Gender activists have welcomed the apparent U-turn by the government on the reintroduction of a clause in the Sexual Offences Bill, which will guarantee that rape survivors receive post exposure prophylaxis (PEP) treatment at state health facilities.
Clause 21, which makes provision for PEP to be provided to the victims of sexual assault, was dropped from the Sexual Offences Bill late last year.
The original clause contained in Section 21 of the Bill read: “Where a person has sustained physical, psychological or other injuries as a result of an alleged sexual offence, such person shall, immediately after the alleged offence, receive the appropriate medical care, treatment and counselling as may be required for such injuries.”
According to a statement released this week by the 25 NGOs involved in the “PEP Talk” campaign: “Following lobbying by women’s rights organisations, the Justice Department agreed last week to write into law a clause giving rape survivors certainty that they will have access to anti-retrovirals.”
The campaign, undertaken during the 16 Days of Activism against Gender Violence in December last year, did spot checks on health facilities and found that 43% of the 32 hospitals and clinics investigated did not provide access to PEP.
“There is not enough attention [paid] to the issue of drugs that can be taken to prevent HIV infections from sexual assault,” says Colleen Lowe-Morna, director of Gender Links, one of the NGOs involved in the campaign. She says that survivors of sexual assault have a right to treatment and that treatment should be freely available at all state health facilities.
The chairperson of the justice portfolio committee, Johnny de Lange, was out of the country when contacted for comment this week, but Fatima Chohan-Khota, a member of the committee confirmed that PEP would only be available at clinics and hospitals that already provide antiretroviral drugs.
She said that the committee will meet the Department of Health next week to discuss the logistics of providing treatment to rape survivors.
Chohan-Khota said that the Bill should be passed in the National Assembly before the upcoming elections (widely tipped to be held this April) as the committee has prioritised deliberations on this issue.
The 25 NGOs said there is no justification for any health facility not to provide PEP.
“This treatment — the common antidote to injuries that might expose health workers to HIV — is readily available in health facilities. It is simply not being consistently offered to survivors of sexual offences because of the general reluctance that has been shown by the government to rolling out antiretrovirals.”
“The problem really is at the clinics, they are most likely to be the first port of call,” she says. The report found that 11 out of 13 hospitals provide PEP, while only three out of 16 clinics provided this treatment.
Yet Lowe-Morna says PEP is only one of the issues surrounding sexual assault. “It’s also about sexually transmitted diseases, trauma counselling, pregnancy and the morning-after pill. There’s a whole package of care that goes with sexual assault.”
While the provision of PEP is laudable, it raises other concerns, according to Liesl Gerntholtz, a lawyer at the Aids Law Project. She told the Mail & Guardian that the preventative drug became available to survivors of sexual assault in public health institutions in April 2002, yet many women have said that they find it difficult to access PEP. She says the public is not aware that PEP is available, despite the high prevalence of both sexual assault and HIV/Aids in South Africa.
She says the real question is not whether the clause is included in the Bill or not, but whether it is working for women. “The implementation barriers are complex.” Making PEP available does not automatically make it accessible, says Gerntholtz. A woman who is in a coercive relationship and is raped may not feel comfortable admitting that rape occurred and would not be able to publicly take steps towards getting treatment, she told the M&G.
The quality of post-rape counselling is not as good as it should be, she added. Many survivors find the thought of having an HIV/Aids test after surviving rape quite daunting and are not being given adequate pre-test counselling.
Gerntholtz says that while it is important to deal with issues of provision of treatment for survivors of sexual assault, society’s attitudes towards rape survivors also needs to change and counselling must focus on allowing survivors to take control of their lives.