GUIDELINES
FOR DOCTORS
Counsel rape survivors about the potential that they may have been infected with HIV by the perpetrator/s. An HIV test must be taken of the survivor if he or she wishes to commence Post Exposure Prophylaxis (antiretroviral therapy). On average 22% of rape survivors are already HIV+ at the time of rape. Those infected cannot commence PEP. Those not infected may commence PEP if they present for treatment within 72 hours of the first act of penetration or attempted penetration. Rape survivors return for HIV tests at 6 weeks, 3 months, 6 months. A tiny percentage may seroconvert and become HIV+ at one year. The rape survivor should practise safe sex for six months after sexual assault. In addition s/he needs to be protected against sexually transmitted diseases, pregnancy and secondary infections. Oral sex also puts survivors at risk of HIV.
If s/he is HIV+ refer her to the closest branch of the National Association of People Living with HIV/Aids (NAPWA) for counseling and information about support groups.
Contact the nearest police station for a crime kit which gives detailed instructions to collect forensic information necessary for a trail. If you remove anything from him or her in the interim do not put it in a plastic bag as this destroys evidence, use paper only. Ask the police for a form J88 and an SAPS308 form – alternatively refer the patient to the nearest district surgeon for a forensic exam.
Absence of injury does not exclude the fact that s/he may have been raped.
FREE COUNSELLING services are offered by many organizations including Lifeline, Childline, Rape Crisis, POWA and others. A useful website on sexual violence and HIV is www.speakout.org.za Or call SASHA 0860-100-262
Those unhappy with the police investigation may complain to the Independent Complaints Directorate, offices in major towns, check phone directory. Complaints or advice about court cases should be directed to the Sexual Offences division of the Director of Public Prosecutions in Pretoria, 012-3175000 or 012-3175784.
Post Rape Medication
Routine syndromic STD therapy
a.. Ciprofloxacin 250mg po stat
b.. Doxycycline 100mg po bd for 7 days (this is contraindated for pregnancy)
c.. Metronidazole 400mg po tds for 7 days
Morning-after pill
Ovral 2 tabs stat then 2 tabs after 12 hours or E-gen- c
Recommended dual-combination
antiretroviral therapy over 28 days AZT (Retrovir) 200mg po 8 hourly
and
3TC (Lamivudine) 150mg po 12 hourly
or
zidovudine (300mg) with lamivudine (150mg) in a combination pill
Combivir, taken twice a day;
or
lamivudine plus stavudine (40mg stavudine twice a day for a person
weighing more than 60kg; 20mg twice a day for a person weighing less
than 60kg; and 150mg lamivudine for person more than 50kg and 2mg per kg
twice a day for a person weighing less than 50kg
Recommended antiretroviral dosage for children from Johannesburg Hospital
For a child under the age of 12,
dependant on weight: AZT 2mg per kg doze, first 48 hours every six
hours. For the following week the child must be given AZT every 8 hours,
and for the remainder of the month take the doze every 12 hours.
In addition the child must be given 3TC - 4mg per kg per dose every 12
hours for 28 days.
Antiretroviral side-effects include - nausea, fatigue, headaches, thirst
(Sources: California Guidelines for PEP after sexual assault, 2001; Centers for Disease Control; Lifesense; Dr Adrienne Wulfsohn and www.speakout.org.za)
Issued by Rape Action Group and Media Against Violence
© Speak Out Terms of use