Confusion still reigns over the degree of government commitment to providing treatment for rape survivors. And where such treatment exists it remains difficult to access.
The controversy arose when a Sunday newspaper report said the Cabinet had removed a clause from a new Sexual Offences Bill that obliges the government to pay for medical treatment to rape survivors.
On Wednesday Nono Simelela, HIV/Aids director in the Department of Health, denied the report, saying the government will not halt the treatment and that it is drafting guidelines for the care of rape survivors.
On the same day the Cabinet issued a statement expressing ”its concern at the misinformation being spread around a decision by Cabinet not to include a provision on preventative treatment (prophylaxis) in a Bill dealing with victims of sexual assault. The fact of the matter is that provision of this relief is already government policy, decided upon in April last year and being implemented incrementally in all parts of the country. This programme will continue.”
But health experts say these attempts at clarification repeat the status quo — namely that the government is refusing to commit itself legislatively to bear the costs of such treatment.
”If there is a big government commitment to the post-exposure prophylaxis [PEP] programme, then why take out the provision in legislation?” asks Liesl Gerntholtz of the Aids Law Project at Wits University’s Centre for Applied Legal Studies.
Gerntholtz says the availability of these programmes has been ”patchy” despite the Cabinet ruling that the general roll-out of PEP would happen by the end of last year.
Research by the Centre for Aids Development, Research and Evaluation says that to qualify for PEP women who have been raped must report the case to the police, obtain a case number, present themselves to a public health facility within 72 hours of the incident and undergo testing.
But there is no clarity over the provision of these packages for those who do not want to take the test, Gerntholtz says, and there is a need for counsellors to be trained to deal with women who tested HIV-positive anyway, not necessarily following a sexual assault.
Sexual assault services are not just about providing anti-retroviral treatment to rape survivors, but providing psychological support and awareness of crisis centres, says Doreen Schultz, a researcher at Wits Medical school who presented her study at the Aids conference in Durban this week.
Schultz based her recommendation on a study of 687 cases of sexual assault from the Sunninghill hospital, where she discovered that 16% of the women were HIV-positive before the rape took place. The majority of these women did not know their HIV status.
”A woman who has just been raped suffers from severe stress and injuries but then has to undergo an HIV test and be told that she is HIV-positive.” She says providing the drugs is the easy part, but these women need comprehensive pre- and post-counselling.
Shultz calls for a holistic approach when caring for women who have been raped. She says counselling should be a common practice in all clinics as well as integrating police services to deal with survivors of rape.