The Office of National Statistics says that the year 2003 saw a 7% rise in
newly diagnosed HIV cases compared with 2002. Two-thirds of newly diagnosed
heterosexuals are women.
I agree with all comments so far which are very much in-keeping with DoH
guidance to healthcare workers on HIV Prophylaxis (revised Feb 2004). For
exposure from an unknown source, it says:
"If there has been a significant exposure and a source patient cannot be
identified, risk assessment should be on an individual basis. This will be
informed by a consideration of the circumstances of the exposure, and the
epidemiological likelihood of HIV in the source. In the vast majority of
such exposures, it would be difficult to justify the use of PEP."
If this advice were to be extrapolated to the general public, then who
should provide prophylaxis and counselling in the rare event, e.g. rape, or,
assault with a dirty needle, out of hours?
Does the last phrase in the above, "difficult to justify the use of PEP",
mean that prophylaxis should not be offered if the source is unknown?
Would the patient who agreed not to take PEP be making an informed choice if
the risks are played down?
Who is legally responsible if there was a failure or undue delay in starting
prophylaxis?
I remember a case of male rape that I dealt with one evening, as an SpR at
Chelsea Westminster, where the HIV Consultant advised that the patient
should commence the prohylaxis "starter pack" and attend a clinic the next
day for counselling and risk assessment. Is this what we should be doing?
Tony Adams
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