Rape survivors and the provision of HIV post-exposure prophylaxis (original) (raw)
Related papers
Southern African Journal of Hiv Medicine, 2008
Eleven years after it was first mooted in 1996, the Criminal Law (Sexual Offences and Related Matters) Amendment Act (32 of 2007) came into effect in December 2007. Law-makers proudly lauded sections 28 and 29 of the Act, which set out how post-exposure prophylaxis (PEP) to prevent HIV infection should be made available to rape survivors.* These clauses are, however, neither particularly novel nor innovative, Cabinet having already approved (in April 2002) the provision of antiretroviral drugs to prevent HIV infection following rape. Subsequent to Cabinet's decision, a few studies were conducted examining various facets of providing PEP as part of a health response to rape. 1-4 In theory, these findings should have provided legislators with some insight into what was required by rape survivors from a PEP service, particularly in relation to psycho-social support. This was not the case, as we will show in this article, which draws on unpublished findings from 67 interviews with rape survivors † exploring their adherence to PEP. *These clauses came into effect on 25 March 2008. † We use the terms 'patient', 'victim' and 'survivor' interchangeably in this report. 'Victim' is used to recognise that a violent crime has been inflicted upon someone, 'survivor' to acknowledge the long-term work required to cope with rape, and 'patient' because rape survivors are also using a health service.
2009
Objective: Sexual violence is widespread globally. HIV post-exposure prophylaxis (PEP) can be used following sexual assault to reduce the risk of HIV acquisition. Especially in settings such as South Africa, where both sexual violence and HIV are endemic, it is critical that health services provide timely and comprehensive care for sexual assault, including PEP. The Refentse study aimed to develop a nurse-driven, post-rape care model that could be integrated into existing reproductive health/HIV services within a rural South African hospital, and to evaluate the impact of this model on the quality of care delivered. Methods: The study was based in a 450-bed district hospital and used a pre/post-intervention study design. After conducting formative research, a five-part intervention model was introduced, including: a sexual violence advisory committee; hospital rape management policy; training workshop for service providers; designated examining room; and community awareness campaigns. 334 hospital charts were reviewed to assess the quality of clinical care provided to patients, and interviews were conducted with 16 service providers and 109 patients. To provide an analysis of cost-consequences, incremental costs to the health sector of improving care through the intervention model were assessed. Results: Initially, the service was fragmented, with multiple obstacles to the timely provision of care. Following the intervention, there were significant improvements in the quality of clinical history and examination, and the provision of pregnancy testing, emergency contraception, STI treatment; HIV counseling and testing, PEP, trauma counseling, and referrals. PEP completion rates increased from 20% to 58%. The incremental cost of the intervention was US$ 200 per case. When one-off development costs were excluded, the incremental cost per case was US$58. Conclusion: It is possible to improve sexual assault services including PEP within a rural South African hospital at modest cost, using existing staff and infrastructure. With additional training, nurses can play a central role in this care.
2005
My sincere thanks and appreciation go out to the following people without whom this research study would have not been possible. My supervisor, Mrs Sisana Majeke for her valuable guidance, support and being a wonderful mentor. The R.K.Khan hospital Management for giving me permission to conduct this research study, all medical and nursing staff for their cooperation and assistance with regard to conduction of interviews. My gratitude goes to all my participants in this study for their time and valuable information. To my Mentor, Mrs Thandiwe Ndebele, in staff Development Department at Inkosi Albert Luthuli Central Hospital for continuous support and encouragement. To my mother, Makhawula, my brothers, sisters and my daughter Mbalenhle for their support, cooperation, and sacrifices they made in order to for me to finish my study.
