Improving Access to and Delivery of Comprehensive Post-exposure Prophylaxis (PEP) for Sexual Assault and Occupational PEP Through Training and Systems Strengthening
Council staff in South Africa are improving access to post-rape care for child and adult survivors of sexual assault as well as occupational PEP for health and emergency care workers on a national scale, in a continuing effort to provide comprehensive post-rape care management and prevent unwanted pregnancies, HIV, and other infections.
Sexual assault and HIV are two prevalent and interrelated public health problems in South Africa. With 5.7 million people living with the virus and a reported sexual assault rate of 194 per 100,000 women, the risk of survivors being infected with HIV is quite high. It is important to note that South Africa also has the highest incidence of child sexual assault in the world. Marginalized groups are particularly vulnerable to HIV infection in South Africa; these include commercial sex workers, intravenous drug users, ethnic minorities, men who have sex with men, and prisoners. Further, health care workers, police, prison wardens, emergency rescue staff, and other service workers also are at significant risk of occupational exposure to HIV. Targeted inclusion of these groups in HIV prevention efforts, such as PEP and occupational PEP, as well as violence prevention efforts is needed.
PEP refers to a set of services that manage specific aspects of exposure to blood-borne pathogens. In the case of HIV, these services comprise a course of antiretroviral drugs to prevent infection and seroconversion and, depending on the event, might include additional services, such as first aid, counseling, HIV testing, and treatment for possible exposure to other infections and to possible pregnancy. Research suggests that when initiated within 48 hours after exposure, PEP is more effective than initiation within 48–72 hours, and that PEP is not effective when given more than 72 hours following possible exposure to HIV. Furthermore, a 28-day course of drug therapy appears to be more effective than courses of treatment lasting 3 or 10 days. In South Africa, there is a strong argument to be made in support of the provision of PEP for HIV given the number of people living with HIV and the high incidence of sexual assault.
The Population Council has established collaborations with government and nongovernmental organizations to improve access to comprehensive PEP for a range of populations who may be at risk of coerced, voluntary, and occupational exposure to HIV.
The Council consulted with representatives from the departments of health, police, and correctional services from five provinces (KwaZulu-Natal, Limpopo, North West, Free State, and Gauteng) in March 2010 to identify gaps in the capacity for providing PEP and sexual and gender-based violence services and to consider activities that could be undertaken to most constructively address service discrepancies. A situation analysis revealed that only 29 percent of facilities had frontline staff adequately skilled in PEP service provision and that only 294/738 cases (40%) had presented to health facilities within 72 hours of exposure. The capacity-building strategy being used includes improvements in human resources, institutional capacity, and networks within facilities and across departments.
To date, Council staff have worked in close collaboration with the Department of Health and the South African Police Service to build capacity in 88 health facilities in five provinces. Approximately 1,000 health and police workers have been trained so far.
During the next five years (September 2011–2016), the Population Council/South Africa will continue to strengthen and expand the scope and scale of the current program in support of the government’s National HIV & AIDS and STI Strategic Plan. In addition, activities are being planned to achieve coverage of all health facilities, prisons, police stations, and military health facilities countrywide.
Project objectives are to:
- Improve the quality of and access to services for comprehensive post-rape care and follow-up for adults, children, and other vulnerable populations
- Improve the quality of and access to services for occupational and voluntary exposure to HIV and other blood infections
- Strengthen systems for collecting information and making it available to guide program implementation, including information on treatment adherence and outcomes
- Coordinate with the Government of South Africa and other partners to ensure national coverage and avoid replication
- Strengthen logistics and management processes to ensure adequate supplies and provision of the comprehensive package of services
- Develop advocacy tools and activities
- Strengthen technical resources within South Africa
Proceedings and presentations from the Free State Child Abuse Indaba
Publication date: 2010
The role of traditional leaders in preventing and addressing sexual and gender-based violence: Findings from KwaZulu-Natal, Northwest and Limpopo provinces in South Africa (PDF)
Teffo-Menziwa,Mantshi; Mullick,Saiqa; Dlamini,Prince Cedza
Publication date: 2010
Women and sexual violence (PDF)
Mullick,Saiqa; Teffo-Menziwa,Mantshi; Williams,Eka; Jina,Ruxana
from South African Health Review 2010, pp. 49-58
Publication date: 2010
Multi-sectoral approaches to preventing sexual assault and domestic violence: A collective force to stop the violence (PDF)
Publication date: 2009
Location: South Africa
Duration: 2/2010 - 9/2010
Population Council researchers:
US President's Emergency Plan for AIDS Relief through US Agency for International Development