Management of Sexual, Injecting Drug Use and other Non-occupational Exposure to HIV

The most effective methods for preventing HIV infection are the ones that protect against exposure to HIV. Preventive behaviours include sexual abstinence, sex only with an uninfected partner, consistent and correct condom use, abstinence from injecting drug use, and consistent use of sterile equipment by those unable to cease injecting drug use. Some health care providers have proposed offering anti-retroviral drugs to persons with unanticipated sexual or injecting drug use HIV exposure to prevent transmission. However, because no data exist regarding the efficacy of this therapy for persons with non-occupational HIV exposure, it should be considered an unproven clinical intervention. Health care providers and their patients may opt to consider using anti-retroviral drugs after non-occupational HIV exposure that carry a high risk for infection, but only after careful consideration of the potential risks and benefits and with a full awareness of the gaps in current knowledge.

Sexual activities associated with a risk for HIV transmission are also associated with risk for unintended pregnancy and STDs (e.g. syphilis, gonorrhoea, chlamydia, or Hepatitis B Virus). Treatment of STDs should follow the standard WHO/NACO guidelines for treatment of Sexually Transmitted Diseases, and victims of sexual assault should receive additional evaluation and counselling. Women at risk for unintended pregnancy should be offered emergency contraception. Persons with possible HIV exposure through percutaneous routes from sharing syringes or needles should be assessed for hepatitis B and hepatitis C virus infections and considered for hepatitis B vaccination.

Persons who report possible non-occupational HIV exposure should be evaluated for sexual and injecting drug use behaviour that might lead to recurrent exposure. In all situations, health care providers should offer confidential risk reduction counselling during initial and follow up visits. Persons who have been sexually assaulted can be referred to anonymous or confidential voluntary counselling and testing within 72 hours of exposure to establish their HIV status at the time of the assault.

Persons with non-occupational HIV exposure should receive medical evaluations, including HIV antibody tests at baseline and periodically for at least 6 months after exposure (e.g. at 4 weeks, 6 weeks, 12 weeks and 6 months). All persons evaluated for possible non-occupational HIV exposure should be counselled to initiate or resume protective behaviours to prevent additional exposure and to prevent possible secondary transmission if they become infected.