Bulletin of the World Health Organization, 2005
To investigate in the South African public health sector where the best services for rape survivors were provided, who provided them, what the providers' attitudes were towards women who had been raped and whether there were problems in delivering care for rape survivors. A cross-sectional study of facilities was carried out. Two district hospitals, a regional hospital and a tertiary hospital (where available) were randomly sampled in each of the nine provinces in South Africa. At each hospital, senior staff identified two doctors and two nurses who regularly provided care for women who had been raped. These doctors and nurses were interviewed using a questionnaire with both open-ended and closed questions. We interviewed 124 providers in 31 hospitals. A checklist that indicated what facilities were available for rape survivors was also completed for each hospital. A total of 32.6% of health workers in hospitals did not consider rape to be a serious medical condition. The mean n...
Delivering post-rape care services: Kenya's experience in developing integrated services
Bulletin of The World Health Organization, 2009
Lessons from the field Problem Comprehensive service delivery models for providing post-rape care are largely from resource-rich countries and do not translate easily to resource-limited settings such as Kenya, despite an identified need and high rates of sexual violence and HIV. Approach Starting in 2002, we undertook to work through existing governmental structures to establish and sustain health sector services for survivors of sexual violence. Local setting In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. Relevant changes A standard of care and a simple post-rape care systems algorithm were designed. A counselling protocol was developed. Targeted training that was knowledge-, skills-and values-based was provided to clinicians, laboratory personnel and trauma counsellors. The standard of care included clinical evaluation and documentation, clinical management, counselling and referral mechanisms. Between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$ 27, with numbers increasing each year. Almost half (43%) of these were children less than 15 years of age. Lessons learned This paper describes how multisectoral teams at district level in Kenya agreed that they would provide post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. The paper outlines which considerations they took into account, who accessed the services and how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.
International Journal of Gynecology & Obstetrics, 2010
To review the evidence and provide guidelines on the management of sexual violence against women, specifically, rape. Outcomes: Outcomes evaluated include effectiveness of post-rape care provision. Evidence: The MEDLINE database was searched for articles published up to December 2008 on the topic of post-rape care and expert opinion was sought from the Sexual Violence Research Initiative membership. In addition, a search was performed for English-language protocols on Google. One Spanish language protocol was considered in the development of the guidelines. Values: The evidence was evaluated by authors and reviewers of the South African Department of Health's sexual assault curriculum, and by members of the FIGO Working Group and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs: Implementation of the recommendations in this Guideline should result in more appropriate management of survivors of sexual violence and better physical and psychological outcomes.
PloS one, 2017
To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements. Adolescents and adults presenting at the specialized Sexual and Gender Based Violence clinic in Harare are offered a standardised package of free medical and psychosocial care. Zimbabwe has an HIV prevalence of 14%, so prevention of HIV infection using PEP for those that present within 72 hours is a key part of the response. STI treatment, emergency contraceptive pills, referral for termination of pregnancy, psychological, social and legal support is also provided. This is a retrospective descriptive study of routine programmatic data collected at the Edith Opperman polyclinic in Mbare SGBV clinic from 2011 to 2014. Chi-square tests and logistic regression were used to describe the different experiences and the differences in uptake of care between clients presenting for rap...
POST RAPE SERVICES IN KENYA: A SITUATION ANALYSIS
2000
Background: Violence is an important risk factor contributing towards vulnerability to HIV and AIDS (UNAIDS, 1999; Jewkes, 2002a). Scientific evidence suggests safety and efficacy of PEP based on observational studies of occupational exposure and mother-to-child transmission (Wade et.al 1998; Rompay et.al 2002). Discussions of opportunities and challenges around post exposure prophylaxis (PEP) to reduce HIV transmission following sexual violence is growing. Gender based sexual violence in Kenya is almost invisible, though reportedly more prevalent than officially acknowledged. Literature on sexual violence in Kenya is limited. Health care workers at primary health centers and Voluntary Counselling and Testing (VCT) sites are reporting increasing numbers of rape clients. There is increasing demand for VCT services and VCT scale-up as a key Kenyan strategy to fight HIV, provide infrastructure, capacity and political support for post rape care services provision.