Johannesburg - In a report released at the 1st South African National Conference on Violence earlier this week, MSF outlined startling levels of sexual violence in the large mining town of Rustenburg, low numbers of women reporting to healthcare services after rape, and numerous barriers to accessing post-rape care, including a lack of knowledge among women about the benefits of receiving urgent medical attention.

Untreated Violence: The Need for Patient-centred Care for Survivors of Sexual Violence in the Platinum Mining Belt, which discusses the findings of an in-depth survey of over 800 women aged between 18 and 49, revealed that one in four women has been raped in her lifetime, with approximately half of women reporting experiences of sexual violence or physical intimate partner violence.

Extrapolating these figures to the municipality as a whole, around 11,000 women and girls in Rustenburg are raped each year. Yet 95 per cent of rape survivors have never told a health professional, and only half of those surveyed knew that HIV could be prevented after being raped.

According to MSF Epidemiologist Sarah-Jane Steele, the findings show that rape is not only highly prevalent in Rustenburg municipality, but that opportunities to reduce the more serious health impacts of rape are being missed.

MSF is using the report and the survey results to call on the South African government and other health actors to urgently roll out a comprehensive and widely accessible medical and psychosocial response that addresses and removes the barriers to accessing a basic package of healthcare services for victims of sexual violence, both in the Platinum Mining Belt around Rustenburg and across the country.

“Treatment and psychosocial counseling for rape survivors reporting within 72 hours can prevent HIV infection and unwanted pregnancy, and help to mitigate long-term psychological suffering,” said Steele, “but the majority of women we interviewed don’t know such treatment exists, services close to where they live are sorely lacking and an absence of financial independence may make access difficult even when services are present.”

Limited access to health services

Rustenburg sits within the Bojanala health district (average population 1.3 million) where MSF, in partnership with the North West Province Department of Health, is piloting the expansion of a patient-centred response to sexual violence, including a care and management clinical mentorship programmed for professional nurses.

According to the North West Province Department of Health, out of the 783 health facilities in the district, only 11 designated as public health facilities provide post-exposure prophylaxis (PEP) to prevent HIV, and support forensic examination for rape survivors. This number includes the MSF/Department of Health Kgomotso Care Centre in Boitekong.

Most of the dedicated facilities for rape survivors are at district hospital or community health centre level. The capacity of each of these designated public health facilities varies, dependent upon the number of trained staff available that can conduct the examinations.

Expanding the patient-centred approach

According to MSF Medical Coordinator Dr Amir Shroufi, what’s urgently required is a patient-centred approach to rape and sexual violence that prioritizes the medical and psychosocial needs of survivors.

For this to happen more trained staff and more widely available comprehensive services are needed.

“All rape survivors should receive access to comprehensive medical and psychosocial services to reduce the risk of contracting HIV and other infectious diseases, preventing unwanted pregnancy, addressing psychological distress and linking the patient to appropriate social support," says Shroufi, “but that doesn’t diminish the importance for all survivors to also be given the option to undergo forensic examination and to pursue a legal response to rape”.    

The basic package of care that MSF offers in Bojanala includes:

• Medical first aid to treat injuries
• Comprehensive medical assessment, including forensic examination
• Post-exposure prophylaxis to prevent HIV infection, and treatment for other sexually transmitted infections
• Vaccinations to prevent hepatitis B and tetanus
• Emergency contraception to prevent unwanted pregnancies
• Counseling as well as links to appropriate social support measures.