Michigan journalist and HIV-positive activist Todd Heywood has an outrageous and upsetting story posted on his site detailing the kinds of struggles he faced recently when trying to get access to post-exposure prophylaxis treatment for a sexual abuse victim:
I accompanied a 2[0-something] who had been the victim of a sexual assault to the hospital on Nov. 21. His experience, and mine with the Sexual Assault Nurse Examiner Justine, was more than acceptable. However, the victim requested a prescription for post exposure prophylaxis- which is a combination of antiretroviral medications taken over a 28 day time period to prevent infection with HIV. Because this was a stranger sexual assault, the HIV status of the assailant was unknown.
This victim and I spent four hours in the E.R. to receive a prescription which should have taken no more than an hour. Sadly, the E. R. Dept. Supervising doctor was unwilling to prescribe the medications, as is recommended by the Centers for Disease Control and Prevention in Atlanta for NonOccupational Post Exposure Prophylaxis (nPEP). In fact, this doctor, a Dr. Moreno was rude, uninformed, and provided several falsehoods to the victim in denying him access to necessary medications.
The CDC has a 24 hour hotline for doctors / clinicians to call if they are unsure of what drugs are appropriate to prescribe in a given situation. The issue of time is signficant here: The drugs are more effective the sooner you start them, and after 72 hours that effectiveness drops dramatically. So getting access quickly is key -- and ease of acesss is also key. This patient had an advocate there for him willing to fight for him, which seems largely to be the reason he ended up getting access -- FINALLY:
Dr. Moreno left the patient to talk with the Risk Management person, a Mr. Cole. And also provided a tablet with CDC guidelines of PEP in occupational exposure situations- which was not the case in a sexual assault, as you can imagine. Right there in paragraph two of the occupational exposure guidelines by the CDC was an 800 number staffed by CDC experts on PEP. Did your doctor find this number and call it?
No, that was left to me. The doctor from the CDC, upon presentation of the clinical facts- 22-year-old, unprotected, nonconsensual same sex activity in a high prevalency area (defined as have a 1% or higher incidence, which Ingham county has)- nPEP was indicated as an immediate treatment.
Dr. Moreno was given the name and telephone number of this CDC expert, and within minutes, the story changed.
The sad truth here is that doctors are grossly ignorant about these issues, and instead of owning up to their own ignorance, they tend to veil their ignorance under the guise of medical authority -- reacting not helpfully, but angrily. "How dare you challenge my authority! I know what's best." But they don't. And instead of getting the information they need, they deny care to patients. It's disgusting.
I recently had an experience VERY similar to this one. Incidentally, Todd recently interviewed me for an upcoming story on the matter. Look for more on that soon!
The interesting thing is, we have a pretty good NPEP program in the state where I come from, and if you attend a hospital ER to get PEP, you'll have exactly the same experience. Provision of PEP is waay outside what ER doctors are trained for, and with a 72-hour timeframe it registers as a very low priority in triage. Four hours and some argument is par for the course.
There is an alternative - accessing PEP through a gay-friendly or sexual health clinic - but in the States, I understand this would probably mean Todd's friend would have to pay for the meds himself?
Mr. Reeders,
The issue was not getting access to free meds, it was getting access to a prescription for the nPEP. In this case the individual had access through insurance. The issue was a medical professional, who SHOULD have known the protocols and procedures, or at least HOW to access the information, failed. It was frustrating and saddening.
The hospital has since added insult to the injuries by continuing to make issue at the fact the medication was advocated for, and that I wrote blogs about the incident. It is all very frustrating, I can assure you.