Government Inaction, Misinformation Undermine South African HIV Post-Exposure Prophylaxis Program Success, Report Says

Government inaction and misinformation has undermined a South African program designed to provide antiretroviral drugs to rape survivors to prevent HIV infection, according to a report released on Thursday by Human Rights Watch, the Chicago Tribune reports. South Africa has some of the highest HIV prevalence and rape rates in the world (Goering, Chicago Tribune, 3/4). In 2002, 52,107 rapes and attempted rapes were reported to the police, an estimated 40% of which were committed against children under age 18, the report says. However, the number of rapes committed is estimated to be "much higher," according to the AP/Las Vegas Sun (Zavis, AP/Las Vegas Sun, 3/3). The South African government in April 2002 announced that it would provide post-exposure prophylaxis antiretroviral treatment for survivors of rape and sexual assault as part of a "comprehensive care package" for sexual assault survivors, including counseling and testing for sexually transmitted diseases, pregnancy and HIV (Kaiser Daily HIV/AIDS Report, 4/18/02). PEP, which usually involves taking a 28-day course of the antiretroviral drugs zidovudine and lamivudine, can greatly reduce the likelihood of contracting HIV if taken within 72 hours of exposure (AP/Las Vegas Sun, 3/3).

Report Findings
The 73-page report, titled "Deadly Delay: South Africa's Efforts to Prevent HIV in Survivors of Sexual Violence," says that the government's earlier reluctance to provide antiretroviral drugs, a lack of publicity and widespread confusion about the program have undermined the effort, according to the Tribune. Access to the drugs is "good" in the provinces surrounding Johannesburg, Cape Town and Durban, according to Charlene Smith, an advocate and writer who led the campaign for the program after she was raped in 1999. However, access to drugs, training and information about the program remains "poor" in rural areas, according to the report. Many nurses and police are unaware that the program exists, and drug supplies are "spotty," the report says, according to the Tribune. In addition, the program requires rape survivors to take an HIV test before they can receive PEP (Chicago Tribune, 3/4). The requirement poses problems for rape survivors under age 14, who may not be able to obtain the required parental consent for the test, the report says (AP/Las Vegas Sun, 3/3). In addition, some service providers who were aware of the program did not dispense the drugs because of concerns that doing so would conflict with broader government policy, according to the report (HRW release, 3/4). The government prior to its August 2003 announcement of a nationwide antiretroviral drug program had been "reluctan[t]" to endorse the widespread provision of antiretroviral drugs, the Tribune reports.

Recommendations, Reaction
The report recommends that the government launch an information campaign; ensure sufficient drug supplies at all government facilities; provide better training for health workers, police and social workers; and continue to establish rape crisis centers. AIDS and rape survivor advocates have suggested that taking these steps makes "financial sense" -- PEP costs about $15 per person, compared with the "tens of thousands" of dollars required to provide long-term care for an HIV-positive person, Smith said, according to the Tribune (Chicago Tribune, 3/4). Jo-Anne Collinge, a spokesperson for the South African Department of Health, "acknowledged significant shortcomings" in the government's response to sexual violence and PEP and said that Health Minister Manto Tshabalala-Msimang plans to "draw attention" to the issue on Monday, which is International Women's Day, according to the AP/Sun (AP/Las Vegas Sun, 3/3). "South Africa's broader plan to provide antiretroviral treatment will encounter many of the same challenges as providing [antiretroviral] drugs to rape survivors: effective public education, clear political support and guaranteed access for children," Rebecca Schleifer, a researcher for HRW's HIV/AIDS and Human Rights Program who worked on the report, said, adding, "The government's inability to implement a small-scale program like PEP raises concerns about its plan to provide antiretroviral treatment on a grand scale" (HRW release, 3/4).