PREFACE TO INFORMATION GIVEN TO PARLIAMENTARY SELECT COMMITTEE ON THE STATUS OF WOMEN: ISSUE -HIV/AIDS
Charlene Smith, SpeakOut!

Many of the honorable representatives here today were children of the revolution.
We looked at the country our parents had made possible - the nation of apartheid - and rejected it. Many were tortured or died to make the freedoms enshrined under our new constitution possible.
They must today, look from their graves and weep.
Because the greatest freedom they gave us was the right to life, and not just life but a good life, South Africa today, for our children is a country of death. The Medical Research Council report on AIDS will tell us that our children - those aged from 15 to 35 are mostly dying of AIDS. And in a report to be released on October 7, they will tell us that those children who do not die of AIDS will be murdered, a person is 12 times more likely to be murdered in SA than any other country of the world except Colombia. Young black men aged from their 16 to 29 are more likely to be shot dead than to die of any other cause except for AIDS.
So you tell me why any young person should accept safe sex messages if they believe they have no hope, no jobs, no opportunities and the risks of them being shot dead are unbelievably high. But we hear few words of comfort, and see, too little action from parliament. How can we as mothers allow the death of our children and be quiet? That is not the African way. Every child is my child.
7 000 babies die of AIDS each month because we don't extend treatment to prevent Mother to Child Transmission to all - what would SA and the world say if we shot dead 7 000 people each month? Or killed 7 000 puppies? But we are silent because our babies die quietly in their mother's arms or battling to breathe in hospitals.
And so we have a situation in Africa where 6 times more girl children are infected than boys or men. Some women here laughed on Wednesday when it was mentioned that men won't accept the word "NO"- shame on you for laughing, because that refusal by men is seeing our women and girls dying.
Rape is endemic. Child rape doubled last year, the Minister of Safety and Security told parliament two weeks ago.
The myth that you can rape a virgin is out of control. The Sowetan carried a front page article less than a month ago about an 8-year-old boy in Kwa Zulua Natal who had been repeatedly raped by 2 men. That boy now has HIV. In SA male rape is not a crime. It is also not a crime to deliberately infect someone with HIV. Why are you not doing your jobs? Why are these things not crimes? In my experience a child raped and who contracts HIV dies in 8 to 18 months, they die quickly because Post Traumatic Stress during rape destroys the immune system, and unless you are rich in SA, you are not going to be able to afford the ARVs that stop HIV. Mothers, why are you allowing a situation where we do nothing to stop virgin rape? Why are you silent? Why are drugs not given to those raped to stop HIV? It would cost the government R200 to supply those drugs - but if we contract HIV, it will cost government a minimum of R150 000 to treat that child before he or she dies a terrible death. Are our children worth less than R200? I bet most people here today are wearing clothes that cost much more than R200.
We need to go back to traditions of respect.
We need to break the silence. There are women here today who have been raped and are silent, and do nothing to help their sisters who are being raped.
This year in South Africa
In the 30 minutes we have assigned to give our presentation 60 men, women or children will have been raped.
Last year according to DoH and UNAIDS 250 000 SAs died of AIDS - that averages to 685 SAs dying each day of AIDS. Most of those who died were, and will continue to be women and children. Mothers, parliamentarians, we look to you as our government, our representatives to help us. We have to stop rape. We have to stop HIV. We have put our trust in you, please do not betray us.



SUBMISSION TO PARLIAMENTARY COMMITTEE ON WOMEN AND HIV
by SpeakOut!
September 20, 2001

South Africa is spending close to R50bn on new military hardware, and is neglecting the real war. AIDS is killing more than five times more people on the African continent than wars (1998- 200 000 died in wars according to the UN, and 2m to AIDS according to WHO).

SpeakOut! is an organisation of rape survivors, those who have experienced domestic violence or other severe criminal violence including murder (Face-It, an organisation of support groups for families of thos murdered emerged with the assistance of SpeakOut!) and those infected with HIV, and our families or those motivated to act against violence and HIV.
SpeakOut! has a website www.speakout.org.za which has been voted the best website on sexual violence and HIV in South Africa and one of the best of its kind in the world.
SpeakOut! is entirely non-profit and all work is voluntary. We have a trust, funded by donations from the public that is managed by Bowman, Gilfillan attorneys in Johannesburg that assists to bring people from disadvantaged communities to occasional seminars on Sexual Violence and HIV. These seminars run by SpeakOut! are intended to train and equip communities, care workers, professionals ranging from ambulance workers to psychologists and lawyers to know how to assist those victimed by sexual violence - whether rape, incest,child abuse, domestic violence - and how to prevent and manage HIV. We agree with a new Medical Research Council report that rape services in Gauteng are, in their words, "appalling" and it is our submission that they are equally as bad, or worse in other parts of the country. Many areas simply provide no services at all.
We advise a wide variety of institutions from churches to pscyhologists, hospitals to research institutions here and abroad on effective rape care including, or in particular, post-exposure prophylaxis (PEP) to prevent HIV after rape and will be noted as co-authors of new guidelines to be released by the Centers for Disease Control, Atlanta, Georgia, USA early next year. We have support groups for rape survivors, accompany survivors for HIV tests in cases where they have not informed families or friends of the rape, counsel the survivor and his/her family, link them to other survivors (we strongly believe in the dictum of "each one, teach one" and that we heal by helping others), we do court preparation and accompany survivors to court. Those that sero-convert and become HIV+ we assist in obtaining care, treatment (where possible) but also advise on how to manage HIV (eg correct eating, lifestyle, etc...), how to disclose to family and partners, and put them in touch with other HIV organisations and support groups.
We also do extensive speaking to schools, businesses, church and womens groups, and usually ask as payment that people donate either a soft toy (which we donate to rape clinics or crisis centres not only to comfort children but to aid in forensic examinations and the taking of statements), or clean panties, second-hand clothes, and toiletries which we give to rape clinics or crisis centres for rape survivors on the day or night that they are raped.

SEXUAL VIOLENCE AND HIV IN SOUTH AFRICA
"One rape is one rape too many," President Thabo Mbeki, before the National Chamber of Provinces, November, 1999

* The Commission on Gender Equality and Rape Crisis report a rape every 26 seconds and that one woman in two will be raped in her lifetime, based on police estimates issued in 1997.
* One in two SA women will be raped (University of SA (Unisa), March 29, 1999; Commission on Gender Equality (1999) - both government bodies; and Rape Crisis, 1999.
* One in four girl children and one in five boy children under the age of 16 have been sexually molested (Childline, 1999).
* Rapists and paedophiles are serial offenders, studies from around the world have shown they cannot be rehabilitated. In SA, NICRO attempted rehabilitation, but says that although they have success for a time, "at some stage they rape again." (National Institute for Criminal Rehabilitation, 1999)
* The SA Law Commission in mid-September, 1999, noted police estimates that only one in 35 rapes are reported; using this rule the SALC concluded that in 1998 there were
1 636 810 rapes in SA. Using the lowest estimate, that of NICRO that one in 20 rapes are reported, in 1998 there would have been 934 960 rapes. Interpol (1999) says, "South Africa remains in an 'undisputed first place' as far as reported cases of rape are concerned."
* In 1998 just under seven percent of the 54 000 rapes reported were prosecuted, and of that 7% only 1% resulted in convictions (Department of Justice, 1999).
* 75% of rapes are gang rapes, a woman or child is more likely to be raped by 3 to 30 perpetrators in SA than by a single person, however, the rapist who acts alone is more likely to kill.(Groote Schuur, Netcare, Tromp Els (forensic exmainer, Kimberly) various district surgeons offices, rape clinics and police figures)
* 60% of rapes take place in the home (Unisa, 1999).
* 85% of rapists are armed, usually with a knife (Unisa, 1999).
* Rape clinics report that 16% of women are already infected with HIV on the day they are raped (Sunninghill Clinic, 1999). Compared to 36% of all pregnant women who are infected (Dept Health). 75% of all paediatric deaths at Johannesburg hospital are AIDS related. (Jhb hospital, 1999 and 2001). One in three children admitted to any public hospital in SA is HIV-infected or suffering from an AIDS related illness (Department Health and hospitals) - and yet Dept Health says that only one in five SAs are infected. By 2005 our average life expectancy in SA will be 35, one percent of GDP will be lost to HIV/AIDS and 75% of hospital budgets will be spent in treating HIV/AIDS (Bristol Meyers Squibb, AIDS research University of Natal, British government, SA government, etc...)
* 40% of those raped who do not receive antiretrovirals become HIV+ (tentative research from HIV and rape researchers, various, 1999 to 2001)

* A study released in Johannesburg in June, 2000, by Community Information Education and Transparency showed that:
* One in four young men in SA admitted they had raped.
For every 400 rapes, only 17 became official cases and only ONE perpetrator is convicted. For every perpetrator convicted, there was a docket lost or sold.

* In South Africa there are 1 800 new HIV infections a day(Department of Health, 1999)
* A person is infected with HIV every minute in South Africa (UNAIDS, 2000)
* The Johannesburg Hospital estimates that 40% of young men aged 20 to 29 - the most common age group of rapists, are infected with HIV (1999)

* June, 2000 - report of the United Nation's Economic Commission for Africa (researcher Carol Coombes): "violence is common and even considered the norm in sexual relationships. Research in one township found that all the girls (mean age 16.4 years) had had sexual intercourse...a third described their first sexual experience as rape or forced sex, and two-thirds of teenagers had experienced sex against their wishes.
"A qualitative study among Xhosa-speaking pregnant adolescent women revealed that violent and coercive male behaviour... directly affected the capacity (of young women) to protect themselves against STDs, pregnancy and unwanted sexual intercourse. Communication between partners on sexual issues was non-existent, and conditions and timing of sex were defined by male partners, giving young women little or no opportunity to discuss or practice safer sex." Similar data was presented to the AIDS conference in Durban by British researcher, Kate Wood, reporting on a 10 month study in Transkei.

* There is a myth across Africa, including SA that a person can cleanse himself of HIV by raping a virgin. Researchers at the World AIDS conference in Durban, July 2000, reported that this myth had spread to Asia.

* Witchcraft, mythology, traditional healing and the virgin myth (from Proud of Me: Speaking Out Against Sexual Violence and HIV by Charlene Smith (Penguin) 2001): No-one is doing anything to combat the myth, prevalent across southern Africa, and based on old African cleansing rituals, that if you rape a virgin you can lose HIV. It is a myth fuelled by a lack of access to treatment.
Very few rural people acknowledge that they have AIDS in their communities. Some call it "this new disease", many sangomas say it is an "old disease", in Northern Province they say it has long been known as Quzula. Very many people say it is caused when one is bewitched by a jealous ex-girlfriend, a neighbour or someone else.
Onica Mathebula notes: "people are afraid to go for an HIV test, so they go to traditional healers and pay R1 000 for each visit, so by the time they die the family has no money left." And all over the country, you hear the same refrain when you ask about condom access, "It's easy to get condoms, men don't know how to use them though, they say it's plastic and they don't get full sexual pleasure," Mathebula notes. A friend chips in, "or they pierce the tip of the condom or cut it off because they say a man is not a man unless he can ejaculate in a woman."
Typhesa Silwane or Nkowankowa village in northern province says that in her small village there were (in the first three months of 2001) five cases of virgin rapes - the children were aged between eight and 11 and the youngest child was two-years-old. "Maybe the president can tell us why these men rape small children and old women, maybe he can give us the solution. Maybe he can give some funds to teach people that this is wrong."
Gloria Manyakanyaka, chief professional nurse who deals with pregnancy terminations at Cecilia Makiwane hospital near East London notes, "women don't have the power to say no to a man. I get a lot of teenagers, I say, why didn't you use a condom, are you ready to be a parent? And the girl will say, my boyfriend would leave me. Women are not empowered. We hear a lot too of the myth that you can cleanse Sexually Transmitted Illnesses by raping a virgin."
Anele Mda (23) and Nomazo Matiso (29) of an HIV activist group called Creative Young Women in Port St Johns say, "men are sleeping with babies from two to five, they say they will be cured of HIV/AIDS. They are raping the grannies because they say they will be cured, they say an old woman who has not had sex for 10 or 20 years is like a virgin."
The myth is endemic across Southern Africa, and although the SA Medical Research Council reported a doubling of child rape last year, no-one is doing anything to quell the myth. ... In the Northern province, although some areas do not report much virgin rape they say, they have noticed an increase in "sex with small children because it is believed that sex with a small child cleanses kidneys."
* The Medical Research Council, August 2000, reports: "the belief that having sex with a virgin can cleanse a man of HIV has wide currency in sub-Saharan Africa. In sexual health promotion workshops in South Africa a third of participants indicated that they believed this to be true at the pre-workshop questionnaire."
* UNISA says the rape graph rises sharply in girls aged 11, and peaks at ages 13 to 25. (March, 1999)
* The Department of Health (DoH) noted in 1998 that the incidence of HIV is highest in girls aged 15 to 25.
* DoH noted in May, 2000, that 20% of girls aged 13 to 19 were infected with HIV.
* The World Bank and Unicef noted, 1999, that six times more girls were infected in Africa than boys.
* UNAIDS noted, June 2000, that half of all 15 year old boys in southern Africa would become infected in their lifetime.
* The National Population Unit report in September, 2000 noted that inequality in relationships between men and women had increased the vulnerability of women to poverty, HIV/AIDS and abuse because they have limited control over their reproductive rights. It said women are put under pressure to have children and bear the brunt of caring for them. Inequality has increased the number of HIV-positive women by 10% compared with men. Two million more women than men are infected with the virus in southern Africa. The report says unequal power relations between men and women limit women's control over sexual activity and their ability to protect themselves. HIV. African women are the most affected due to exposure to poverty, patriarchy and violence, the report says.
The unit's head, Jacques van Zuydam, said: "These trends were caused by a tendency to regard HIV/AIDS as a health issue as opposed to being an economic issue." The unit concurs with many of the findings in a recent United Nations Population Fund study. The UN report The state of world population encourages gender equality, health and education and the practising of responsible fatherhood. Zuydam says the national and provincial welfare departments have begun implementing measures to protect women. These include integrating resources between the various departments and getting nongovernmental organisations and churches on board. He says that government will have to resort to voluntary labour as the demand for social welfare is increasing while the budget is shrinking. In addition, economically active people are affected by HIV/AIDS and leaving behind the elderly and the very young.

