title: Uptake to HIV post-exposure prophylaxis in Haiti: opportunities to align sexual violence, HIV PEP and mental health.
abstract: Sexual violence is a public health problem in Haiti, potentially augmenting HIV transmission. Reports from L'Hôpital de l'Université d'État d'Haiti (HUEH) suggest severe underutilization of antiretroviral post-exposure prophylaxis (ARV-PEP) among rape survivors. Cross-sectional design using mixed methods. Informational interviews were conducted with HUEH personnel to learn about post-rape service offerings. HUEH surveillance data were used to estimate the sexual assault reporting rate/100,000 and to examine the proportion of survivors receiving ARV-PEP within 72 hr, stratified by age (<18 years, ≥18 years). Informational interviews revealed that survivors were navigated through two hospital algorithms to receive post-rape care; however, <5% of victims sought mental health services. Surveillance data show that 2193 sexual assault survivors (adult and pediatric) reported a rape to HUEH personnel between 2004 through first quarter of 2010. Annual estimates suggest a twofold increase comparing cases in 2004 versus 2009. Between 2008 and 2009, uptake to ARV-PEP within 72 hr was lower for pediatric (38.4%; N = 131/341) compared with adult survivors (60.1%; N = 83/138) (χ(2)  = 18.8, P < 0.001). The prioritization of funding and comprehensive interventions that align sexual violence, HIV, and mental health is crucial to support the timely uptake to ARV-PEP.
authors.affiliation: Department of Biostatistics and Division of Policy, Translation and Leadership Development, Harvard School of Public Health, Boston, MA, USA. linda.marc@post.harvard.edu
authors.forename: Linda
authors.initials: L
authors.lastname: Marc
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Honoré
authors.forename: Patrick
authors.initials: P
authors.lastname: Néjuste
authors.forename: Monica
authors.initials: M
authors.lastname: Setaruddin
authors.forename: Nika-Nola
authors.initials: NN
authors.lastname: Lamothe
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thimothé
authors.forename: Jean-Ronald
authors.initials: JR
authors.lastname: Cornely
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology* / Q000635:transmission; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D008603:Mental Health; D011902:Rape; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents