Neither Anne Arundel hospital has switched to automatically giving rape victims AIDS tests or providing a spermicide believed to kill the deadly virus, despite a recent medical study calling for both measures to slow the spread of AIDS.
Instead, Anne Arundel Medical Center offers AIDS tests upon request, while North Arundel Hospital refers rape victims who fear they've been exposed to the virus to the county Health Department for free, anonymous exams.
The two rarely if ever supply treatment with Nonoxynol-9, the active ingredient in over-the-counter contraceptive foam, shown in laboratory tests to kill the human immunodeficiency (HIV) virus, which causes AIDS. Medical research has not proven whether Nonoxynol-9 or vinegar, which also has been effective in lab tests, would be equally effective after sexual intercourse.
Routine AIDS testing and Nonoxynol-9 applications were recommended to help prevent the spread of the contagious virus by two researchers who surveyed 20 rape treatment centers in Maryland earlier this year.
"With rape, the risk of trauma is great, so the risk of transmission is much higher," said Ilene Foster, a nurse with the Baltimore County Health Department. Foster conducted the study together with John G. Bartlett, a professor of medicine and chairman of the infectious diseases division at Johns Hopkins University in Baltimore.
Only two of the 20 hospitals routinely counseled rape victims about AIDS and offered blood tests, Foster said. Francis Scott Key Medical Center in Baltimore and Dorchester General Hospital already provide those services. Four other hospitals are considering changing their emergency room procedures for rape victims.
"We are looking to incorporate Nonoxynol-9 into our protocol and also possibly offer some sort of counseling for AIDS," said Dr. Michael Stang, director of the emergency department at Carroll County General Hospital, one of the four hospitals. Rape victims currently are referred to Carroll's Health Department for AIDS tests, he said.
But Stang said the proposed change still is months away because "a lot of the material is brand new, and some of it may be controversial."
Karen Goldman Lyon, executive director of the Anne Arundel Sexual Assault Crisis Center and Hot Line, also called the issue thorny. She cited three reasons why she objected to routinely giving sexual assault victims AIDS tests in the emergency room.
Rape victims could feel a false sense of security if they test negative immediately after an assault, she said. They also might wind up footing the bill or losing the cloak of confidentiality provided by the Health Department's tests. "When you test for HIV immediately after a rape, that test will only tell you your status prior to the rape," she said.
But Foster said testing soon after a rape may reveal exposure to the AIDS virus. "No one knows how quickly the virus can be absorbed," she said.
Lyon instead supports referring victims to the Health Department for counseling and testing. Trained volunteers from the rape crisis center, who provide support for victims at the hospital, hand out brochures and discuss the risk of sexually transmitted diseases, including AIDS.
"We work as advocates," she said about the center's staff of eight full-time and 55 volunteer counselors who respond to emergency calls 24 hours a day. "The aftermath of rape has so much to do with a loss of control. Our job is really to empower (the victim) with information."
Lyon declined to comment on using Nonoxynol-9 in the emergency room, saying she was not up-to-date on the latest findings. Evelyn E. Stein, spokeswoman for the county Health Department, also said she could not comment on emergency room procedures.
Anne Arundel's two hospitals typically don't provide Nonoxynol-9 applications, representatives said.
Although the research is inconclusive, Stang said he considers Nonoxynol-9 the best remedy to combat exposure to the AIDS virus.
"It's inexpensive, it's safe, and it really does offer some degree of protection," he said.
Foster and Bartlett also said the chemical would not interfere with the crime analysis needed to prosecute the assailant. They suggested administering either Nonoxynol-9 or a vinegar douche immediately after taking a semen sample.
"Vinegar douches may well be worth considering because most rape victims never seek medical attention, and vinegar obviously is readily available for rapid use in the home," Bartlett said.