National standards to improve trauma care for rape survivors

New guidelines and standards for immediate post-rape care were launched at the international Sexual Violence Research Initiative (SVRI) conference at Spier, Stellenbosch on 16 September. The guidelines, developed collectively by 33 community organisations and leading academics, aim to ensure consistent standards of immediate post-rape care for survivors across the country to mitigate the impact of rape.

A variety of services are available to help survivors and their families cope with the aftermath of sexual violence – a significant and well-publicised problem in South African communities. Based at police stations, courts, health facilities and non-profit organisations’ premises, they are designed to address survivors’ health, social support and justice needs. But there are substantial gaps in these services and significant variations in practice, which means that not all survivors receive the same range and quality of care.

“In 2013 we started working with organisations providing services at Thuthuzela Care Centres (TCCs) and designated rape centres with support from the Global Fund to Fight AIDS, Tuberculosis & Malaria,” says project manager Sharon Kouta from NACOSA. The Centres are one-stop facilities for survivors of sexual violence – recognised in South Africa and internationally as a successful multi-disciplinary approach to supporting survivors of sexual assault. “We are working with organisations in 41 of the 56 TCCs and in seven designated rape centres and have learned so much about how best to help rape survivors in that first stage of trauma. This is our attempt to try and address the gaps in care we have observed.”

Non-profit organisations provide a 24-hour ‘first response’ service to support survivors through the initial process of forensic examination, HIV counselling and testing, provision of post-exposure prophylaxis (PEP) and emergency contraception, giving a statement and referral to other services. The booklet launched today, Guidelines and Standards for the Provision of Support to Rape Survivors in the Acute Stage of Trauma, is the product of the collective learning and knowledge developed by the organisations and people who provide these services to survivors; 24 hours a day, every day of the year.

Good support can lessen the immediate mental health consequences of rape, as well as prevent its medium and long-term effects (such as depression, or PTSD) but mental health services are not widely available, particularly in the public sector. In many communities, non-profit organisations are the only source of help for rape survivors.

The guidelines introduce a set of norms and standards to guide support workers employed by non-profit organisations at health facilities, TCCs or police stations. “We call these workers ‘first responders’,” continues Kouta, “but the guidelines are also useful for health workers, police officers and any other frontline worker who interacts with rape survivors.”

First responders are special people. They must be professional, compassionate and non-judgmental but also able to work well with a range of people and be emotionally secure enough to deal with very distressing situations. Rape survivors interact with many different people on their journey through the health and justice systems so first responders must collaborate closely with all the other service providers to ensure rape survivors and their families receive quality care. The role of the first responder is therefore a dual one: they act both as a victim’s advocate and as their support worker.

Thumeka, a first responder at a TCC in Durban, points out the range of support that they must offer: “I recently dealt with a victim who only found out she was [HIV] positive when she came to the centre. This was a double trauma on her but I managed to give her the support she needed. We were taught the importance of referrals as well as to follow up even after the referral.”

The guidelines booklet includes important information on how to provide “psychological first aid” to victims with complex and differing needs; guiding principles for services; recommended standards for services at police stations and TCCs and the recruitment, training and supervision of first responders. The standards are a significant step forward in a field that has been overlooked in the past.

“You should feel a great deal of pride for the work that has been accomplished and the contribution the work makes to such an important area of care for survivors,” commented academic, Sheila Young Steinbrenner (PhD, RN) from the Indiana University School of Nursing.

Compassionate and professional support for survivors of sexual violence in the acute stage of trauma plays a critical role in reducing the psychological impact of trauma, reducing secondary victimisation and preventing HIV and other sexually transmitted infections. First responders are on the frontline of South Africa’s response to unacceptably high levels of sexual violence which is fuelling the biggest HIV/AIDS burden in the world. “These guidelines and standards are dedicated to these heroes – and to providing them with the conditions and support they need to do their work,” concludes Kouta.


Make a plan to stop GBV

Gender based violence (GBV) is one of the biggest drivers of HIV in women and girls and South Africa has a significant and well-publicised GBV problem. Yet there is still no national strategic plan to address it.

Studies show that women who have been exposed to gender based violence are 1.5 times more likely to acquire HIV. Particularly vulnerable are children, sex workers and lesbian, bisexual and transgender women.

Gender based violence is a fundamental violation of human rights, as enshrined in our constitution. Although we have supportive legal and policy frameworks in place to tackle gender inequality and violence, the issue in South Africa is a lack of coordination and poor implementation of the laws and policies already in place to safeguard girls.

Without a coherent, coordinated and budgeted plan to address GBV, it will continue to ravage our communities, perpetuated by an inter-generational cycle of violence. It is vital to sensitise and train frontline workers like the police, teachers, health and social workers and community care givers so that they provide compassionate and appropriate care to survivors of GBV.

Addressing gender equality is critical. Worldwide, support for women’s movements has been found to be a significant predictor of government action to redress violence against women.

We call for ZERO for women and girls in the National Strategic Plan (2017 – 2021) as well as a National Strategic Plan to stop GBV. Academics, civil society groups, NGOs and concerned citizens from across the country are calling on the South African Government to make a plan now to stop GBV.

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