After sexual assault: HIV, PEP and getting care

What happened to you is not your fault. Whatever the circumstances, whoever the other person was, and whatever you did or didn’t do, sexual assault is never the fault of the person it happened to.

This page covers the practical health steps, especially around HIV. Take it at your own pace.

Where to go

• An emergency department. Open at all hours, and able to start PEP and treat injuries.
• A specialist sexual assault service, where one exists. In the UK these are called sexual assault referral centres (SARCs). In the US, ask whether a sexual assault nurse examiner is available. CDC guidelines recommend involving one where possible.
• A sexual health clinic or your own doctor, if they can see you today.

Getting medical care doesn’t commit you to anything. In the UK, the NHS says you don’t have to report the assault to the police if you don’t want to. A forensic examination can be done and the evidence stored while you decide, and it’s your choice whether you’re examined at all.

If you’re thinking about keeping evidence, the NHS suggests trying not to wash or change your clothes straight away. But if you already have, that’s okay. Please still go for care.

What care can include

You can say yes or no to each part, and you can ask questions at any point.

• PEP for HIV. CDC guidelines say PEP should be offered as part of care after an assault when there’s a substantial risk of HIV. You’ll take it daily for 28 days. You don’t have to describe more than you’re comfortable with, but the timing and the type of contact help the clinician decide.
• Emergency contraception, if pregnancy is possible. Ask about it at the same visit.
• Other infections. The CDC recommends treatment to prevent chlamydia, gonorrhea and, for women, trichomonas. You may also be offered hepatitis B vaccination and, where suitable, HPV vaccination.
• Injuries, including ones you may not have noticed yet.
• Tests. A baseline HIV test, and tests for other infections if you choose.

Paying for care

Cost shouldn’t stop you from getting help. The CDC says that if you’re prescribed PEP after a sexual assault, you may qualify for partial or total reimbursement of medicines and clinical care costs. In the US, CDC guidelines note that survivors who report the assault to police may be eligible for reimbursement of medical expenses through victim compensation programs. Ask staff what applies where you are.

Follow-up

If you take PEP, plan for HIV tests about 4 to 6 weeks and 12 weeks after the assault. A negative result at 12 weeks rules HIV out. If you get a fever, rash, sore throat or swollen glands in the weeks after, contact the clinic and ask for an HIV test. HIV test accuracy by week explains test timing.

If it has already been more than 72 hours, PEP is no longer recommended, but testing, STI care and support are still important. See what to do after 72 hours.

Support

There is no right way to feel afterward. Some people feel numb, some feel overwhelmed, and feelings can change from day to day. You don’t have to deal with it alone.

• Sexual assault hotlines give you someone to talk to. In the US, CDC guidelines point to RAINN. In England and Wales, the NHS lists Rape Crisis.
• Staff at the hospital or clinic. Ask whether there’s someone who can support you through the visit and explain your options, including reporting.
• People you trust. A friend or family member can come with you to appointments.

If worry about HIV is weighing on you while you wait for results, coping with HIV anxiety may help.

What to do now

1. If you’re in danger, get to a safe place and call your local emergency number.
2. If it was in the last 72 hours, go for care now and ask about PEP.
3. Ask about emergency contraception and STI treatment at the same visit.
4. Decide about reporting in your own time. You can get medical care either way.
5. Reach out for support from a hotline, an advocate or someone you trust.