Have you been raped? Report to an HIV centre immediately

Sep 19, 2006

I was told that people may need to go to health centres for post exposure prophylaxis for HIV.

Dear Doctor
I was told that people may need to go to health centres for post exposure prophylaxis for HIV. I would like to know what this means, what is normally done and where one can get such a service if needed
Regina.

Dear Regina,
Post exposure prophylaxis (PEP) refers to the use of antiretroviral drugs (ARVs) to try to prevent human immunodeficiency virus (HIV) infection after being exposed to the virus. For example when a doctor is pricked by a suturing needle during surgery, exposing him or herself to possible infection from his or her patient (occupational) or when a person is raped (non-occupational).
PEP is where ARVs are used when there is fear of having been exposed to HIV (secondary prevention) while primary prevention is preventing exposure to HIV, which is by far the most effective mechanism of preventing infection.
It is important that exposure is reported as soon as possible to a qualified and competent health care provider. The initial evaluation of the exposed individual should take place as soon as possible, preferably within 24 hours though this can be extended to 72 hours. Later than that, PEP may not help because the virus could have already started multiplying in the blood.
Before PEP is given, blood should be drawn from the individual to ascertain their HIV sero-status and if possible, blood should also be drawn from the source of the exposure. If the source of exposure is HIV positive, then the exposed person qualifies for PEP. If it is difficult to ascertain the sero-status of the source of exposure –– like in cases of rape where the rapist may not be found, then it is better to assume that source of the exposure is HIV positive and put the exposed individual on PEP. This of course is done if the exposed person was HIV negative because if they are positive then they should be counselled and prepared for Antiretroviral Therapy (ART).
In giving PEP, we use three drugs or ART such as combivir (Zidovudine + Lamivadine) plus Indinavir for 28 days. For health care givers who may get exposed during their line of duty, we at The Mildmay Centre can offer this service free if they report early. We would do the same for children who may be sexually assaulted or abused.
It is important that women, who often find themselves in compromising situations when they may be forced to have sex with people whose sero-status they do not know or being raped should know this.


Dear doctor,
My body itches but nothing shows on the skin. I do not know whether there are illnesses which start like that. Do you think I should go for HIV testing? What could this problem be? I have been having it for over four months. Please help.
Worried Aaron

Hello Worried Aaron,
It is possible for HIV to manifest itself as skin itching. A condition known as “prurigo”, where a person can get a very itchy skin rash, often occurs in what is clinically known as “second stage of HIV infection”.
However, what you describe as itchy skin with nothing appearing on the skin, could be caused by anything which irritates the skin.
You may need to visit a doctor specialising in skin diseases who will advise you on possible tests to find out the cause of your problem. There are other medical conditions that can cause skin itching, but we cannot discuss them in this column.
It is wise to know your HIV status. All adults should do HIV tests as part of their regular annual medical check up as it is for other diseases like cancer and diabetes. The biggest problem we have is that most Ugandans do not know their HIV serostatus.
HIV affects human beings and so the basic risk of catching it is being human. So instead of getting worried, the best thing you could do for yourself is to go for medical check-up and also go for an HIV test.

Write to the Health Editor, The New Vision. P. O. Box 9815, Kampala or health&beauty@newvision.co.ug

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