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Forensic Science, Medicine and Pathology

, Volume 14, Issue 3, pp 332–341 | Cite as

The use of HIV post-exposure prophylaxis in forensic medicine following incidents of sexual violence in Hamburg, Germany: a retrospective study

  • Julia Ebert
  • Jan Peter Sperhake
  • Olaf Degen
  • Ann Sophie Schröder
Original Article

Abstract

In Hamburg, Germany, the initiation of HIV post-exposure prophylaxis (HIV PEP) in cases of sexual violence is often carried out by forensic medical specialists (FMS) using the city’s unique Hamburg Model. FMS-provided three-day HIV PEP starter packs include a combination of raltegravir and emtricitabine/tenofovir. This study aimed to investigate the practice of offering HIV PEP, reasons for discontinuing treatment, patient compliance, and whether or not potential perpetrators were tested for HIV. We conducted a retrospective study of forensic clinical examinations carried out by the Hamburg Department of Legal Medicine following incidents of sexual violence from 2009 to 2016. One thousand two hundred eighteen incidents of sexual violence were reviewed. In 18% of these cases, HIV PEP was initially prescribed by the FMS. HIV PEP indication depended on the examination occurring within 24 h after the incident, no/unknown condom use, the occurrence of ejaculation, the presence of any injury, and the perpetrator being from population at high risk for HIV. Half of the HIV PEP recipients returned for a reevaluation of the HIV PEP indication by an infectious disease specialist, and just 16% completed the full month of treatment. Only 131 potential perpetrators were tested for HIV, with one found to be HIV positive. No HIV seroconversion was registered among the study sample. Provision of HIV PEP by an FMS after sexual assault ensures appropriate and prompt care for victims. However, patient compliance and completion rates are low. HIV testing of perpetrators must be carried out much more rigorously.

Keywords

HIV Post-exposure prophylaxis Sexual violence Sexual assault Forensic medical examination Forensic medical specialist 

Notes

Acknowledgments

We thank Jennifer Barrett, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Julia Ebert
    • 1
  • Jan Peter Sperhake
    • 1
  • Olaf Degen
    • 2
  • Ann Sophie Schröder
    • 1
  1. 1.Department of Legal MedicineUniversity Medical Center Hamburg–EppendorfHamburgGermany
  2. 2.Outpatient Center, Department InfectiologyUniversity Medical Center Hamburg–EppendorfHamburgGermany

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