* 2000: UNAIDS commenced a two- year campaign, titled "AIDS: Men Make a Difference" which focusses on the role of men in the AIDS epidemic. UNAIDS says that across the world, women find themselves at special risk of HIV infection because of their lack of power to determine where, when and how sex takes place. What is less recognized, according to UNAIDS is that the cultural beliefs and expectations that make this the case also heighten men's vulnerability. HIV infections and AIDS deaths in men outnumber those in women on every continent except sub-Saharan Africa. Young men are more at risk than older ones: about one in four people with HIV is a young man under the age of 25.
Male violence further drives the spread of HIV through wars and the migration they cause, as well as through forced sex. Millions of men a year are sexually violent towards women, girls, and other men sometimes in their own family or household. Worldwide, a recent report states that at least one woman in three has been beaten, coerced into sex or otherwise abused in her lifetime.
At end 1999, 34.3 million men, women and children were living with HIV or AIDS, and 18.8 million had already died from the disease. In 1999, there were 5.4 million new infections worldwide, of which 4 million were in sub-Saharan Africa, and 800,000 in South and South-East Asia.

UNAIDS noted in December, 2000, that for US$1.5bn all the countries in sub-Saharan Africa could "buy symptom and pain relief (palliative care) for at least half of AIDS patients in need of it; treatment and prophylaxis for opportunistic infections for a somewhat smaller proportion; and care for AIDS orphans." Let's convert that into Rands, using an exchange rate of R8 to the $1; that would add up to R120bn - which would mean that for the money we are currently spending on an arms deal we could extend this UNAIDS suggestion to a third of southern Africa. Or we could effectively end the AIDS epidemic in this country and begin eliminating poverty through development.
Or, for the same amount of money UNAIDS says the region could achieve "massively higher levels of implementation of all major components of succesful prevention programmes for the whole of sub-Saharan Africa. These would cover sexual, mother-to-child and transfusion-related transmission, and would involve approaches ranging from awareness campaigns through the media to voluntary HIV counselling and testing, and the promotion and supply of condoms."

DEATH STATISTICS - SOUTH AFRICA
* 14% of the population (the highest sector of the population) in 1990 were babies aged 0-4, by 1996 they formed only 10% of the population. The total overall population was 30,9m in 1991 and 40,5m in 1996.
The second highest section of the population in 1990 and 1996 were people aged 80 and over, they formed 12% of the population in 1990 and 11% in 1996. Those aged 55 to 79 formed the next biggest slice of the population at 7% followed by those aged 30 to 54 at 6%.
Among younger people, mortality is rising as AIDS takes hold: in babies aged 0-4 20,207 died in 1990 compared to 32,903 in 1996. But this was less serious than the three-fold increase in deaths among children aged 15 to 19 which rose from 2 597 in 1990 to 6 074 in 1995 and to 6 811 in 1996.
Death trebled among young people aged 20 to 24 from 4 419 in 1990 to 11 922 in 1995 and higher still to 14 280 in 1996. Funerals for those aged 25 to 29 increased three and a half times in those aged 25 to 29 from 5 129 in 1990 to 17 741 in 1996.
Death trebled in those aged 30 to 34 - 5 767 (1990) to 19 266 (1996) and in those aged 35 to 39 it began slowing down to just under a three-fold increase - 6 249 (1990) to 18 237 (1996), and thereafter starts slowing down dramatically.
MOST COMMON CAUSES OF DEATH - Endocrine, nutritional and metabolic causes (diarrhea is common in those who die of AIDS) were most frequent, with a threefold increase from 5 726 deaths in 1990 to 16 939 in 1995.
Unnatural causes - here we see some of the impact of crime - more than doubled from 1990 - 19 248 deaths to 54 937 in 1995. While infectious and parasitic diseases (AIDS is an infectious disease while parasitic diseases include that other big killer, malaria) saw a doubling in deaths from 12 942 in 1990 to 27 187 in 1995.
(Stats SA, 2000)

POLICE STATISTICS FROM SOUTH AFRICA AND NEIGHBOURING COUNTRIES - RAPE
* SA Police Service statistics show that in 1996, 19 755 children aged 0 to 17 years were raped (this does not include indecent assault (anal or oral sex), only vaginal penetration or attempts), in that same year 30 726 women aged 18+ were raped. In KwaZulu Natal the province with the highest incidence of HIV (and where the myth about raping virgins is prevalent) 4 107 (0-17) were raped, compared to 4 599- 18+.
1997: 0-17 = 21 404
18+ = 30 756
KZN: 0-17 = 4 259
18+ = 4 380
1998: 0-17 = 19 836
18+ = 29 440
KZN: 0-17 = 4 300
18+ = 4 225

* In early September, 2001, Minister Steve Tshwete responding to a question in parliament said child rape had doubled in the past year.

