By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
The United Nations also recommends PEP as part of the basic package of emergency care for rape survivors.
Using antiretroviral drugs within hours of exposure may inactivate the HIV virus and prevent it from migrating to lymph nodes, reproducing in cells and spreading into the bloodstream. Since HIV takes about three days to reach the lymph nodes, there's a small temporary window when the infection may be blocked.
The sooner the drug treatment is started, the more likely it is to interrupt HIV transmission.
PEP does not work 100 percent of the time, and failure is often attributed to a delay in receiving treatment. But human and animal studies as well as findings from case studies and public health registries show PEP can significantly reduce the risk of HIV transmission, says CDC spokeswoman Nikki Kay.
In fact, PEP is associated with an 80 percent reduction in risk of HIV infection among healthcare workers exposed to the virus on the job, according to data compiled by the CDC. Providing antiretrovirals to HIV-infected women during labor and delivery and to newborns immediately after birth has been shown to cut risk of mother-to-child transmission by about 50 percent.
Every rape intake center in the country should at least inform rape victims about the potential benefits of PEP, says Dr. Amy Kindrick, infectious diseases specialist at the University of California, San Francisco.
"Why providers are not informed about PEP continues to be a mystery to me," says Kindrick. "It hasn't been absorbed into the standard of care consistently."
Cities such as Boston, Providence, Los Angeles and San Francisco have been home to PEP clinics for nearly a decade. The New York State Department of Health in 1998 began recommending PEP for rape victims whose assailants can't be found.
In Houston, where three people contract HIV every day, it's a totally different story.
Kathy Barton, spokeswoman for the city of Houston's Department of Health and Human Services, which provides testing and information for HIV prevention, told the Houston Press that she had never even heard of PEP.
After consulting with some doctors, Barton said the city does recommend PEP for occupational exposures but not post-rape. When informed that the federal guidelines were expanded in 2005 to include rape victims, Barton said, "I don't know that we have looked at this since 2005."
Barton added: "We don't want [PEP] to simply become like the morning-after pill, because it gets expensive."
The CDC expresses a similar concern, advising that "PEP is not a substitute for abstinence, mutual monogamy, consistent and correct condom use, use of sterile needles to inject drugs and other behaviors that can help avoid HIV exposure in the first place."
But various studies have shown that increased awareness and availability of PEP does not lead to an increase in risky behavior. PEP is a 28-day commitment, and the drugs often produce severe short-term side effects including intense nausea, fatigue, headaches and hallucinations.
Last summer, a new law went into effect in Texas establishing requirements for hospitals offering emergency services for survivors of sexual assault. These include a private area for victims to await treatment and "access to appropriate prophylaxis for exposure to sexually transmitted infections."
Michelle says she was offered neither during her visit to Memorial Hermann Northeast.
Another provision in the new law states that rape survivors must be provided "a forensic medical examination...if the examination has been approved by a law enforcement agency."
It is this passage that may have been misinterpreted by local rape counselors and emergency-room nurses who told Michelle she had to file a police report to receive medical care.
Ann Brimberry, a Memorial Hermann spokeswoman, wrote the Press in an e-mail: "All victims of sexual assault that present to a Memorial Hermann Emergency Center are seen and offered treatment whether a police report is filed or not."
But when the Press called Memorial Hermann Northeast, an emergency-room nurse contradicted this. "You don't just walk in and get treatment; it's a long process," said the nurse, who asked not to be identified since she did not receive permission to speak with a reporter. "Police has to be notified; we have to have a case report number."
At 1:15 p.m. on Monday, April 21, Michelle left work to go stand in line at Legacy Community Health Services on Westheimer in the Montrose neighborhood. She learned about Legacy through her gay friends after lying that she needed to refer a pro bono client to a good HIV clinic.
"We're sort of known underground as being one of those places that will prescribe meds off-label," says Eric Roland, senior director of marketing at Legacy.
Michelle felt out of place in her conservative work attire, but found immediate relief when a man at the front desk said he knew about PEP and promptly sent her upstairs to the clinic's education department.
Waiting for a consultation, Michelle sat for several minutes watching an anime program about a black man who contracted HIV by having unprotected sex with other men "on the down-low" but hadn't told his pregnant wife.
"The woman sitting next to me — who knows what her story is?" Michelle says. "You feel like passengers on a sinking ship."