt Dunn
Warwick


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