* In Zambia, research conducted by the government and Unicef showed the rate of HIV infection in girls is five to seven times higher than among boys the same age. Doreen Mulenga, health officer for Unicef, Zambia said the biggest contributor to the difference is "cross generation infection" - older men passing the virus to younger girls.
Research conducted in the early 1990s in Uganda, Zambia, Tanzania, Central African Republic, the Republic of Congo, Rwanda and Burundi has pointed to higher infection rates among young girls and men older than 30. At that time, the phenomenon was largely attributed to the so-called sugar daddy syndrome, in which teenage girls pursue relationships with well to do men to escape poverty... Across Africa, the burden and guilt of sexually transmitted diseases traditionally fall upon women; in Shona, the language of most Zimbabweans, AIDS and other sexual infections are known as chirwere chevadkadzi (women's diseases)
During the first 3 months of 1998, 5 214 SA girls under 18 were reported raped keeping pace with last year's record of 21 404. Reported rapes in Zimbabwe have increased 30% in the last five years and more than half the cases in 1997 involved children, a large number of them under 5. (Los Angeles Times, December, 1998)
* The rape of girls under the age of 12 increased 65% in 1998 and 1999 (Government of Botswana Survey of Rape, 1999)

"The very high prevalence of rape largely reflects a high level of social
tolerance of the crime. This is expressed in the trivial way in which
complaints are treated by the police, particularly if they involve date rape;
the lenient sentences handed down by judges and magistrates in the small
proportion of cases that ever get to court; the hostile attitude of district
surgeons toward rape survivors and the careless way in which examinations
are performed; the small price for which a docket can be 'lost' and the
efforts of friends and relatives who often discourage women from laying
charges, particularly if the rapist is known to them," Rachel Jewkes, Medical
Research Council, August, 2000.

* Police figures for rape are broken down into "reported rape" which in terms of present definitions can only include vaginal rape. Male rape is not included in statistics and is not classified as rape, it is extraordinarily difficult to get male rape investigated. Male rape was previously classified as sodomy, however, sodomy is no longer a crime and in a rare instance it may be classified as indecent assault. Anal and oral rape are classified as indecent assault - indecent assault is listed separately. Sex with adolescent girls under the age of 16 is called "statutory rape" and is classified with the rape of so- called "imbeciles". Based on those categories rape in 1997 - 52 160; girls under age or "female imbecile" 537; indecent assault 5 053 =
total all rape in 1997: 57 750
1998: rape reported 49 280; under age and "imbecile" 474; indecent assault 4 851
Total all rape in 1998: 54 605


Rape per 100 000 population according to the SA Police on reported figures and not including underage/imbecile or indecent assault was in 1994 109,6;
95 - 119,8; 96 - 124,4; 97 - 125,6; 98 - 115,8.

* In 1995 (when 35 000 rapes were reported) the Human Sciences Research Council reported that SA had 149,5 rapes per 100 000 population, compared to 34,4 rapes per 100 000 in the USA. In other words, a woman has a five times higher chance of being raped in SA than in the USA.
* Rape homicide expert, Dr Lorna Martin, a forensic pathologist at the University of Cape Town says a woman is 40 times more likely to be raped in Cape Town than in any city in Europe (June, 1999).

The last rape statistics issued by the SA Police Service show that rape statistics for January to June for the years 1994 to 1999 were: 94 = 18 801; 1995 =21 540; 1996 = 24 269; 1997 - 24 806; 1998 = 23 374;
1999 = 23 900.

The CIET survey (cited above) showed no correlation between sexual violence and unemployment. Even when it came to jack-rolling or recreational rape at gunpoint, two percent more of the employed than the unemployed said they liked raping.(Leadership, August 2000)

* 21 July 2000, the Financial Mail reported on studies by the SA Medical Research Council (MRC). It reported: "At the ANC's national general council in Port Elizabeth last week, Mbeki, for a second time this month, slammed suggestions that rape is endemic in this country. To say so, he implied, was unpatriotic. But the latest available police statistic - 54 000 reported rapes in 1998 - is among Interpol's highest reported rape rates worldwide. Moreover, a national study by the MRC says that only one in 10 rapes is reported which, by simple arithmetic, suggests that rape is indeed a social pathology in this country...."
The MRC report, published in August 2000 revealed a figure 10 times higher than reported rape statistics, Rachel Jewkes of the MRC Women's Health Unit notes that while "police statistics indicate that there are 240 incidents of rape and attempted rape per 100 000 women each year, representiative community based surveys have found that in the 17 - 48 age group there are 2 070 incidents per 100 000 women each year." The MRC found that rape was most common in the Western Cape, Mpumalanga and Gauteng. It notes " a doubling of child rape recently."

The Demographic & Health 1998 Survey by the Department of Health, which collected data from 12 000 women around the country, found that 70% of the women canvassed said they had been raped.

