Focus on providing drugs to rape survivors

The Sunninghill Rape Crisis Clinic in Johannesburg is one of a few institutions in the country that provides antiretrovirals to women who have been raped. It has been doing so since 1998. Following the government's announcement on Wednesday that rape survivors were to be provided with AIDS drugs at public health institutions as soon as possible, the director of the clinic spoke of the challenges involved in providing this service. High levels of sexual violence in the country have been compounded by the growing HIV/AIDS epidemic. According to the South African Police Service, 37,711 rape cases were reported to the police between January and September 2001. According to a study by the University of South Africa (UNISA), one million women and children are raped annually. "With HIV/AIDS and rape being such a serious problem here (in South Africa) we should be doing something," Dr Adrienne Wulfsohn told delegates at a conference on gender-based violence and health in Johannesburg this week. National policy has previously prohibited the distribution of post-exposure antiretrovirals to rape survivors in public health facilities. Although part of the private Sunninghill Hospital, the Rape Crisis Clinic is open to "women of all financial groups". Most of the women who attend the clinic are from informal settlements around Johannesburg and travel long distances to seek help. Despite such obstacles, though, the clinic had a 65 percent follow-up rate, Wulfsohn told PlusNews. The clinic tried to alleviate the trauma associated with the medical examination and police questioning by providing counselling before and after the HIV test, she said. "A question we ask ourselves every day is 'how do you subject someone to the additional trauma of HIV testing after what they've been through?'" Wulfsohn stresses that a compassionate and empathetic environment can make all the difference to a rape survivor. "I worry that provincial hospitals will not treat survivors with empathy because they won't be compelled to," she added. A challenge for other provincial rape clinics was the delay between the rape and medical care, as the treatment was most effective four hours after possible exposure to the HI virus, Lynn Denny, a Cape Town based gynaecologist said at the conference. To address this problem, Denny suggested that clinics administer the first dose of the antiretroviral drug immediately on arrival, regardless of the survivor's HIV status. Sunninghill, however, experienced very few delays. A good working relationship with the police eliminated most delays, Wulfsohn said. The only delays experienced where when survivors were sent from one provincial hospital to another, until being referred to Sunninghill. Over 64 percent of the patients at the clinic came in on their own, before going to the police. "We have pretty high visibility because of word of mouth and media reports," Wulfsohn said. The time taken for testing and counselling was another challenge, Denny added. "Clinics need to individualise their approach and consider the impact of discovering you are HIV positive when under extreme emotional distress," she said. Adherence to the antiretroviral treatment was essential if post-exposure prophylaxis was to be effective, Denny said. Victimisation by the health and police systems sometimes made it difficult for rape survivors to follow-up the treatment. "The side effects of multiple medications, as well as taking medicines that are a constant reminder of the rape, puts many women off," Denny said. The government said it would soon release a national protocol on the provision of antiretroviral drugs for sexual assault survivors. "I think it's wonderful. I am quite willing to assist with the training programmes so that they (government) won't have any excuses when implementing it," Wulfsohn told PlusNews.