(i). HIV Exposure through needlestick injuries.

(i). HIV Exposure through needlestick
injuries.
Needle-stick injuries in a non-health
care setting can prompt requests for
post-exposure prophylaxis. Factors to
consider in this instance include the
potential source of the needle, type of
needle, presence of blood and skin
penetration. Vaccination to prevent
tetanus may be indicated for needle
stick injuries resulting in puncture
wounds.
(ii). HIV exposure through bites.
Although possible, HIV transmission
following bites is thought to be extremely
rare. While there have been many
reported instances of bites, the few
documented cases of possible HIV
transmission following a human bite
exposure were in adults exposed to
blood-tinged saliva3 .
(iii). HIV exposure following sexual
assault.
Whenever possible, survivors of sexual
assault should be treated in an
emergency department where all
appropriate medical resources are
available. The recommendation for postexposure
prophylaxis should be
communicated simply and clearly to the
patient considering his/her emotional
state and ability to comprehend the
nature of the intervention. If the survivor
is too distraught to engage in a
discussion about whether to initiate
therapy or not, a first dose of medication
should be offered and arrangements
made for a follow-up appointment within
3 days. Starter-packs of medication
should be available on-site for rapid
initiation of post-exposure prophylaxis
following sexual assault. Emergency
contraception and sexually transmitted
infection(s) treatment have become part
of some standard medical protocols in
many countries4 .
Baseline testing for patients who
present with risk exposures.
Baseline HIV testing of the exposed
person should be done. Initiation of postexposure
prophylaxis should not be
delayed pending HIV test results.
Refusal to undergo baseline testingshould not preclude the initiation of postexposure
prophylaxis. The risks and
benefits of the intervention should be
carefully explained and on-going
counselling and support provided. Rapid
HIV testing is the preferred method of
testing in this situation because it can
immediately identify previously infected
persons and thus avoid unnecessary
risks from inappropriate initiation of postexposure
prophylaxis. Counselling and
referral for further care must be provided
for clients who test HIV-positive at baseline.