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Rape and Post Exposure Prophylaxis’s (PEP) ULRICKA BEUKMAN 10 OCTOBER 2012.

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Presentation on theme: "Rape and Post Exposure Prophylaxis’s (PEP) ULRICKA BEUKMAN 10 OCTOBER 2012."— Presentation transcript:

1 Rape and Post Exposure Prophylaxis’s (PEP) ULRICKA BEUKMAN 10 OCTOBER 2012

2 Agenda What is Rape? What is the protocol after rape? What is Post exposure prophylaxis (PEP) What does it do in the body Availability of PEP How do we as peer educators support someone on PEP / after Rape

3 What is rape? Rape is forced, unwanted sexual intercourse.

4 South Africa’s definition of rape The South African Sexual Offences Bill that came into effect in 2007 has broadened the definition of rape to include – forced anal or oral sex, – irrespective of the gender of either the victim or the perpetrator. This means that male rape is now recognised by law whereas it was previously classified as indecent assault.

5 Rape and children A child under the age of 12 can under no circumstances consent to sex and therefore any sexual act is considered rape. If a child between 12 and 16 consents to sex it is considered statutory rape.

6 Rape in South Africa Rape in South Africa: Who was the perpetrator? 30% of victims were attacked by someone they know 20% by their partner 50% strangers Source Stats SA 2011

7 Rape in South Africa - Where did it occur 30% of incidences occurred in their home 20% in a fiends home 18% in the street, 34% in a field or park Source Stats SA 2011

8 Rape in South Africa - Why did it occur? 20% of rapes occurred due to jealousy 17.5% was motivated by money 12% due to long term personal anger

9 Rape in South Africa – How did it occur 90% of perpetrators used force 31% a gun 24% a knife

10 Rape Statistics in South Africa A woman is raped in South Africa every 17 seconds… The highest increase in attacks has been against children under the age of seven, largely due to the myth that sexual intercourse with a virgin will cure a man of HIV It’s estimated that women born in South Africa have more chance of being raped than learning how to read It’s estimated that half a million rapes are committed each year in SA A study by Interpol shows that South Africa has the highest rate of rape in the world. A quarter of South African men who took part in a survey by the Medical Research Council (MRC) admitted to raping someone,

11 What is it to rape? They beat her on the head and whipped her with canes, they kicked her from every side as a football. Pale, bruised and trembling with fatigue her frail bones felt like broken sticks under her hands. Copyright 2009 Bhuwan Thapaliya When she lost her consciousness, they raped her in turn. What is it that makes a man rape, a woman, the pivot, on which the whole way of life has revolved? God, if it is a man’s way of asserting himself and his superiority then I am ashamed of being a man.

12 What needs to be done if you are raped? Treatment 1.Prevent HIV with PEP 2.Treatment sexually transmitted infections 3.Treatment injuries 4.Prevention of pregnancy 5.Collect evidence via rape kit Psychological support 1.Treat the psychological shock (including post- traumatic stress disorder, disturbed sleep and eating patterns, anxiety and depression) 2.Assist with disturbance in relationships 3.Decide on laying a criminal charge

13 Supporting organisation Police – the police have been trained to deal sensitively with the rape survivor Rape Centre – attached to each police station to assist rape survivors - volunteers to assist Many Lifeline offices offer rape crises centres or can direct the survivors to support networks Government institutions are mandated to provide PEP and other treatment to rape survivors Netcare Casualty facilities

14 Procedure for laying a criminal charge The decision is yours whether to lay a charge unless you are under the age of 16 A charge can be opened at any time – but waiting makes a conviction harder Rape can be reported at any police station within the magisterial district where the rape occurred The police will take the victim to the nearest rape crisis centre and the district surgeon will be called to the centre to do an investigation Once reported the case is prosecuted by the state The case can only be withdrawn in front of a magistrate

15 HIV and Rape Violent or forced sex can increase the risk of transmitting HIV to both women and men. This can occur in the following ways: In forced vaginal or anal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus into the bloodstream.

