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June 28, 2007

POZ editor's Newsday op-ed

This op-ed appeared in Newsday on June 28, 2007

Help Rape Survivors Immediately

by Regan Hofmann

Giving a rape survivor the option of forcing a suspect to be tested for HIV under court order would seem to be useful for the survivor's health and peace of mind. But forced HIV testing doesn't get rape survivors access to what they need most: medical treatment after an attack that can prevent HIV infection if begun within 72 hours of possible exposure to the virus.

Forced testing of rape suspects for HIV, which would become a choice for women in New York State under a bill now awaiting Gov. Eliot Spitzer's signature, is one of the worst ways to ensure that rape survivors avoid potential HIV infection. Supporters of the bill argue that it gets important information into the hands of survivors.

But the best information they can get is about the efficacy of a treatment known as post-exposure prophylaxis, or PEP, a 28-day course of antiretroviral medications. In fact, the State Senate rejected an amendment to the forced-HIV-testing bill that could have made PEP available quickly to women who need it.

Rape survivors can't afford to wait for an indictment of a suspect to decide whether to take PEP. Nor should they make this critical health decision based on a potentially misleading HIV test result. A suspect who turns up HIV-negative (or positive) may later turn out to be innocent of the crime. Worse, a suspect who tests as HIV-negative may be in the "window" period in which he may test negative but turn out to be carrying the virus.

Even if a rape survivor is given PEP, there's the danger that her alleged attacker will test HIV-negative and she will decide to go off her lifesaving meds. But what if the suspect is innocent or if he is guilty and simply in the "window" period?

The only substantial benefit from testing a suspect is where there is a small likelihood of HIV transmission - where a suspect is undoubtedly the perpetrator (perhaps known to the victim) and the suspect tests negative and a clinician determines the survivor is at low risk for HIV.

Whatever psychological comfort a rape survivor might draw from knowing the results of an HIV test of her attacker, she will benefit far more from being immediately proactive about saving her own life.

I favor HIV testing in general and in theory am not opposed to forced testing of accused rapists. But the potential dangers of relying solely on HIV test results of perpetrators - at the expense of offering a rape survivor PEP regardless of a test result - are too great to risk. The focus should be on the rape survivor and her health - not on the rapist and his.

If the identity, HIV status and guilt of the suspect have been confirmed and the suspect's tests are negative, encourage the survivor to stop treatment. In some cases, treatment may already be completed by the time the rapist is caught, identified and tested.

Another point is that this legislation will almost certainly add to the stigma around HIV. Whenever a court orders forced testing, it likely will be an occasion for overblown media coverage that could lead the public to connect HIV with the commission of violent crimes. This furthers the stigma regarding HIV, which in turn will increase the number of people who are afraid to get tested, seek treatment, disclose to partners, and seek the emotional and financial support they need to help them access care. The deepening of stigma surrounding HIV/AIDS is a setback for education and prevention efforts.

Instead of the bill on Spitzer's desk, we need a law that allows all women who have been raped free access to PEP as soon as possible after an attack. The state could then bill HMOs or Medi-caid for those with insurance and pick up the cost for the uninsured, which would run $1,200 to $1,800.

In a hospital, medical workers who are accidentally stuck with a needle are typically offered PEP immediately. Why should it be different for rape survivors?

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