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The LifeSense Rape Care Programme

South Africa has the highest incidence of rape in the world. And the highest incidence of HIV.

The rape graph rises sharply in girls aged 11, and peaks in young women aged 13 to 25 (Unisa, March,1999)

The highest incidence of HIV is in girls aged 13 to 19 (SA Department of Health, May, 2000)

In every workplace there are rape survivors. In every workplace are employees who have wives, children, mothers, sisters, friends or partners who have been raped.

Rape impacts not only on the woman, child or man raped, but on the entire family.

It has a profound impact, through Post Traumatic Stress Syndrome, and fears about her health, on the productivity of an employee raped - and on her family who battle to deal with the trauma of this tragic event.

What role can business play in defeating the high rates of sexual violence in our communities and strengthening their employees or clients to deal with this most violent of all traumas - as well as play a role in combating the accelerating incidence of HIV/AIDS?

The LifeSense Group

The independently-owned LifeSense Group, a human asset management organisation that cares for over 600 000 individuals in sub-Saharan Africa, offers a programme, LifeSense Rape Care, that attempts to remove every stressful factor from the life of a person raped. And contribute to rape prevention and detection, as well as decreasing the risks of HIV infection and deepening awareness around HIV management.

Research and Development

During the development of the Programme, which began in early 1999, immense consideration was given to the reaction of the public towards such a highly sensitive and emotive issue.

Researched and developed by a woman, in consultation with HIV/AIDS specialists, rape survivors, forensic specialists, the police and a wide range of anti-rape organisations, the Programme offers a comprehensive range of benefits designed around the highly specific needs of the rape survivor and his/her family.

LifeSense Disease Management (Pty) Ltd, a member of the LifeSense Group of companies, and a specialist in the field of HIV/AIDS management, also played a major role in formulating the programme. LifeSense Disease Management is one of the largest organisations of its kind in the country and currently manages in excess of 600 000 lives, of which over 3 000 HIV-positive patients are being effectively managed for the disease.

The Programme enables survivors, wherever they are in the country, to go to a private facility and get the requisite treatment, antiretroviral therapy and counselling. In addition, the 28-day triple-combination antiretroviral course is delivered to the survivor’s door.

The Launch

The successful launch of the Programme, a mere three weeks after a similar product was disastrously launched by a large insurance company, proved that such a programme - properly researched, developed and priced - could indeed offer a positive contribution, provided that the supplier was correctly positioned to administer such a programme.

The LifeSense Rape Care Programme received the support and endorsement of government, the public, media and prominent rape survivors, including Charlene Smith. Proving that the employment of a profit motive to help combat rape, HIV and the issues surrounding them is acceptable in the correct circumstances.

Costs - both in the development and administration of the Programme and the end-user pricing - was kept as low as possible because LifeSense believes it imperative that as many people as possible benefit from the Programme. It is designed to be flexible so that if, for example, government does provide free antiretroviral therapy to rape survivors, or if cheaper antiretrovirals are allowed into the country, the benefits will be adjusted accordingly.

The Programme has been designed not only to help heal the survivor and his or her immediate family, but also has a strong educational intent around the management of rape trauma and HIV/AIDS.

The LifeSense Rape Care Programme is a uniquely South African solution to a unique and serious problem.

The LifeSense Rape Care Programme builds survivors.

Investing in your staff

Companies such as the Altron Group have already invested in the programme for their staff. However, any company that invests in the programme as a benefit for employees and/or clients - whether an insurance company, banking group or retail outlet - will give a powerful indicator of their abhorrence of sexual violence and their commitment to protect the innocent and the vulnerable, as well as informing and protecting their employees/clients about and against the HIV virus.

Charlene Smith, rape survivor, activist and journalist writing in the Mail and Guardian on April 8, 1999 about the attack and rape against her noted: “And if I have HIV? I pray that I don’t, but I believe all of this happened for a purpose. God sent me this challenge. I have to turn this evil into good and that is why I am speaking out. Rape victims are not statistics, we are people. We have nothing to be ashamed of. It’s a so-called moral society that does nothing that should be filled with shame.”

Antiretrovirals or post-exposure prophylaxis (PEP) such as AZT, 3TC, Crixivan and other antiretroviral drugs are already routinely given in countries such as Canada - which has an 0.03% risk of HIV infection; and the USA which has a 6% risk of HIV infection compared to dramatically higher figures in South Africa and its neighbouring countries.

Rape and HIV

One in five South Africans, according to the Department of Health (1999), is HIV-positive, with women, particularly those in the 15 to 25 age group, forming the highest category of infected people.

