When people can’t get to healthcare, healthcare needs get to them.
Services for rape survivors may need to go mobile if the country is serious about reaching victims of gender-based violence.
Although rape remains under-reported in South Africa, the South African Police Service recorded almost 40 000 rape cases in 2016/17 alone.
For some survivors, counselling and legal services after a rape will come from the country’s 55 Thuthuzela Care Centres (TCCs), or the one-stop facilities designed to provide sexual and gender-based violence survivors with access to medical, psychological and legal support services all in one place. The centres are run by the departments of health, justice and social development. But counselling services at TCCs are the responsibility of nonprofit organisations, half of which are funded by the department of social development. An equal percentage of these bodies receive financial support from the international funding organisation Global Fund to Fight Aids, Tuberculosis and Malaria. But this money is due to end in March 2019, which could jeopardise not only mental health services but also HIV prevention efforts such as the provision of post-exposure prophylaxis (PEP), Lisa Vetten, a gender-based violence researcher at the University of Witwatersrand warns.
PEP is a short course of antiretrovirals that can help to prevent HIV-negative survivors from becoming infected with the virus following a rape. PEP must be taken within 72 hours to be effective.
But TCCs are only one part of post-rape care, Vetten explains. As the country tries to increase services for survivors as part of the latest national HIV plan, here are four ways we can transform care for rape victims.
1. Rape services need to hit the road
A 2017 South African Medical Council study found that some survivors live as far as 20km to 50km from the closest TCC in the Durban region, making it difficult for them to keep follow-up counselling sessions. To help people keep appointments, researchers provided survivors with a free shuttle service or a transport allowance. At the end of the two-year study, three out of four rape victims had managed to complete the counselling programme.
To put services within the reach of survivors, Vetten recommends mobile clinics include rape care alongside basic health services such as vaccinations and screenings. Integrating sexual violence care into existing clinics such as these could also help to destigmatise rape counselling, she says.
The country’s latest national strategic plan (NSP) on HIV and tuberculosis commits the government to increasing sexual and gender-based violence screening among people living in informal settlements, where up to one in five people live with HIV, according to the country’s latest household HIV survey .
2. Special cases, special care
Some TCCs are not open 24 hours a day, forcing after-hour victims in those areas to report to hospital casualty wards. Amid cases of gunshot wounds and car accidents, rape survivors often find themselves at the back of the queue to be seen.
Although the national health department has designated 265 public healthcare facilities to provide health and forensic services to survivors, the majority do not offer these services in “victim-friendly settings”, a 2017 survey of almost 170 of these facilities by the international organisation Doctors Without Borders (MSF) found.
Generally, rape survivors may wait hours in casualty wards to be treated by doctors who are not trained in rape care and who are often unwilling to testify as part of rape cases, Vetten says. In April, the KwaZulu-Natal branch of the South African Medical Association penned a letter voicing similar concerns.
MSF’s survey found that one in five designated facilities did not offer forensic assessments, the kind of examination needed to be entered into evidence during rape trials.
Both Vetten and MSF recommend more staff at hospitals and clinics be trained to provide medical and psychological care to survivors. Education for forensic nurses should also be expanded, the MSF report found. As of 2017, only the University of the Free State offered a one-year graduate diploma in forensic nursing.
3. Fewer lunches, more services
The department of social development devotes 12% of its budget to victim empowerment — a broad category that includes everything from funding for women’s shelters to lunches given out as part of the annual 16 Days of No Violence Against Women and Children campaign, Vetten says.
To protect crucial services such as rape counselling, money should be ring-fenced, she argues.
Earmarked funds should also be given to organisations in three-year cycles.
“[The department of social development] funds you [organisations] on a one-year basis. So you never know from one year to the next if you’re still going to have services next year,” Vetten explains.
“They need to create some assurances.”
4. Supporting survivors is a family affair
Vetten explains that family support plays a vital role in helping rape survivors to cope. Family members are often the first to know when someone has been raped. Including family members in counselling, especially when the victim is a child, can ensure they know what to expect and how they can offer support.