KEY AIDS DATA:
* By the year 2007 one million South Africans will be dying from HIV each year, Dr Brian Williams, CSIR, October 2000
* Mother-to-child transmission: Economist Nicoli Nattrass of the University of Cape Town said funding a short course of AZT is 18 times cheaper than caring for a child born with AIDS over the average 5 years of its life (Sunday Independent, June 11, 2000). Government rejected an offer of free Nevirapine, including all shipping and delivery costs.
Pfizer gives Diflucan free to SAs with cryptococcal meningitis - by September, 2000 the government had still not taken up the offer.
* In 1996, Gencor estimated that 20% of its 100 000 workforce was infected with AIDS with 30 mineworkers dying each week.
* In Carletonville, 80% of prostitutes are infected with HIV, according to Dr Brian Williams of the CSIR (October, 2000)
* In Carletonville 70% of girls aged 25 are infected with HIV compared to 50% of men aged 32 (the highest infection age in that area), 25% of girls who have had only one sexual partner are infected with HIV compared to only slightly higher rates for girls with two or more partners. Brian Williams, CSIR, 1998.
* July, 2000: the SA Democratic Teachers Union announces that two teachers are dying each week from AIDS and that by 2001, teachers will be dying faster than government can train them.
* The Minister of Minerals and Energy notes that 28% of mineworkers are HIV+ and this has led to production losses of 15% (Sunday Independent, June 11, 2000)
* The US Central Intelligence Agency, February 2000, estimated that 70% of the SA National Defence Force was HIV+

Comparitive - Rape and HIV in the USA:
* As of June 1999, women accounted for 16.3% of all persons ever reported with AIDS in the USA, and 23% of person with AIDS in the most recent reporting year. A large proportion of women acquire HIV through their sexual relationships with men - from 15% in 1983 to 40% in 1999. Centers for Disease Control, 2000.
* National Center for Injury Prevention and Control, CDC, 2000: The revised National Crime Victimization Survey for 1992-1993 estimates that annually 172,400 women were raped. There were 71 forcible rapes per 100,000 females reported to United States law enforcement agencies in 1996. 84% of rape survivors did not report the offense to the police.
Using Uniform Crime Report data for 1994 and 1995, the Bureau of Justice Statistics found that of rape survivors who reported the offense to law enforcement, about 40% were under the age of 18, and 15% were younger than 12.
The National Crime Victimization Survey indicates that for 1992-1993, 92% of rapes were committed by known assailants.About half of all rapes and sexual assaults against women are committed by friends and acquaintances, and 26% by intimate partners.
Risk factors for perpetrating sexual violence include: early sexual experience (both forced and voluntary), adherence by men to sex role stereotyping, negative attitudes of men towards women, alcohol consumption, acceptance of rape myths by men.
The adult pregnancy rate associated with rape is estimated to be 4.7%. There may be 32,101 annual rape-related pregnancies among American women over the age of 18.
Non-genital physical injuries occur in approximately 40% of rape cases.
Rape survivors often manifest long-term symptoms of chronic headaches, fatigue, sleep disturbance, recurrent nausea, decreased appetite, eating disorders, menstrual pain, sexual dysfunction and suicide attempts. Sexual assault was found to increase the odds of substance abuse.
Estimates of the occurrence of sexually transmitted diseases resulting from rape range from 3.6% to 30%. HIV transmission cases through rape have been documented in Sweden, South Africa, Kenya, Uganda, Nigeria, Zimbabwe, Botswana, Namibia and Great Britain.
Victims of marital or date rape are 11 times more likely to be clinically depressed, and 6 times more likely to experience social phobia. Psychological problems are still evident in cases as long as 15 years after the assault. A study examining the use of health services over a five year period by female members of a health maintenance program found that the number of visits to physicians by rape survivors increased 56% in the year following the crime, compared to a 2% utilization increase by those not raped.
The National Public Services Research Institute estimates the lifetime cost for each rape with physical injuries which occurred in 1987 to be $60,000.
- Centers for Disease Control and Prevention, February 10, 2000