According to a report published by UNISA on March 29, 1999, the rape graph rises steeply at age 11, and peaks between ages 13 and 25.

Rape activists do not believe the high rate of infection in young women is coincidental.

The real rates of HIV infection among women are possibly higher than one in five - a third of women attending ante-natal classes are HIV-positive; one in three babies born in Soweto are infected by their mothers; one in three children admitted to state hospitals are infected; and 65% of paediatric deaths at Johannesburg Hospital are due to AIDS-related illnesses.

The SA Law Commission in its September 1999 draft Sexual Offences legislation noted: “Rape is … not comparable to any other form of sexual crime … rape violates a victim’s physical safety (and) their sexual and psychological integrity. It is … sexual terrorism. Rape is invasive, dehumanizing and humiliating. It is a crime akin to torture.”.

Interpol, in a 1999 report, says, “South Africa remains in an ‘undisputed first place’ as far as REPORTED cases of rape are concerned”. Based on reported cases (and not debunked estimates) South Africa has a rate of just over 104 rapes per 100 000 population; compared to 34.4 per 100 000 in the USA (in second place).

Reporting rape

Many rape survivors do not report the crime, and will not go to district surgeon’s offices.

LifeSense Rape Care does not insist on either a police report or a district surgeon’s report. It simply requires written confirmation from a registered medical practitioner that there is evidence of rape, and the survivor’s consent to the release of his/her HIV test results to LifeSense. This procedure is handled in strictest confidence.

The programme enables survivors, no matter where they are in the country, to go to a private facility and get the requisite treatment, antiretroviral therapy and counselling. In addition, the 28-day antiretroviral therapy course is delivered to the survivor’s door.

Rape and HIV

The risk of contracting HIV from rape is particularly high in South Africa.

Triple-combination antiretroviral therapy provided by the programme, and particularly in instances of gang rape where a protease inhibitor such as Crixivan is required, is essential in helping to reduce the chances of a rape survivor contracting HIV.

Access to such therapy is limited: it is also costly and beyond the reach of the majority of South Africans.

Whilst antiretroviral therapy cannot entirely eliminate the risk, recent studies (by the Centre for Disease Control in the United States amongst others) show that a 28-day PEP course reduces the chance of contracting HIV by almost 100% if properly adhered to.

Programme benefits

The LifeSense Rape Care Programme offers modular benefits, flexibly priced, for organisations and their employees/clients. One single programme will cover the principal member, spouse and all other members of his/her immediate family under the age of 21.

Benefit options

Case Management Option

Due to market requirements and improved ease of access for members, the LifeSense Rape Care Programme is now available in a modular format.

At no time, however, should this modular structure be used to create an inappropriate benefit structure. Each of the benefits included in the Programme plays a significant and integral part in the recovery of the rape survivor and cannot be omitted without potential trauma for the survivor. Only in the instance of an organisation being able to provide part of the treatment and recovery benefit itself, such a medical scheme providing antiretroviral therapy, should an individual grouping of benefits be considered.

The Case Management Option must be purchased as a whole and may not be broken down into separate benefits.

It comprises:

Call centre (24-hours, 365 days-a-year with unlimited access);

Case management facility;

Security benefit;

Legal benefit.

Call Centre

Our call centre provides an unlimited access and counselling service, 24-hours, 365 days a year for LifeSense Rape Care clients. The centre is equipped with state-of-the-art technology and can provide clients with up-to-date information on issues from sourcing counsellors to medical facilities and emergency pharmacies.

The call centre is staffed by qualified medical personnel who have undergone training on rape counselling.

All calls are treated confidentially.

Case management

LifeSense Case Management provides a comprehensive and confidential monitoring service for all clients. All aspects of a rape survivor’s progress is supervised - from initial HIV-testing through to counselling progress.

Security benefit

Statistics show that 60% of rapes happen in the survivor’s home and fear is a significant immediate and long-term disabler of the rape survivor. A security benefit allows the survivor to take immediate steps to boost security in their home, such as replacement of locks and keys at a domestic dwelling, or installation of burglar bars. This benefit also covers self-defence courses and personal defence items such as mace sprays and personal body alarms.

Legal benefit

Individuals claiming throughout the year who wished to legally pursue the case via the court system inspired the inclusion of a legal benefit in the Programme. The benefit may be used to cover any legal costs relating to the incidence of rape.

Medical Benefits Programme

The benefits included in the Medical Benefits Programme are optional but may be added to the core package as a whole to provide a customised care programme.

