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HIV PEP After Rape and Sexual Assault

Medically Reviewed by Jennifer Robinson, MD on April 14, 2022

Rape and sexual assault affect over 450,000 Americans each year. And younger people, especially between ages 12-34, are at the highest risk for sexual violence. Besides the physical and emotional trauma, you may also be at risk for sexually transmitted infections such as HIV.

If you suspect HIV exposure, see a doctor or get medical attention right away if you can. To lower your risk of infection, ask your doctor if post-exposure prophylaxis (PEP) is an option for you.

What Is PEP?

PEP is a combination of three antiretroviral drugs that you take soon after a possible HIV exposure. It’s designed to prevent the virus from taking hold in your body and multiplying. But for it to be effective, you have to start to take it within 72 hours (3 days) of exposure, or it won’t work.

Every hour counts. The sooner you start this therapy, the better. This is because HIV takes root and infects your body very quickly – usually within 24-36 hours after exposure.

Who’s Eligible for PEP?

PEP may be right for you if you are HIV-negative and don’t know your attacker’s HIV status. But PEP should be taken only in emergency situations. It’s not meant for regular use if you’re frequently exposed to HIV.

If you seek medical attention within the 72-hour period after an incident like rape or sexual assault, your doctor will first do a rapid HIV test to check for your status. But because of the urgent nature of the drug, your doctor may start you on PEP without any delay if a test isn’t available.

The doctor will consider prescribing PEP for you if, during your assault, you came into contact with bodily fluids from a person who may have HIV through your:

  • Vagina
  • Anus
  • Eyes
  • Mouth
  • Skin with cuts or wounds, or a puncture from a needle stick

If you’re seeking PEP treatment after sexual assault or rape, hospitals or doctors should provide you with a 28-day supply of HIV PEP.

If you’re a minor, you don’t need a parent's or a guardian’s approval for the initial medication.

How Long Do You Need to Take PEP?

Usually, PEP contains a series of three drugs that you take over 28 days. It’s important not to miss any doses. If you do, the drug may not work as effectively.

The recommend preferred PEP regimen may include:

Your doctor may suggest an alternative PEP regimen if the regular treatment doesn’t work for you. This will include a combination of:

  • Tenofovir disoproxil fumarate (TDF), once daily
  • Emtricitabine (FTC), once daily
  • Darunavir (DRV), once daily
  • Ritonavir (RTV), once daily

While you take PEP, you’ll still need a series of HIV tests to check your status. The recommended timeline for follow-up tests after exposure are:

  • 30 days
  • 90 days

If you later test positive for HIV, or if the sexual offender is found to be HIV-negative, you may stop taking PEP.

How Well Does PEP Work?

If you don’t take PEP within the 72-hour window, it may not be as effective. But even if you do, there’s no guarantee that you won’t get HIV. Some research has shown that it lowers your risk for HIV by 80%.

A 2016 review by the CDC that looked at six studies found that out of 1,535 men who took PEP, 1,487 remained HIV negative. But 48 tested positive for HIV after sticking to the PEP regimen as prescribed. The status of 40 of these men was linked to ongoing exposure to HIV. Only 8 had HIV because PEP failed – a 0.5 percent failure rate.

Does PEP have Side Effects?

PEP is a safe course of therapy. Most people can tolerate it well. But about 40% of those who take PEP may have side effects that usually range from mild to moderate.

Common side effects include:

  • Nausea
  • Fatigue
  • Vomiting
  • Headaches
  • Diarrhea

In most cases, these side effects are treatable and aren’t life-threatening. If they’re serious, talk to your doctor before you stop taking PEP.

How Can You Pay for PEP?

In many states, PEP is covered by insurance, including Medicaid. But if you don’t have insurance, there are several assistance programs that can help cover the costs. Since your PEP regimen is prescribed after rape or sexual assault, you may qualify for partial or total reimbursement for PEP medicines and other health care costs. This is covered by the Office for Victims of Crime, which is funded by the U.S. Department of Justice.

If your insurance doesn’t cover PEP, your doctor may be able to connect you with medication assistance programs for free PEP through one of the drug manufacturers.

Show Sources

SOURCES:

AIDS Foundation Chicago: “You know about PrEP, but have you heard of PEP?”

CDC: “Post-Exposure Prophylaxis (PEP),” “PEP for HIV Prevention: FAQs.”

CDC Stacks: “Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016.”

HIV.gov: “Post-Exposure Prophylaxis.”

LA County Department of Public Health: “Post-Exposure Prophylaxis (PEP) FACT SHEET.”

Medscape: “What is the efficacy of HIV postexposure prophylaxis (PEP)?”

NY Office of Victim Services: “NEW LAW taking effect - FRE/HIV-PEP Update.”

RAINN: “Victims of Sexual Violence: Statistics.”

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