South Africa: HIV-Prevention Program Fails Rape Survivors
Mass AIDS Plan Should Learn From Post-Rape HIV-Prevention Efforts

(New York, March 4, 2004) - The South African government has
undermined its promising initiative to provide anti-AIDS drugs to
prevent HIV among rape survivors, putting lives at risk amid a
dual epidemic of sexual violence and HIV/AIDS, Human Rights Watch
said in a report issued today.

The 73-page report, "Deadly Delay: South Africa's Efforts to
Prevent HIV in Survivors of Sexual Violence," documents how
government inaction and misinformation from high-level officials
have undermined the effectiveness of South Africa's program to
provide rape survivors with post-exposure prophylaxis
(PEP)-antiretroviral drugs that can reduce the risk of
contracting HIV from an HIV-positive attacker.

"The South African government has taken a crucial step in
recognizing the importance of HIV prevention for rape survivors,"
said Rebecca Schleifer, researcher with Human Rights Watch's
HIV/AIDS and Human Rights Program. "But there is a deadly
disconnect between the government's stated intention to provide
drugs that can prevent HIV and the reality for rape survivors who
can't get them."

In the face of South Africa's explosive AIDS epidemic, rape and
other rampant forms of sexual violence can be a death sentence
for women and girls. In April 2002, the government pledged to
provide PEP as part of a comprehensive package of services for
rape survivors. Obtaining PEP quickly can reduce the risk of
contracting HIV after rape.

However, the government launched its PEP program in near silence.
Government failure to provide adequate information or training on
PEP has left both service providers and rape survivors in the
dark. Given the state's history of opposition to antiretroviral
drugs, the lack of clear messages from high-level officials
supporting PEP has further undermined rape survivors' ability to
get the drugs.

"Police and nurses who should have been helping rape survivors
get anti-HIV drugs didn't do so, sometimes because they had no
idea that the program even existed," Schleifer said. "And some
service providers may not have offered these drugs even when they
knew about them, because they thought that doing so was against
government policy."

After years of government opposition to providing anti-AIDS drugs
in the public health system, including statements by President
Thabo Mbeki questioning whether these drugs were too toxic to
use, the government announced in August 2003 a nationwide
treatment program for people with AIDS.

"South Africa's broader plan to provide antiretroviral treatment
will encounter many of the same challenges as providing anti-HIV
drugs to rape survivors: effective public education, clear
political support, and guaranteed access for children," Schleifer
said. "The government's inability to implement a small-scale
program like PEP raises concerns about its plan to provide
antiretroviral treatment on a grand scale."

Police often respond inadequately to rape complaints, neglecting
to help rape survivors get medical treatment, or in some cases,
even turning them away. Coupled with health professionals'
insistence that rape survivors file a police report to get
medical services, which is a requirement at odds with Department
of Health policy, these factors have further impeded access to
PEP. One counselor told Human Rights Watch, "almost all the time
police refuse to open a case" for rape survivors. In turn,
doctors have refused to examine rape survivors who had not
reported their cases to police.

Children, an estimated 40 percent of rape and attempted rape
survivors in South Africa, are especially harmed by the
government's failure to take their needs into account. By law,
children under 14 cannot consent on their own to PEP services or
the prerequisite HIV testing. This poses problems for children
seeking services unaccompanied by a parent or legal guardian-a
common problem, particularly for children in communities hard hit
by HIV/AIDS. Moreover, national PEP guidelines do not include
information on how to give PEP to children under 14, leaving many
health professionals without basic guidance for younger children.

Few African countries provide PEP for rape survivors, although
this is a standard service in many other countries. South
Africa's PEP program could become a model as other states in the
region begin to develop PEP services and broader antiretroviral
treatment programs.

Human Rights Watch calls on South Africa to take urgent action
to:
- Launch a comprehensive public education campaign on PEP
services for survivors of rape and other forms of sexual
violence, and make clear statements supporting antiretroviral
drugs;
- Issue a clear policy directive that filing a police report
is not a prerequisite to obtaining PEP or other medical services
following rape or other forms of sexual violence;
- Ensure adequate training on PEP and sexual violence for
police, health professionals and other service providers who work
with sexual violence survivors;
- Adopt procedures to facilitate prompt consent to PEP
services and HIV testing for children under 14; and
- Restore and enact provisions in the Criminal Procedure
(Sexual Offences) Amendment Bill requiring the state to provide
PEP as well as other appropriate medical treatment and counseling
to sexual violence survivors.

To read the Human Rights Watch report, please see:
http://hrw.org/reports/2004/southafrica0304/

For more information on HIV/AIDS and human rights in Africa,
please see: http://hrw.org/doc/?t=hivaids_africa