South Africa has the world's highest rate of rape, and the most violent, according to Interpol - sexual assault figures have climbed steadily since democracy.

Sexual violence is the fastest growing crime in the world - and the one least likely to result in an effective conviction. New York, as an example, in 2003 managed to bring all crime down by 10%, except for rape which went up 5,6%; in Britain little more than 5% of rapes result in convictions.

The World Health Organisation and UNAIDS say that sexual violence is a primary contributor to high rates of HIV in sub-Saharan Africa. The lack of capacity of women to negotiate sex, results in statistics like these noted by the UN's special envoy to Africa, Stephen Lewis on his return from Swaziland in late March this year: "The HIV prevalence among pregnant women attending ante natal care centres in 1992, was 3.9%; in 1994, was 16.1%; in 1996, 26%; in 1998, 31.6%; in 2000, 34.2%; in 2002, 38.6%... that's a jump of almost 900% over the course of a decade. But hear this: eighty-seven per cent of these infected women are under the age of 30; sixty-seven per cent are under the age of 25." (In Swaziland life expectancy - because of AIDS - is 27).

UNICEF notes that in Africa , six times more girl children are HIV infected than boys. UNAIDS noted last year that two and a half times more young women in SA are HIV infected than their male contemporaries, and in a country where one in two women gets raped in her lifetime, rape is a significant causative factor in HIV transmission. I estimate that if post exposure prophylaxis (PEP - medication to prevent HIV) was given immediately and universally to SA rape survivors we would cut new transmission, immediately, by 20% - and yet pathetically little is done to advance this HIV preventative mechanism.

A growing problem too is children raping children. The Teddy Bear clinic in Johannesburg claims that 24% of the offenders they deal with are children aged seven to 14 - yet pathetically little is done in schools to assist children raped, or who rape, psychological services have been cut back, there is no compulsion to report to educational authorities - or efficient mechanisms in place to deal with reporting.

The Teddy Bear clinic, Rape Action Group and Childline report little or no response to complaints to educational authorities. Childline has a dossier of 250 outstanding complaints to the Kwa-Zulu Natal provincial authorities.

Although it is a criminal offence to fail to report the rape or abuse of a child there is no case on record of anyone being prosecuted for this.

Teddy Bear clinic manager Luke Lamprecht reports the following examples of how schools deal with rape:

• "Would the three girls who were gang raped last week please come to the office', shouted by educator across playground at a Soweto Primary School;

•  “A primary school child was placed on the floor of the staff room so that the teachers could ‘examine' her vaginally and check what a raped child looks like;

•  "'Whose penis was the longest' - principal at a private school confronting a 13 year old girl after she reported that three 17 year old members of the school rugby team had raped her. He confronted her in his office with the three boys and the male vice-principal present. She was alone.

Lamprecht notes too the prevalence of families accepting `financial' compensation paid by a perpetrator to the family and says, "this is a primary reason for children 'failing' to testify." Meadowlands police station commander, Nico Strydom, notes that 90% of the rape in their community of close to 300 000 is against children under the age of 12, but less than 17% make it to court despite three-quarters of perpetrators being arrested because families accept 'compensation'. Nothing in law acts to remedy this situation.

Since democracy there has been an array of new laws to protect women (and children), but laws don't walk with us in the streets, or guard us in our homes - where 65% of South African women will get raped, and one in six will get murdered. Domestic violence legislation introduced in 1998 seems to be doing little to dent high rates of interpersonal violence, instead, abusers have become adept at manipulating protection orders which are issued with as little care as pass law 'offenders' were processed under apartheid.

A dramatic overhaul is needed for this legislation - it's not working, and it's become a tool of abuse.

Constitutional court victories have been important including a ruling on the right of HIV+ mothers to have access to medication to prevent mother to child transmission. But, most HIV+ women still lack access to this medication, and despite a cabinet promise of April 17, 2002 to give HIV preventative post exposure prophylaxis to rape survivors this rarely occurs. If two percent of the 1,69m people raped each year in South Africa (according to a 1999 SA Law Commission estimate) get drugs to prevent HIV, it's a lot, and that is despite research that shows that in SA those raped have a 40% risk of becoming HIV+ if they do not get PEP within 72 hours (for adults, and 24 hours for children).

Indeed, children under the age of 12 are the least likely to get PEP with almost no hospitals or clinics in the state or private sector carrying the liquid antiretroviral medication for small children, or information on the correct, weight-related dose. This is despite the fact that 40% of those who report rape each year in South Africa are children under the age of 12. ( Botswana reports that 60% of those raped as children under the age of 12.)

And while there is a concerted push for ARVs for those already infected, there is no similar pressure for HIV preventative medication for rape survivors.

Professor Ames Dhai of the University of Natal points out that there are twice as many rape survivors at risk of seroconversion (seroconversion is the way your body becomes HIV+) than babies born in SA to HIV+ mothers, and yet there have been few calls for Post Exposure Prophylaxis (PEP) for rape survivors. "Is it because of residual stigma against those raped?" she muses.

She authored a paper in the SA Medical Journal in January 2003, which said that in terms of the constitution, PEP falls under emergency medical care. "In the constitutional court case of Subramoney, a man who applied for kidney dialysis as his constitutional court right, the court turned down his application and said such rights to care could only be considered in a sudden catastrophe which demands emergency medical care - PEP after rape is most certainly that."