DOES PEP (ANTI-RETROVIRALS) AFTER RAPE WORK?
Dr Adrienne Wulfsohn head of Netcare's rape clinics, (Netcare is the largest private hospital group in SA with 48 hospitals and clinics) has been conducting research at Sunninghill, Garden City and Milpark clinics into rape for two years and has assessed more than 700 survivors to whom they have given AZT and 3TC (or more recently Combovir). In a presentation to a SpeakOut! conference on rape and HIV on August 18 she said that not one person given ARVs within 72 hours seroconverted - this supports findings in Europe and the USA where even where assailants where known to be HIV+ giving Post Exposure Prophylaxis (PEP) - whether just AZT or AZT & 3TC stopped transmission. Of the one woman at Sunninghill where they gave the drug 90 hours afterwards, that woman seroconverted and became HIV+.
Because Netcare gives free care to indigent rape survivors and works closely with sexual offences units, they get very many patients from indigent areas, especially informal settlements.
Of the 700 patients, 260 arrived with the police, the remainder arrived on their own, Wulfsohn said the others did not lay charges - in other words, a third of the patients they saw did not lay charges. She says the follow up rate at 6 weeks (for return HIV testing) is 75% (compared to a worldwide average of 35% at 6 weeks); and drops to about 50% at 6 months (almost zero elsewhere). She says compliance is 100% - Wulfsohn's study into rape, HIV and ARVs is the biggest of its kind in the world. "Of all our rape survivors on PEP only one was stopped after 2 weeks because she became violently ill and could not complete the 28 day course. Side effects were very low in others.
"About 15% to 16% are HIV+ on the day/night they are raped and cannot commence PEP - about 92% of our patients are from informal settlements.
"Private sector costs of treating a rape survivors - drugs for STDS, to stop pregnancy, to prevent infection and to stop HIV, as well as HIV tests and doctors charges are R5 400 (to buy Combovir alone it costs just under R1 500 privately). Those are one off costs.
"However, if the person is or becomes HIV+ their MONTHLY drug costs are R1 400, lab costs R250 and consultation costs R150 = R1 900 per MONTH.
"The annual costs of treating an HIV+ person privately are R22 800 - lifetime costs R684 000."
That would bankrupt any family, any medical aid.
What would the cost be to the state to give ARVs for rape - R200; Elisa test R4,50 but the new rapid tests cost the state R1,20.
Cost of not treating and the child/adult becomes HIV+? Hundreds of thousands of rand to the State - beside the moral outrage of not acting to protect a life, which the State in terms of its constitution is impelled to do.
In late 1998, Dr Josh Bamberger, a San Francisco doctor attached to its health department began studying the impact of PEP after rape on more than 200 women. By October 2000, the State of California issued guidelines for post-exposure prophylaxis (PEP) after rape based on the outcome of Bamberger's study. By June 1999, a similar study was underway in France. A study delivered to the Durban AIDS conference in July by scientists, Jean-Pierre Benais and a team from France had identical results: of 100 rape survivors given anti-retrovirals from five Parisian clinics since June 1999, not one had sero-converted. "Two perpertrators were known as HIV positive and the others refused testing."
Data from Denmark published in July, 2000, in the American Journal of Physicians from scientists at the National University Hospital Rigshospitalet and State Serum Institute in Copenhagen, showed that antiretroviral treatment given to a 13-year-old child, 50 hours after receiving a blood transfusion of HIV infected blood from a donor with fullblown AIDS, saw the child test negative for HIV for more than a year after the transfusion. The child is still clear of infection.
Given this research and that from the USA, most particularly, California, New York and France which showed HIV cannot be transmitted after rape if antiretrovirals are given, the CDC embarked on writing new guidelines for PEP after rape.
The Centres for Disease Control in Atlanta, USA is considered the most authoritative AIDS research organisation in the world. The 1998 CDC guidelines, based on needlestick injuries, suggested that triple therapy (such as AZT, 3TC and Crixivan) taken soon after a rape would probably ensure that 81% of patients would not become HIV+.
Thus far, no rape survivor who was HIV negative on the day of the rape, and who takes antiretrovirals after rape develops HIV, even when it can be proven that his or her rapist or rapists were HIV+ - in other words ARVs taken within 72 hours after rape or high risk sex are 100% HIV preventative.
The California guidelines, were in turn influenced by those from the New York State AIDS Institute for "HIV prophylaxis folowing sexual assault" which have been in place since 1997. The California guidelines note: "PEP medications taken soon after exposure to HIV can prevent HIV infection... The CDC’s Hospital Infections Director has recommended that PEP be initiated within 72 hours for individuals with recent sexual exposure to HIV and San Francisco’s non-occupational PEP service uses 72 hours as its cut-off. In the sexual assault context, given the delay that commonly occurs between assault and medical treatment, the advisory panel recommends setting the cut-off for treatment initiation at the outermost acceptable limit."
It notes aspects of rape that increase risk: "presence of blood; survivor or assailant with a sexual transmitted disease with inflammation such as gonorrhea, chlamydia, herpes, syphilis, bacterial vaginosis, trichomoniasis, etc.; significant trauma to survivor; ejaculation by assailant; multiple assailants or multiple penetrations by assailant(s)."

Superintendent Andre Neethling of the Family Violence, Child Protection and Sexual Offences Unit, Johannesburg told a conference on sexual violence and HIV on 18 August at Vodaworld that "we are seeing a high increase of sexual abuse among children, either perpetrated by adults on children or children against children (such children tend to have been abused themselves), there was a case of a child in Johannesburg who was lured to a house by her 10-year-old classmates and gangraped, the boys then urinated into a cup and made her drink it. In another instance a seven year old raped another child of the same age and put rocks up his anus."

WHAT NEEDS TO BE DONE?

