In a report released at the first South African National Conference on Violence, held in Johannesburg earlier this month, Doctors Without Borders (MSF) outlined the high levels of sexual violence in the platinum belt, in Rustenburg, in the North West.

One in four women between the ages of 18 and 49 surveyed revealed that they had been raped in their lifetime.

The report, ‘Untreated Violence: The Need for Patient-Centred Care for Survivors of Sexual Violence in the Platinum Mining Belt’, revealed that only about 5% of women reported to healthcare services after being raped. It also revealed that there are a number of barriers to accessing post-rape care, including low levels of knowledge among women about the benefits of receiving timely medical attention.

The report, which is based on a survey of about 900 women in the Bojanala health district, in Rustenburg, also found that about half the women surveyed reported experiences of sexual violence or physical intimate partner violence.

Extrapolating these figures to the municipality, about 11 000 women and girls in Rustenburg are raped each year. Yet, 95% of rape survivors had never told a health professional of the incident, and only half of those surveyed knew that HIV could be prevented after being raped.

According to MSF epidemiologist Sarah-Jane Steele, the findings show that not only is rape highly prevalent in Rustenburg but that opportunities to reduce the more serious health impacts of rape are also being missed.

“Treatment and psychosocial counselling for rape survivors reporting within 72 hours can prevent HIV infection and unwanted pregnancy, and help to mitigate long-term psychological suffering, but the majority of women we interviewed do not know that such treatment exists.”

A lack of financial independence and services close to where they live might make access difficult, even when there are services, Steele explains.

MSF, in partnership with the North West provincial Department of Health, is piloting the expansion of a patient-centred response to sexual violence, including a clinical mentorship programme for professional nurses on the care and management of sexual violence. The Bojanala district has a population of about 1.3-million people.

According to the Department of Health, only 11 designated public health facilities out of 783 in the district provide post-exposure prophylaxis (PEP) to prevent HIV infection and support forensic examination for rape survivors.

Most of the dedicated facilities for rape survivors are at district hospitals or community health centres. The capacity of these designated public health facilities varies, depending on the number of trained staff available that can conduct the examinations.

According to MSF medical coordinator Dr Amir Shroufi, a patient-centred approach is urgently required for rape and sexual violence, as it will prioritise the medical and psychosocial needs of survivors.

For this to happen, more trained staff and more widely available comprehensive services are needed.

“All rape survivors should receive access to comprehensive medical and psychosocial services to reduce the risk of contracting HIV and other infectious diseases, preventing unwanted pregnancy, addressing psychological distress and linking the patient to appropriate social support.” Survivors

He asserts, however, that this does not diminish the importance of all survivors being given the option to undergo forensic examination and pursue a legal response to rape.”

The South African National Conference on Violence aims to mobilise science, communities and policy to prevent all forms of violence in the country.