16 Likely hood of transmission of HIV Those who suffer anal rape are also considerably more susceptible to HIV since anal tissues can be easily damaged, allowing the virus an easier entry into the body. Adolescent girls are particularly susceptible to HIV infection because their vaginal mucous membrane has not yet acquired the cellular density necessary to provide an effective barrier - this develops in the later teenage years. “Gang rape”

17 Testing of the perpetrator for HIV The victim has the right to insist that the suspected rapist be tested for HIV. It is important to note that the rapist can be in a window period and the victim must complete the ARV treatment even if the HIV test comes back negative.

18 What is Post Exposure prophylaxis? PEP is a course of medication that can stop you becoming HIV positive after you've been exposed to the virus. A rape victim is entitled to post-exposure prophylaxis (PEP) to prevent HIV infection. For this to be effective, it should be accessed within 72 hours after the rape. It is best to start within 3 hours after being rape

19 Where can you get PEP Any government hospital Many private institutions A starter kit can be obtained from most chemists / pharmacy A workplace clinic

20 How does PEP work? PEP works by preventing HIV from reproducing before HIV infection can be established in a person’s body. As with other medications, it is important you take the pills as stated to maintain the right amount of the medication in your bloodstream at all times. This will mean that the medication will be as effective as possible. PEP works best when taken at the right dose, at the right time, without missing doses.

21 How could the HIV infection be stopped? It is important to test and ensure the survivor is negative before starting PEP Taking 2 or 3 anti-HIV drugs everyday for 4 weeks might stop the HIV before it gets a permanent hold in the body. PEP’s not a ‘morning after’ pill that’s taken just once – it’s one month of drugs.

22 Does PEP have side effects? Some people have no side effects Other might have diarrhoea, headaches, feeling sick and vomiting. Side effects should get less after day 3 – 5 of taking the medication Speak to the doctor / nurse about the side effect and possible remedies

23 Follow-up visits for survivors who do not receive post-exposure prophylaxis 2 week, 6 week and 3 month follow-up visit The survivor should be evaluate for pregnancy Check all medication has been taken for STIs. If prophylactic antibiotics was not given, evaluate for STI, treat as appropriate, and provide advice on voluntary counselling and testing for HIV Their mental and emotional status should be evaluated and treat as needed

24 How to support someone who has been raped and is on PEP Social support and psychological counselling are essential components of medical care for the rape survivor. Most survivors of rape will regain their psychological health through the emotional support and understanding of people they trust, community counsellors, and support groups. All survivors should be offered a referral to the community focal point for sexual and gender- based violence.

25 How to behave if someone disclose to you? The majority of rape survivors never tell anyone about the incident. If the survivor has told you what happened, it is a sign that she trusts you. Your compassionate response to her/his disclosure can have a positive impact on their recovery.

26 How to behave if someone disclose to you that they have been raped? Provide basic, non-intrusive practical care. Listen but do not force her to talk about the event, and ensure that her basic needs are met. Because it may cause greater psychological problems, do not push survivors to share their personal experiences beyond what they would naturally share.

27 Ask the survivor if she has a safe place to go to, and if someone she trusts will accompany her when she leaves the health facility. If she has no safe place to go to immediately, efforts should be made to find one for her.

28 Enlist the assistance of the counselling services, community services provider, and law enforcement authorities, including police or security officer as appropriate. If the survivor has dependants to take care of, and is unable to carry out day-to-day activities as a result of her trauma, provisions must also be made for her dependants and their safety.

29 Survivors are at increased risk of a range of symptoms, including: feelings of guilt and shame; uncontrollable emotions, such as fear, anger, anxiety; nightmares; suicidal thoughts or attempts; numbness; substance abuse; sexual dysfunction; medically unexplained somatic complaints; social withdrawal.

30 Tell the survivor that these feelings are normal Advise the survivor that she needs emotional support perhaps from a trusted family member or friend. Involuntary orgasm can occur during rape, which often leaves the survivor feeling guilty. Reassure the survivor that, if this has occurred, it was a physiological reaction and was beyond her control. Many cultures blame the survivor. Reassure the survivor that it was not their fault! Refer to EAP if possible

31 What can you do to prevent rape from happening in your workplace / community Teach your children, peers and community that this is unacceptable behaviour Give your children and peers the skills to prevent increasing their risk of being raped Ensure that you are equipped to provide support to family members or peers who have been raped Look at the risks at the work / community

32 Questions

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