Firstly, we have to Acknowledge the high rates of rape and HIV in our nation ... but instead of becoming frightened, we need to Act. We need to devise cutting edge Solutions to change the situation, because escalating sexual violence and HIV are worldwide problems. We have the Opportunity to find solutions that could create jobs and see South Africa hailed, again, as a nation that comes up with innovative and progressive ways - but also money-making ways - to combat challenges.
No war in the world claims as many deaths as HIV/AIDS or sexual violence. The worst war in the world is that against women and children.
The following are suggestions that may help:

* Peer mediation and conflict resolution programmes to be established at all schools to help children find non-violent solutions to aggression and frustration, and to respect the rights of others.
* Antiretroviral treatment must be extended to every child, woman or man raped.
* Programmes to prevent mother to child transmission must be made available to all who attend state clinics or hospitals.
* Huge programmes to combat worms in children and adults - in concert with dramatic improvements in sanitation - need to begin urgently. It would cost around R10m to combat worms in all children each year. Repeat worm infections destroy the immune system and make HIV infection easier and the progress of the disease more rapid. The MRC estimates that in informal settlements around Cape Town 95% of children are infected, and 50% of all adults in SA.
* The budget to combat sexually transmitted diseases needs to be doubled and information about STIs openly, regularly and graphically distributed through the popular media and to young people, especially those in high school, and tertiary educational institutes.
* Tax benefits should be given to employers who have HIV/STI clinics in the workplace.
* Directly Observed Therapy (DOT) programmes for TB need to have food aid combined to them - most of this country goes to bed hungry at night, and because TB drugs make a person nauseous if they have not eaten - they stop taking the drugs. By 2004 according to the World Health Organisation, SA will have more multi-drug resistant TB than ordinary TB - it costs R25 000 to treat MDR TB, instead of only R250 to treat ordinary TB. TB and HIV are linked.
* Massive campaigns have to begin through all the media to make it clear that it is not possible to lose HIV by raping a virgin - and that those found guilty of this will receive the most harsh sentences possible. However, such campaigns need to be linked to improved treatment access for all.
* Compulsory testing of alleged rapists is essential because even though the rape survivor still needs to go onto anti-retrovirals to prevent HIV, knowing the status of the alleged rapist/s will contribute to her state of mind. The fear of believing you may be HIV+ as a result of rape is terrifying and continues for a full year while the woman, child or man returns for repeat HIV tests. And in the case of virgin rape, in particular, it becomes attempted murder.
* Male rape needs to be recognised in law, and more sensitive assistance given to boys and men who report rape.
* The very slow progress of new rape legislation over more than three years needs to be accelerated and brought before parliament.
* The HIV awareness of general pracitioners is pathetic - ways need to be found to encourage, if not compel greater awareness and education among these doctors.
* Food garden campaigns need to be encouraged to boost the nutritional needs of children and those infected with HIV, with cheap seeds available and training in organic farming techniques given.
* Access to clean water needs to be accelerated dramatically especially as HIV-infected mothers dare not breastfeed for fear of increasing HIV transmission risks to their babies.
* Increased resources need to be given to those police units investigating interpersonal crime. The Scorpions, as an example, focus on crimes about money. We need to make crimes against people more serious than the loss of money.
* There needs to be far greater co-operation between traditional healers and the conventional medical fraternity. There is one doctor for every 40 000 people in SA and one traditional healer for every 500 people. Traditional healers offer not only medical but psychological support. If they receive appropriate training, and are also invited to share their insights into medical and psychological care considerable inroads could be made into curtailing an epidemic of virgin rape, sexual violence and HIV.
* Research by the Medical Research Council into traditional remedies that could be effective against HIV needs to be given a priority rating and massively increased funding. As this could provide medicines that could not only be cheaply marketed to our people, but the world (by 2005 there will be 100-million HIV infected people in the world).
* Children whose parents are ill with AIDS, or who are dying or who have died, go through profound psychological trauma. Trauma support groups need to be set up at every school in the country to assist children not only traumatised by this, but too by violent crime. These groups should be teacher or peer-run and overseen by educational psychologists or university psychological departments.
* A culture of volunteerism needs to urgently be encouraged - and it needs to begin with parliamentarians being SEEN to be ACTIVELY and FREQUENTLY involved in communities, regardless of political affiliation, helping those affected by violence and HIV.
* The Parliamentary Committee on the Status of Women should make an annual award - or even suggest a presidential medal - to the volunteer of the year involved in combating (a) violence and (b) HIV in his or her community. Similarly, an annual award needs to be given to the police officer who has shown outstanding diligence in bringing a rapist/s or abusive partner or parent to book. And too, to a prosecutor who has done outstanding work in this field. Unless we acknowledge and reward excellence, and give an incentive to improve this, mediocrity and aparthy will reign supreme.
* Women parliamentarians need to show that it is not shameful to go for an HIV test, but necessary as an act of responsibility to one's partner and family. All women parliamentarians should publically go for testing. Results can remain confidential, unless a parliamentarian chooses to disclose.

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