There's a Morning-After Drug to Prevent HIV Infection

The treatment is called post-exposure prophylaxis. So why do so few medical groups in Houston know about it?

At 9:30 p.m. on Friday, April 18, Michelle Lee (not her real name) left a swimming pool party at an apartment complex in The Woodlands, strolled a couple blocks to her SUV wearing only flip-flops and a two-piece bathing suit with a towel wrapped around it and opened the driver's side door when a strange man suddenly gripped her throat from behind, told her to shut the fuck up, shoved her inside the car onto her stomach and raped her with the door left open.

"I was paralyzed," says Michelle, her hands trembling as she recounts the incident. "My body couldn't do anything."

Michelle knows little about her attacker, only that he was African American and smelled like sweat. "I saw his face," she says, "but don't remember it."

Nurses kept telling Michelle that no such treatment existed.
Daniel Kramer
Nurses kept telling Michelle that no such treatment existed.

A 32-year-old attorney who has worked on numerous sexual assault cases, Michelle knew better than to go home, bathe and fall asleep, but that's exactly what she did. "I wanted to forget about it," she says. "I wanted to get clean."

It took 24 hours before Michelle could finally cry and admit to herself that she had been raped. She said it aloud. Feeling inexplicably guilty, shameful, she did not want to tell friends or family. But she had to tell somebody.

So she called a national rape organization she knew about through work, which referred her to the Houston Area Women's Center's sexual assault hotline. A counselor there repeatedly instructed Michelle to report the incident to police, even going so far as to say that she might not be able to receive medical care unless she filed a police report.

This made no sense to Michelle, who was adamant about not telling authorities since she had known victims of violent crimes whose cases dragged on for years. "I didn't want this cloud over me for the rest of my life," she says.

As the night wore on, Michelle became increasingly panicked that she might have contracted HIV or some other sexually transmitted disease. She typed "HIV test" into Google on her home computer in Humble and stumbled upon a San ­Francisco-based Web site that described a month-long antiretroviral drug treatment called post-exposure prophylaxis.

PEP, she learned, is an emergency medical treatment commonly used to protect people exposed to the human immunodeficiency virus by preventing the infection from taking hold in the body. The three-drug combination includes the same toxic medication given to people with AIDS.

But the drug regimen must be initiated right away, the Web site warned. It's not effective in aborting HIV if begun more than 72 hours after the incident.

"I needed this PEP like I needed oxygen," Michelle says.

And the clock was ticking.

At 11 a.m. on Sunday, April 20, Michelle arrived at Memorial Hermann Northeast Hospital in Humble. She wasn't interested in getting her blood tested since it was too soon to verify an infection. Nor was she concerned about being pregnant since she uses long-term birth control. And she didn't care to speak with a rape counselor since she already did that.

All she wanted was the PEP.

But the intake nurses insisted that no such drugs exist, according to Michelle. They told her there is no way to ward off HIV after being exposed.

"I felt beaten down and confused," Michelle says. "I thought maybe I was crazy."

Michelle waited in the emergency room for seven hours without ever seeing a doctor. "I thought, 'Fuck it; fuck it; time's ticking away. I don't want to deal with these people.'" And she left.

She spent the night with her 38-year-old boyfriend of ten months, who remains the only person close to her that she has confided in about the assault. He told her to call police, that they could still inspect her car. She refused.

"It was awful," Michelle says. "We spent the night sleeping one foot from each other, fully clothed."

The next morning, Michelle went to work at her office in downtown Houston. More than 48 hours had passed since the rape. She still had time to act.

She called Planned Parenthood of Houston and Southeast Texas. A counselor put her on hold, then told her nobody there knew of any such drug regimen. This was confirmed by Laura Leon, a spokeswoman for the agency.

The Planned Parenthood counselor advised Michelle to contact The Schrader Clinic, apparently unaware that Dr. Shannon Ray Schrader, who is well known in the Houston area for treating AIDS patients, last year stopped accepting most new patients.

At this point, Michelle considered flying to San Francisco for treatment since it seemed nobody in Houston's medical community could help her.

In fact, the federal government since 1996 has recommended PEP for healthcare workers accidentally exposed to infected blood or needles. In 2005, the national guidelines were expanded to include people exposed to HIV through rape, drug use and unsafe sex.

The national guidelines, which call PEP "an important safety net to reduce the risk of HIV infection," were developed by the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration, the Health Resources and Services Administration and the National Institutes of Health.

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