Rape survivors and the provision of HIV post-exposure prophylaxis.

Abstract

To the Editor: Rape and HIV/AIDS are two scourges of epidemic proportion in South Africa which is known for high levels of sexual violence and one of the fastest-growing HIV epidemics in the world. While the link between rape and long-term physical and mental health problems is well established the vast majority of rapes go unreported and only a small proportion of women attend health care services after rape with many believing that their actions will not lead to punishment for the perpetrator. Another factor that may worsen matters even further is the latest version of the original bill on sexual offences (Criminal Law (Sexual Offences) Amendment Bill) passed in 2003. The latest version of the Bill states that the provision of post-exposure prophylaxis (PEP) is dependent on the victim laying a charge. This is likely to have a major negative impact on rape survivors receiving PEP within 72 hours and may impede the ability of medical and police officials to obtain medical evidence that is crucial for the successful prosecution of the perpetrator. Furthermore the Bill does away with measures to provide for the comprehensive management care and treatment of rape survivors and the omission of these measures is arguably dismissive of the needs of rape survivors. Another issue of concern is that women who do lay a charge and attend a health care service after rape do not optimally access and utilise the range of services available. Many primary and secondary level services in this country provide HIV testing and counselling PEP treatment of sexually transmitted infections pregnancy testing and prevention forensic examination and treatment of injuries. Health services providing the spectrum of post-rape care have an important role to play in changing the horrendous image of rape and HIV/AIDS and more particularly in fulfilling the needs of rape survivors. However compliance and follow-up remains a major challenge at ground level. (excerpt)