Background:
Before HIV post-exposure prophylaxis (PEP) was available, 31% of rape victims returned for follow-up. Post-advent of HIV PEP, follow-up rates and factors associated with compliance with HIV PEP post-rape are unknown, particularly for adolescents.

Objective:
To describe use of HIV PEP and explore barriers to PEP completion in adolescent rape survivors.

Method:
Retrospective chart review of adolescents presenting July 2001 to June 2003 to two urban academic pediatric emergency departments within 72 hours of rape. We performed bivariate analyses using Pearson's Chi-square test or Fisher's exact test to examine associations between PEP completion and demographic and assault characteristics.

Result:
Of 177 charts reviewed, adequate documentation of rape and subsequent medical management was available for 145 patients. Among these 145 patients, 96% were female, 38% were black, 15% Hispanic. Many patients were uncertain regarding their exposures; 27% were unsure if a condom was used, 54% were unsure if ejaculation occurred, and 21% blacked out during the assault. 110 (76%) began HIV PEP. Of 96 patients referred for follow-up at the academic centers, 37 returned for at least one visit and 13 completed a 28-day PEP regimen. 46% of those taking PEP who returned for follow-up reported medication toxicity. 47% of adolescent rape survivors carried a psychiatric diagnosis prior to rape. PEP adherence was lower among adolescents with psychiatric illness.

Conclusion:
We observed low rates of HIV PEP completion among adolescent rape survivors. Potential difficulties using PEP in this population include uncertainties regarding exposure risk for HIV transmission, high rates of psychiatric co-morbidity, and low rates of follow-up.

Implications:
Our findings suggest that mental health providers should consider counseling their patients regarding risks of rape and strategies to reduce this risk. Further studies are needed optimize PEP regimen compliance and follow-up for adolescents.