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South Africa: Rape & HIV/AIDS - Part Two - 2003-09-02

In South Africa, there are a reported 54-thousand rape cases every year. But official estimates say the true number of rapes may be as high as one-point-six million. The violence is helping to spread HIV/AIDS in South Africa, where experts say up to 40-percent of rape cases could result in HIV infections. In part two of this series, we look at efforts to protect rape victims from a deadly fate.

It’s called P-E-P for short. Post-Exposure Prophylaxis to be precise. It’s a medical and counseling regimen that could prevent rape victims from contracting the AIDS virus and help them survive the trauma of sexual assault.

Charlene Smith is a rape survivor. But her knowledge as a journalist covering the HIV/AIDS pandemic may have saved her life. She knew about P-E-P and how the quick use of anti-retroviral drugs could prevent infection.

She says, "I was raped in April 1999 and I was the first person to start campaigning for Post-Exposure Prophylaxis after rape. I’d been writing about HIV for many years and I knew that you needed to get onto those medications within 72 hours. I went to three different hospitals who all refused to give it to me – until I finally grabbed a doctor. I had also been stabbed and had masking tape around most parts of my body because I had been bound. And I grabbed the doctor in casualty and I said I need those drugs and I need them now. I’m not prepared to die."

It worked. She is HIV negative. Nevertheless, she describes as “torture” the weeks she had to wait to make sure she was not infected.

"It’s as though you’re in a continual process of being raped, " she says. "The torture of not knowing whether you are HIV positive is unbelievable. You become absolutely fixated by it."

Her daughter became so afraid of what might happen to her mother she developed a head to toe case of shingles – an itchy, rash-filled, painful infection caused by the same virus that triggers chickenpox. Ms. Smith says she didn’t want others to go through the same trauma and began campaigning for P-E-P.

Dr. Adrienne Wulfsohn is an expert on Post-Exposure Prophylaxis. Her research is being used by the U-S Centers for Disease Control.

She says, "A sexual assault patient comes in to us – I prefer to call them patients or survivors – come to us within 72 hours. We do a basic baseline HIV test. A lot of people in this country don’t know their HIV status and the test is fairly quick and we get the results; and the patient is started on anti-retrovirals. We also then treat them prophylactically for all other sexually transmitted diseases and pregnancy."

Dr. Wulfsohn says research shows P-E-P has been a success.

"We’ve treated over 875 rape survivors and of that 673 were HIV negative. Those that were HIV negative came in within 72 hours. They were given the post-exposure prophylaxis. They didn’t develop the serious side effects. There were no toxic effects like nausea or vomiting or anything like that," she says.

Counseling is also a major part of the program both for the rape victim and their families. Often the full impact of rape may not be felt for six weeks. So it’s important for follow-up medical and counseling sessions at that time.

Charlene Smith says while P-E-P can help many rape victims, it is not widely available. A government promise to make it so has yet to be fulfilled. But she also says more must be done to prevent rapes and she reminds police that rapists don’t just rape.

She says, "The person who raped me, for example, had an outstanding murder charge, three outstanding rape charges and an outstanding attempted murder charge. They are involved in other crimes. So if you start attacking rape and rapists in a concentrated measure, it will effectively bring down criminal statistics as well."

Joan van Niekerk coordinator of the group Childline, helps children who’ve been sexually assaulted. She says improving the economy could also help reduce the number of rapes.

She says, "Because of the poverty and the civil socio-economic sectors children are very vulnerable to sexual assault. And, of course, because of their smaller physiology are very vulnerable to contracting HIV/AIDS."

Ms. Van Niekerk says more must also be done to dispel the myth that having sex with a child or virgin will cure a person of AIDS. She says a new sexual offenses bill has been drafted. However, she says, “Some of the most critical clauses that would ensure sexual offenses were adequately dealt with have been deleted.” She says a lobbying effort is underway to have them reinstated. One of the provisions deleted would have provided P-E-P to all rape victims.

She says, "We’re also very concerned about the removal of the treatment clause because it had preventative and ongoing treatment requirements. They also removed from the bill the assessment of the sexual assault victim and the use this information in order to inform sentencing."

Many say stigma and discrimination prevent more women from reporting rapes and getting treatment. Lisa Vetten of the Center for the Study of Violence and Reconciliation says as a result many women who become pregnant opt for unsafe abortions.

She says, "The attitudes of many service providers are often so punitive towards women that they often actively try to deter women. That again, getting access to services can often be very difficult particularly in rural parts of the country. And generally I think there is still a good deal of stigma attached to seeking an abortion. So I think sometimes women do keep quiet and sometimes they’ll resort to back street options."

Ms. Vetten says the government must not just pass laws protecting rape victims. It must also back those laws with funding. Otherwise, she says a good law is “a failure in practice.”