“This needs to stop”: Gender-based Violence in Cape Town

Like thousands of other women living in or near Cape Town, Samara (not her real name) dialed the helpline of the Rape Crisis Cape Town Trust, a nongovernmental organization whose counsellors speak English, Xhosa and Afrikaans. A few hours later, she had an appointment with the Rape Forensic Unit at Victoria Hospital where rape survivors are examined, treated and referred for further care. At the small brick building adjacent to the hospital, a first response counsellor from Rape Crisis was waiting for her, and a comprehensive process of post-rape care began.

As in any country where HIV prevalence is high – more than one in 10 South Africans today is HIV-positive – rape contributes significantly to HIV transmission. Violent sexual assault can cause trauma to the vaginal wall that allows easier transmission of the virus. In addition, fear of violence may prevent women from negotiating safe sex, and use of a condom. Among young women in South Africa (aged 15-24), approximately one out of every four new HIV infections is thought to stem from violence in some form.

So in places like the Victoria Hospital Forensic Unit, helping survivors of rape goes beyond clinical and psychosocial care – it’s also a race against time to ensure HIV-negative survivors are treated with HIV post-exposure prophylaxis (PEP), which can reduce the risk of infection by 80 percent. The clinical care they receive also includes treatment of any injuries, prophylactic treatment of sexually transmitted infections, and referral for ongoing counselling to prevent the mental health problems associated with unresolved psychological trauma.

Should they choose to, survivors may also be supported and prepared for the various processes of the criminal justice system: filing a case with the police, linkages to legal aid if required and seeking prosecution in court. In the long term, increasing access to justice, challenging the culture of silence and breaking the cycle of impunity are critical.

The Forensic Unit is part of a system of ‘Thuthuzela’ Care Centers, a name that means ‘comfort’ in Xhosa. It’s an example of a remarkably strong collaboration between Department of Health medical staff, specialist detectives from South Africa’s National Police Service, prosecutors from the National Prosecuting Authority, and Rape Crisis first response counsellors.

When counsellor Nono Magano receives a survivor at the center, the job of comforting is her first concern. “Most of the time I’m thinking ‘I wish I could take the pain for you,’” she says. “I wish I can put an arm around your shoulder, just until you are able to fly solo again.” Counsellors also prepare the survivor for the forensic medical examination carried out by a doctor or nurse, to gather any semen, hair or other evidence from a person’s body or clothing. A ‘rape kit’ to store and document material evidence will be critical as part of the prosecution for rape.

As the first person to meet with a rape survivor like Samara, Nono is trained to be a respectful and supportive listener. And one of her primary aims is to reduce the secondary trauma of reliving an experience of rape by handling a counselling interaction with care, and allowing the survivor to lead the conversation. “I didn’t know what to expect,” remembers Samara. “I was thinking, ‘are these people going to judge me on my past, or my faults?’ It was totally the opposite of that. They were there to encourage me to speak, not just hear me but to listen to me.”

After a chance to shower and receiving clean clothes, survivors are given a care pack of toiletries and other comfort items, often including messages of support and reassurance from volunteers in the community who have pre-packed the bags. Some care packs also include toys; although the vast majority of rape survivors are women, colorful murals of flowers and animals to make the Thuthuzela Care Center rooms child-friendly are a chilling reminder that a significant number of rapes involve children.

To prevent or mitigate gender-based violence and provide support to survivors, the Global Fund is scaling up investments in South Africa and beyond: New funding for the South Africa gender-based violence program for 2016-2019 includes US$11.5 million for preventing and responding to gender-based violence, managed by the National HIV/AIDS Community of South Africa (NACOSA) and the AIDS Foundation of South Africa (AFSA). In 2016, the Rape Crisis counsellors program supported more than 2,000 women, with support from the Global Fund and other partners and donors.

While the main focus of the gender-based violence program is on young women and girls, other at-risk populations targeted by the program include sex workers, men who have sex with men, transgender people and people living with infectious diseases.

For Samara, enough time has passed since her initial visit that she at least has closure about her HIV status and has filed a case against her husband. “I’m not looking for [retribution] of what was done to me, in the fact that I was raped,” she says. “I’m looking for… that the person knows that he will not treat another woman with disrespect. I don’t think I was this conscious ever in my life of who I really am, what I really wanted out of life, and how much it takes for us in this society, in this world we live in, to come forward and say ‘I’ve had enough. This needs to stop.’”