Inter Press Service - June 21, 2001
Farah Khan

In a country where a woman is raped every 26 seconds, the horror is exacerbated as rape survivors now deal with a second trauma - that the rapist has passed on his HIV infection.

Activists believe that one in four women in South Africa is a victim of domestic violence. Hence such vulnerable women are more likely to be subjected to unsafe sex and consequent infection. International studies have found that abusive men are more likely to have multiple sexual partners.

Despite this awful scenario, there are less than 10 centres around the country which provide free emergency Aids drugs to rape survivors. They are all private - recently one of them was evicted from a state hospital for not following national policy.

"There is a very clear link between gender violence and HIV/Aids," says Lisa Vetten of the Centre for the Study of Violence and Reconciliation.

Aids organisations and the lobby against gender violence " have started to think about links between rape and HIV," she says, "But a gap has emerged. There is less thinking about rape and coerced sex in relationships and the limitations this places on women's ability to negotiate safer sex," she says.

In 1999, journalist Charlene Smith was raped by an intruder in her suburban Johannesburg home. She documented the rape and the agonising months which followed it, as she waited for the results of HIV tests. There is a three month window between infection and a positive result. Smith's results were negative - she was saved, probably because she had access to potentially life- saving Aids drugs, called anti-retrovirals.

Most rape survivors do not have access to the drugs, because even though the government promised last year that it would consider emergency treatment for rape survivors, its come to nought.

Smith has become a crusader for treatment for all people living with HIV/Aids, and particularly for rape survivors - her campaign has begun to shift public opinion toward demanding treatment for rape survivors.

Kelly Hatfield the director of People Opposing Women Abuse (POWA) says women subject to sexual violence should be a primary category for treatment. "Women in this situation do not have negotiating power to decide whether they want sex or not, much like babies in the wombs of HIV-positive mothers have not exercised a choice."

Together with a local magazine, POWA managed to collect over 700,000 signatures in support of free treatment for rape survivors. Their petition has been submitted to government - they have heard nothing.

Hatfield supports the extension of treatment, but is aware it will be difficult to implement and must be multi-layered. Emergency drug treatment will work if rape survivors are not already HIV-positive.

A study at two counselling centres suggest that between three and seven in 10 women were HIV-positive prior to the rape.

While government says the rate of rape is slowing, South Africa still has one of the highest incidence in the world, which intersects with its equally high incidence of HIV/Aids - estimated to be second highest after Botswana in sub-Saharan Africa.

Best practice, recommends Hatfield, would be rape counselling accompanied by pre and post HIV-test counselling. Ideally, treatment should include emergency contraception and a course of anti-retrovirals, which have nasty side-effects but have been shown to reduce the risk of infection.

"You cannot just give people the medicine," says Hatfield, "with our low levels of illiteracy, there must be a support system to take people through a very difficult process".

Government's view is that an effective treatment campaign is about more than just giving people with HIV drugs - although it is still studying toxicity levels of the key drugs, Nevirapine, 3TC and AZT. In addition, the treatment demands a sophisticated infrastructure to help people use the drugs effectively. Government claims not to have the money for this.

Vetten's study of the impact of HIV/Aids on domestic violence called "Violence, Vengeance and Gender" has found that HIV-positive women face further victimisation, given the stigma of Aids.

The story of 37-year old Grace, a mother of four, reveals the layers of new prejudice that face women who live with HIV. Her marriage to Thomas 10 years ago has been one of almost constant abuse - she left him once and then returned.

Two years ago, both were diagnosed as HIV-positive, and Thomas has continued to have affairs. Grace discovered his last affair and disclosed her husband's status to his latest mistress. For that, he abandoned her, stripping her of a joint right to his medical aid. Recently a High Court judge recommend he receive custody of their children. Her case is continuing.

The only study linking HIV/Aids with domestic violence has been conducted in Tanzania. It found that women in abusive relationships were two and a half times more likely be infected. In women under 30, the incidence was 10 times higher. A similar study needs to be conducted in South Africa, Vetten says.

Preventive programmes she recommends includes the use of microbicides - a barrier method similar to gels, foams and spermidicides. This is because women have almost no power to negotiate the use of condoms.

Another option would be female condoms, although these also suffer the same perception problem as the male version. Condoms are associated with both sexes with "loose" women and with unfaithfulness. "All prevention must be woman-controlled," says Vetten.

President Thabo Mbeki has drawn international fire for his controversial views on the causes and treatment of Aids. And there are no indications that government will introduce national treatment in the near future despite its recent victory over the pharmaceutical companies and the rapidly falling price of Aids drugs.

"Government has no plans to introduce the wholesale administration of anti-retrovirals in the public sector," said Health Minister Manto Tshabala-Msimang earlier this month. The Minister has also dragged her feet on efforts to provide emergency treatment to pregnant mothers (to limit infection to the unborn child) and to rape survivors.

As HIV/Aids in South Africa begins to approach its killing zenith, it can sometimes appear that all options are too little, too late. And in a region where the gender pattern of infection has been inverted (in all other regions male infection is higher), it's once again too little, too late for women. (END/IPS/HE/fk/cr/01)

* Editors Advisory. This is one in a series of IPS features previewing the United Nations Special Session on AIDS, to be held in New York June 25-27.. It is the first-ever Special Session devoted to a single disease. .
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