Two separate pieces of research published by the Networking HIV and AIDS Community of Southern Africa (NACOSA) highlight the need for services and screening for victims of gender based violence as a critical part of the country’s HIV response.
A study by NACOSA in Wentworth, KwaZulu-Natal, looked at simultaneously screening people for HIV and gender based violence (GBV) and found that almost half (45.7%) of the people screened had a positive history of past or present GBV and required support. The study concluded that victims of GBV should be recognized as a key population for HIV testing in South Africa and showed that the number of people testing positive amongst this group was much higher than that of the general population.
An evaluation of NGO services at Thuthuzela Care Centres (one-stop sexual violence centres based in state hospitals), found that these services had a profound impact on the lives of survivors and also supported survivors to take post exposure prophylaxis (PEP) to prevent the transmission of HIV post-rape. A large proportion of the South African population is unaware of the locations or the services provided at Thuthuzela Care Centres or unable to access to them as they are located far from the communities in which they live, which is problematic given the high rates of both rape and HIV prevalence in the country.
Critical to the effectiveness of the NGO services is that they are available 24 hours and are tailored to the immediate needs of rape survivors of all ages. One survivor, Nombuso (not her real name), was escorted to a Thuthuzela Care Centre by the police early on a Sunday morning and was nervous about what would happen. She was guided through the process by an NGO-trained and -appointed counsellor who also ensured she completed all her counselling sessions and attended two support groups. Nombuso described the services she received, “what I can tell you is that the counsellors here are very patient. They have love. From the way I saw them, they can handle even young children. This is what I saw while I was sitting there waiting for help. They have love.”
The initiation of PEP is time-sensitive, with the first dose of drugs needing to be administered within 72 hours of the rape having occurred. The time-bound nature of this treatment can particularly disadvantage children who often only disclose sexual abuse some time after it has occurred. Other delays found to affect access to PEP, for both adults and children, include a lack of awareness of the time-bound nature of PEP initiation, the time spent taking statements from rape survivors, as well as long waits in casualty. Communities may also not know that HIV infection can be prevented through the administration of PEP.
Whilst considerable barriers to PEP follow-up and adherence were acknowledged, NGOs were reported to contribute to a number of facilitating factors including offering adherence support and increasing motivation of survivors during follow-up phone calls and homes visits as part of the longer term psychosocial support they are able to offer. Completion rates for PEP are low both in sub-Saharan Africa, as well as in more developed countries, but quantitative monitoring data collected by NGOs at TCCs demonstrated a clear improvement in reported PEP completion thanks to the dedicated efforts of NGOs.
According to a nurse working in a TCC, “the services are excellent because they are doing a lot, counselling and giving them transport and doing home visits and in most of the cases they do the calls. They do call them to come for the results… they even give us reports to say they were able to reach which people and which ones didn’t return back and we work hand in glove with them nicely.”
Psychosocial support services provided by NGOs to survivors at TCCs are currently funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria however this funding will come to an end in March 2019, leaving a gap in the funding of these critical services to survivors of GBV. A doctor working in a TCC interviewed for the research said:
“If we do not have any NGO support, it means the psychosocial services are going to literally come to a standstill. There is going to be such a long waiting list for this one social worker. And she does not even specialise in children. So, the presence of the NGO here is of utmost importance. They really do a major, major part of the service.”
With recently released crime statistics showing an increase in reported sexual assaults (up by 8.2%) and rape (up by 0.5%), it is more critical than ever to support the continued services of NGOs in TCCs as well as increase the integration of screening for GBV alongside HIV testing services.
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