Optional benefits include (either as a package or individually):

Starter pack (3-day course, AZT & 3TC)

28-day antiretroviral therapy (AZT, 3TC and Crixivan)

Medical consultations (four)

HIV Elisa test (one)

PCR tests (three)

Anti-STD medication

Morning-after pill

Two other benefits are available as add-ons:

Alternative therapy

To deal with the fear of being touched that so many rape survivors experience after rape - and that contributes to the breakdown of relationships - an alternative therapy benefit is available which covers such treatments as facials, reiki, shiatsu, homoeopathic remedies, aromatherapy and reflexology.

Physiotherapy costs are also covered under this section of the programme.

Alternative therapies play an important role in helping the survivor rediscover his/her dignity and self-respect. They are completely unique in insurance because rape is a crime that cannot be compensated financially. The LifeSense Rape Care programme, by providing this benefit, looks at helping the survivor survive healthily, physically and emotionally. It creates the first steps for total healing.

Counselling

The counselling benefit has a limit of R5 000 and is available for the rape survivor and members of his/her immediate family.

Rape is a severely traumatic event that extends to the families of survivors and can damage their closest relationships.

Statistics show that eighty percent of relationships, including marriages, fail within one year of the rape.

To deal with this trauma, counselling benefits that extend to the whole family, including live-in partners, are included in the programme. And there is a toll-free 24-hour, 365 days-a-year trauma line.

Although LifeSense can make recommendations, the final choice of counsellor lies with the individual.

Social Responsibility - LifeSense Community Care

LifeSense will make valid data available to the police to assist in the investigation of sexual crimes. As an example, if it is noted, according to the information received, that a series of gang rapes are happening in a certain area, they will provide the information at their disposal - excepting the names of the survivors - to enable the police to focus preventative and detection measures in that area.

LifeSense will also use their database to provide statistics around rape on an annual basis. President Thabo Mbeki expressed his concern about the reliability of rape statistics, and while LifeSense statistics will not be definitive, as they cannot track every incidence of rape in the country, they will add to the understanding and detection and prevention of rape.

LifeSense is committed to an ongoing process of backing organisations that contribute to the prevention of sexual violence, or that assist in the management and care of survivors. It has established a Section 21 company, LifeSense Community Care, that makes allotments in the furtherance of these aims. Benefactors may include organisations that promote education in schools to reduce violent attitudes and sexism; a police trauma centre; a major counselling group or research organisation; or the foundation of LifeSense trauma centres.

To date, LifeSense Community Care has funded the refurbishment of four specialised sexual offences courts, intermediary and waiting rooms in Protea North, Soweto, one of the busiest courts in the country. The refurbishment included the installation of television sets and monitors in the courts and their intermediary rooms, enabling sexual offences survivors to testify in-camera. It also included the installation of burglar-bars and doors, curtains, furniture, anatomic dolls, heaters, blankets and toys.

Each month, a fixed amount from each existing programme is paid into this fund.

Rape statistics in South Africa

South Africa has the highest incidence of rape in the world (Interpol, 1999)

One in two South African women will be raped in her lifetime (UNISA, March 1999)

A woman, man or child is raped every 26 seconds in South Africa (UNISA, People Opposed to Women Abuse [POWA])

One million men, women and children are raped each year in South Africa

40% of men aged 20 to 29 are HIV-positive (Johannesburg Hospital)

According to Groote Schuur Hospital, 75% of rapes are gang rapes

In South Africa, a person is more likely to be raped by anything from 3 to 30 people than by a single perpetrator (Groote Schuur hospital, Sunninghill rape clinic, Charlene Smith)

South Africa not only has the highest incidence of rape in the world, but the most violent and every person raped is at risk from HIV infection (Charlene Smith)

Only 17% of the 54 000 reported rapes in 1998 were prosecuted and, of these, only 9% resulted in a guilty verdict (Department of Justice, 1999)

60% of rapes take place within the survivor or victim’s home (UNISA/SAPS)

A weapon is used in 85% of rapes (UNISA, SAPS, 1999)

Costs

Case Management Option R4.41 (inc VAT)

(The VAT portion on this option is R0.12 as certain elements of this option are VAT-exempt).

Medical Benefit Option R5.52 (inc VAT)

(The VAT portion on this option is R0.11 as certain elements of this option are VAT-exempt).

Full Programme Option R9.93 (inc VAT)

For more details contact Audrey Potter at apotter@lifesense.co.za