Introduction of HIV post-exposure prophylaxis for sexually abused children in Malawi

Jane C Ellis ^1*, Shafique Ahmad ¹ and Elizabeth M Molyneux ¹

¹ University of Malawi, Malawi

^* To whom correspondence should be addressed. E-mail: janeellis123{at}yahoo.co.uk.

Accepted 5 September 2005

Abstract

Background:Child sexual abuse (CSA) is a global problem. The consequences of CSA are physical and psychological damage. In areas with a high prevalence of HIV infection there is the additional risk of acquiring HIV infection. This can potentially be prevented by HIV post-exposure prophylaxis (PEP) with antiretroviral therapy (ART).

Objective:To improve the care of children who are victims of CSA by routinely assessing eligibility for HIV PEP and to investigate the feasibility, safety and efficacy of such treatment started in a paediatric emergency department in Malawi.

Method and setting:Children presenting to the Paediatric Emergency Department, Queen Elizabeth Central Hospital, Blantyre between January 1st 2004 and December 31st 2004 with a history of alleged CSA were all assessed for eligibility for HIV PEP and followed prospectively for 6 months.

Results:The number of children presenting with a history of alleged CSA in the 12-month period was 64. There were 63 girls and one boy. The mean age was 83 months.

Of the 64 children seen, 17 (26.5%) were offered PEP. The remaining 47 children were not offered PEP because of absence of physical signs of abuse in 20 cases (31.3%); delay in presentation beyond 72 hours from assault in 11 (17.2%); repeated sexual abuse in the preceding 6 months in 15 (23.4%); and one child (1.6%) was found to be HIV-infected on initial testing. No family refused an HIV test. No side effects due to ARV therapy were reported. Of the 17 children commenced on PEP, 11 returned for review after 1 month (64.7%), seven returned at 3 months (41.2%) and two of 15 (13.3%) returned at 6 months post assault. None have seroconverted.

Conclusions and recommendations:In a resource- poor setting with a high HIV prevalence HIV PEP following CSA is acceptable, safe and feasible. The opportunity to prevent acquisition of HIV infection should not be missed. HIV PEP should be incorporated in to national guidelines in countries with a high community prevalence of HIV infection.

Keywords: HIV post-exposure prophylaxis, sexual abuse, resource-poor setting

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This article has been cited by other articles:

• Ellis, J C, Ahmad, S, Molyneux, E M (2006). Introduction of HIV post-exposure prophylaxis for sexually abused children in Malawi. Sex. Transm. Infect. 82: 30-30 [Full Text]