Inter Press Service - May 22, 2006
Joyce Mulama

Known as post-exposure prophylaxis (PEP), the anti-HIV treatment is available in just seven of the 73 government district hospitals in Kenya, and one of the eight provincial hospitals.

PEP reduces the chance of HIV infection when a woman is raped by someone carrying the virus, if administered within 72 hours of the crime. It involves a 28-day course of two anti-retroviral drugs (ARVs): zidovudine and lamivudine.

Official statistics released earlier this month indicate that 2,867 rapes were reported in 2005, while 2,908 and 2,308 were reported in 2004 and 2003 respectively. Government puts HIV prevalence in the East African country at 6.7 percent; about two million of Kenya's estimated 30 million citizens are infected with the AIDS virus.

"There is a need to increase access and have PEP available in all government health institutions," Solomon Marsden, deputy head of the Department of Reproductive Health at the Ministry of Health, told IPS.

At present, women in poverty-stricken urban areas and in rural regions may not be able to obtain PEP.

"A rape survivor in the interior parts (faces) walking or taking a matatu (minibus taxi) to the nearest facility, which could be 50 kilometres away," said Hardley Muchela, the post-rape care programme co- ordinator at Liverpool VCT & Care Kenya (LVCT): a non-governmental organisation that assists with the provision of PEP in Kenya. (VCT stands for "voluntary counseling and testing". The LVCT, based in the Kenyan capital of Nairobi, is associated with the Liverpool School of Tropical Medicine in Britain.)

"Often she will be faced with the challenge of spending 50 Kenya shillings (less than a dollar) on the matatu, or buying food, given the high poverty level in the country," Muchela noted.

About 56 percent of Kenyans live on less than a dollar a day, according to official figures.

The difficulties faced by rural women have also prompted calls for making PEP available in dispensaries, which are more accessible to people in outlying areas.

However, Muchela cautioned that expanding post-rape care -- which also entails counseling -- required more than increased supplies of drugs: "Our (public) hospitals are understaffed. If comprehensive post- rape services are to be issued, we will be adding to the workload of a few staff. There is a great need to increase health staff."

A recent study by LVCT shows that many public hospitals lack trained employees to dispense ARVs, and provide post-rape and HIV/AIDS counseling. But, an announcement by the government that more health personnel are to be taken on may lead to improvements in this situation.

While PEP treatment can be sought at private clinics, the fees charged by these institutions put them beyond the reach of most Kenyans.

The cost of a PEP course at a modest private hospital is about 23 dollars, while an HIV test costs in the region of 24 dollars, according to Muchela. As the test has to be repeated after a fortnight, this brings the cost of testing to some 46 dollars, excluding consultation fees -- which average 14 dollars in Nairobi. (PEP and HIV testing are offered free of charge in government hospitals.)

An exception to the rule is the Nairobi Women's Hospital. Although it is private, this facility offers free PEP and counseling services to survivors of sexual assault. The hospital has also assisted with compiling guidelines on how to dispense PEP in public facilities.

Alongside concerns about the shortage of PEP, there are fears that rape remains severely under-reported in Kenya. According to LVCT, only 30 percent of rape cases are reported.

In a bid to address the myriad of problems surrounding sexual assault, government has drawn up guidelines for how survivors of this violence should be treated.

'National Guidelines: Medical Management of Rape and Sexual Violence', issued in 2004, also highlights the importance of emergency contraceptives (ECs) to prevent rape from causing pregnancy.

These contraceptives, which can be given up to 72 hours after rape, are widely available in government hospitals, according to Marsden. "Emergency contraception is our area and we have all the ECs distributed in our hospitals," he noted.

A Sexual Offences Bill that seeks harsher penalties for rape and defilement was also tabled in parliament last month. Whereas the current law only stipulates maximum sentence for rape, the proposed bill spells out stiff minimum and maximum sentences for rape and defilement -- amongst other provisions.

Under the bill, rape would carry a minimum sentence of 10 years in jail and a maximum sentence of life imprisonment.

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