Mail & Guardian (Johannesburg) - January 18, 2002
Charlene Smith and Nawaal Deane

The findings of the study, conducted on hundreds of rape survivors at the Sunninghill Clinic in Sandton, Johannesburg, over the past two years, contrast starkly with the government's controversial contention that the efficacy of such treatment remains unproven - in particular the stance of President Thabo Mbeki and Minister of Health Manto Tshabalala-Msimang.

The government has objected to administering anti-retrovirals in state hospitals. The ban has been slated as particularly bizarre in the cases of raped women - at risk of getting the disease from their attackers - or HIV-positive pregnant women - for whom the drugs can be highly effective in preventing transmission to the unborn child.

South Africa's position is becoming increasingly out of synch with the rest of the world. The World Health Organisation reported this week that two-thirds of HIV-positive women in Rwanda became infected as a result of rape - which debunks Mbeki's questioning of women's vulnerability to HIV in cases of rape.

The new Sunninghill study coincides with the latest embarrassment to hit the government over its anti-retroviral policies. Last week the Mail & Guardian reported that the Northern Cape health MEC had blasted Kimberley hospital for administering anti-retrovirals to "Tshepang", the nine-month-old baby who was allegedly raped and sodomised by six men last November.

The saga at Kimberley hospital exposed how officials across the country have fallen under the spell of Mbeki's controversial beliefs about the connection between HIV and Aids and the efficacy of anti-retroviral drugs. The government's position on anti-retrovirals has not been codified, but instead disseminated through statements from the president and debate in the media.

The M&G was alerted to the clash between the government and the Kimberley hospital by a German doctor who was suspended by the hospital for, among other things, criticising Mbeki in a report to her foreign funders. This week the South African Medical Association reacted to the saga by saying that doctors should do as they wish with regard to anti-retrovirals, and should not allow their ethics to be affected by government thinking.

The Sunninghill study, by Dr Adrienne Wulfsohn, has proved the efficacy of the treatment if anti-retrovirals are given to raped women within 72 hours of the attack, confirming similar studies elsewhere that have so far been ignored by the government. Wulfsohn's study - the largest of its type yet in the world - confirms that no rape survivor becomes HIV-positive if she receives anti-retrovirals within 72 hours.

Wulfsohn has monitored more than 1 000 rape survivors - of whom more than 600 have come through Sunninghill. Her findings form part of the world's first guidelines for post-exposure prophylaxis after sexual assault to be issued soon by the influential Centres for Disease Control (CDC) in the United States.

In preliminary notes the CDC says: "Post-exposure anti-retroviral therapy after sexual exposure to HIV should be considered where the risk of HIV exposure in the assault appears significant."

Apart from proving the drugs' efficacy, the study also contains observations about their toxicity, one of Mbeki's main bugbears. The CDC says: "Post-exposure prophylaxis appears to be well tolerated in adults and children, and significant adverse effects are rare in the short periods of time during which prophylaxis is taken."

In South Africa, researchers estimate that the risk of HIV after rape is 40%, given the prevalence of HIV in young men - those most often involved in rape - and given the fact that most rape in South Africa is gang rape.

Wulfsohn's research began almost three years ago when she set up the first Netcare rape clinic at Sunninghill. "I couldn't find any research data and so began monitoring my patients," she says. Although Sunninghill is a wealthy area, 95% of rape patients come from poor areas such as Tembisa, Diepsloot and Alexandra.

"We have a big enough research study to show that post-exposure prophylaxis after rape works," Wulfsohn says. However, her approaches to the government have met with no response. Wulfsohn says it will cost the state much more to treat HIV-infected women than to administer the drugs. What makes the government's stance even more puzzling is that the price of the drugs has dropped almost 300% over the past two years.

Post-exposure prophylaxis to rape survivors is being administered widely in 20 European countries, Botswana, Thailand, several US states and Canada. According to a South African Law Commission report in 1999, South Africa has about 1,6-million rape attacks a year.

Jo-Anne Collinge, spokesperson for the national Department of Health, said of the Sunninghill study: "The department would be open to looking at any research that exists because one of the great problems is the lack of research." She added that the study will be of "great interest" to the department.

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