None have acted on this and cabinet last year scrapped a groundbreaking clause that would have compelled government to give post exposure prophylaxis to rape survivors, along with medication to prevent pregnancy, other sexually transmitted illnesses and counseling. (see box)

A person raped is at heightened risk of HIV in SA given that 75% of rape is gang rape, according to Groote Schuur hospital (60% according to Dr Adrienne Wulfsohn who did a study of just over 1 000 rape survivors in Johanesburg).

Last year a report released by the African Network for Prevention and Protection Against Child

Abuse and Neglect (ANPCAN) in Uganda , noted that in 2002, 5 868 cases of child abuse and neglect were reported in Uganda , 4 495 were rape cases and many children were HIV+ as a result. New sexual offences legislation in Uganda and Lesotho compels mandatory HIV testing of offenders and in Uganda , the psychological rehabilitation of rape survivors. Legislation before the SA parliament allows for rape survivors to request the testing of alleged perpetrators before conviction, although some organizations, including the Treatment Action Campaign have campaigned against it because they say it violates the rights of alleged perpetrators. The psychological wellbeing of the rape survivor appears less important.

The sexual assault unit of the Department of Justice: Directorate of Public Prosecutions under Advocate Thoko Majokweni notes that 50% of all crimes before South African courts are rape, but for Durban and Mdantsane where 60% of all cases are sexual assault.

Her unit has made significant progress in the creation of Thuthuzela (we care) centres across South Africa where rape survivors can get treatment, access to a police officer and counselling services in one place. The system works particularly well in Cape Town where monthly meetings with the State advocate and NGOs keep track of rape trends and care needs and attempt to meet them.

By 2005, police officers should have small hand held computers being designed by the CSIR that will allow them to instantly input details of a rape, and provide instant computer linked information on trends, serial rape, the operation of gangs etcetera. South Africa will hopefully become better at detecting rape and arresting perpetrators, but too little is in place to help survivors through the process of testifying before courts or to secure their mental and physical health. Too little looks at rape prevention strategies.

The Law Commission felt that treatment policies that rely on the good will of politicians and resources would have little chance of being enacted. Law would compel treatment.

The failure of policy can be seen in this simple example: the Northern Cape became the first province to give PEP to rape survivors in October, 1999. In November 2001, a nine-month-old baby, Tshepang was raped in the Northern Cape and given PEP. Health MEC Dipuo Peters responded by firing the doctor and banned PEP after rape. Policy fails when reliant on the whims of a politician.

Kwa Zulu Natal and Gauteng have trained small numbers of rape forensic nurses. However, the Northern Cape led with this in 1995 - one of those rape forensic nurses worked in Uitenhage at the time baby Tshepang was raped. She wasn't called in. Acute staff shortages in hospitals mean forensic nurses are likely to be assigned to other duties and rarely called to assist rape survivors.

What are the costs of providing PEP? The cost to the state of each HIV test is less than R1. PEP at wholesale prices now costs around R100 for 28 days. To treat 54 000 reported rapes each year would cost government less than R600 000.

Dr Wulfsohn says the hospital costs of treating a rape survivor who contracts HIV is around R600 000 each during her shortened life. The cost of not treating rape survivors could collapse an already stretched health system.

If women and children are to be reduced to economic units then the cost of treating rape survivors efficiently in terms of PEP, preventative mechanisms for STIs and pregnancy and counselling are cheap compared to the long term health costs of not taking these preventative steps.

Legislation ensures that budgets are drawn up, that ministers and health officials become accountable. Better treatment of rape survivors will result in higher reporting and greater potential to convict rapists. Few rapists are involved only in sexual assault, they typically are also involved in other crimes from house breaking to murder. A country that protects it's women, protects all.


The clause excised for rape survivors from the Sexual Offences Bill by cabinet on July 24 last year, SA's cabinet despite it promising PEP (in full page newspaper ads) on April 17, 2002:

"21. (1) Where a person has sustained physical, psychological or other injuries as the result of an alleged sexual offence, such person shall, immediately after the alleged offence, receive appropriate medical care, treatment and counselling as may be required for such injuries.

"(2) If a person has been exposed to the risk of being infected by a sexually transmissible infection as the result of a sexual offence, such person shall, immediately after the reporting of the alleged offence to the South African Police Services or to a health care facility -

"(a) be advised by a medical practitioner or a qualified health care professional of the possibility of being tested for such infection; and

"(b) have access to all possible means of prevention, treatment and medical care in respect of possible exposure to a sexually transmissible infection.

"(c) The State shall bear the cost of the care, treatment, testing, prevention and counselling...."

This clause protecting the rights of rapists remains:

"2. (1) A court may, upon conviction of a person of having committed a sexual offence and if satisfied that the convicted person is dependent on or has the propensity to misuse alcohol or any drug and may benefit from treatment, grant an order in terms of section 296 of the Criminal Procedure Act, 1977 (Act No. 51 of 1977): Provided that such an order may be made in addition to any sentence, including a sentence of imprisonment which is not suspended."

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This article appeared in Gender Links, SA (end April 2004)

From Charlene Smith, +27 (0)21 646 7637