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Rape survivors must fend for themselves
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'Rape survivors must fend for themselves'

By Charlene Smith

The cabinet has removed a treatment clause obliging the government to provide medical treatment to rape survivors to prevent sexually transmitted illnesses and pregnancy - not because they don't want to give such treatment, they say, but because they don't want to budget for it.

On Tuesday and Wednesday the new Sexual Offences Bill goes before the justice portfolio committee in parliament, minus section 21, a treatment clause cut out by the cabinet, which passed the bill on July 23. Women's groups and parliamentarians are responding with anger.

This comes a week after the World Bank warned that the government was heading for catastrophe by failing to extend treatment for HIV, and a week before Women's Day, and in a week in which the government has provoked international ire because the Medicines Control Council (MCC) is threatening to deregister nevirapine for babies born to HIV-infected mothers.

The step affecting rape survivors will potentially affect far more people than babies - with 54 000 reported rapes a year, and an estimated 1,6 million actual rapes, according to the Law Commission. The move by cabinet, a year after promising "immediate" universal access to post-exposure prophylaxis (PEP) - which has occurred in only a few hospitals and clinics where the drug Combovir is given after rape - could have devastating consequences.

Paul Setsetse, the spokesperson for the ministry of justice, said "the amendment was effected due to cost implications. But having said that, there will be other alternatives looked into, cost-effective solutions such as counselling. People will engage the health department, social welfare and police protection units and see how best we can synergise efforts to ensure, once a person is a victim of sexual abuse, what counselling should we bring into place".

However, he also said that, "the fact that a person must be provided with anti-retrovirals immediately (after) they are raped at the nearest state hospital remains. They don't have to have a medical aid. The concern in amending the law (to remove the state obligation to provide PEP) was concerns that if government makes this compulsory, then they have to budget for it and people would find that difficult to do. So we don't necessarily legislate it, we make it a principled position."

Setsetse could not explain how the government could provide anti-retrovirals for about 1,6 million rape survivors each year without budgeting for that scenario.

It appears that these measures have been taken without consulting the department of health. Dr Ayanda Ntsaluba, director-general of the health department, promised to comment on the matter, but was later not available. However, Dr Nono Simelela, the head of the Aids directorate, said she was "surprised" at the excision of the treatment clause, "no one has informed me yet". Dr SH Khotu, the head of information systems, said that "for now, our policy (to give PEP to rape survivors) stands". However, neither he nor Dr Simelela could say what the affect of the removal of the treatment clause could have to the continued roll-out of PEP to rape survivors, or if it would cease. They also could not give figures on how many rape survivors had received PEP or how many health centres were dispensing it. Joanne Collinge, the spokesperson for Manto Tshabalala-Msimang, the minister of health, failed to respond to messages.

It will cost the government more in the long term not to give PEP HIV preventative medication to rape survivors. It costs about R200 per rape survivor to give the preventative medication, which can greatly reduce the risk of HIV transmission to the survivor if the assailant is infected. In preliminary research the Centres for Disease Control in the United States says it lowers the risk by at least 35 percent. Research in South Africa, however, has shown that no rape survivor given the drug within the required 72 hours for adults, and 24 hours for children, has become HIV infected.

However, if the medicine is not given, and the survivor becomes infected, research by Dr Adrienne Wulfsohn of Johannesburg has shown it will cost the state more than R600 000 for the medical costs of a rape survivor who becomes HIV-positive. According to unpublished police data, rape in Gauteng jumped a further 30 percent between October to December last year, with most incidents perpetrated against children. Because of their thin vaginal membranes (or anal membranes in boys), children raped are at much higher risk of HIV infection after assaults.

A senior police officer, when told of the excision of the treatment clause from the bill, said, "I wish those people in parliament could be with us when we tell a rape survivor she can't get the drugs for HIV".

Research by Dr Ames Dhai, formerly of the Nelson Mandela School of Medicine in KwaZulu-Natal, and Dr Wulfsohn, has shown that, because of the high prevalence of HIV in South Africa, a rape survivor here has a 40 percent to 30 percent risk of becoming HIV-positive after a rape if she does not receive rapid access to the anti-retrovirals in PEP.

The excision of the clause not only covers medication for PEP, but also medications to prevent pregnancy and other sexually transmitted diseases. A lawyer that advises the government said the government might be afraid that they could get sued if a rape survivor did not receive treatment, "however, a rape survivor could sue now because cabinet made a published promise to extend PEP on April 17 and are not doing it, and appear determined never to do it."

Cabinet members, parliamentarians and their families receive PEP in terms of their medical aid if raped.

Published on the Web by IOL on 2003-08-03 12:26:19 _______________________________________________ DEBATE mailing list DEBATE@lists.kabissa.org http://lists.kabissa.org/mailman/listinfo/debate