By Peroshni Govender
Friday, April 19, 2002
In South Africa, where more people are affected by AIDS than anywhere else in the world, rape and other violence is putting women at increased risk of contracting the disease.
JOHANNESBURG (WOMENSENEWS)--It happened again: the punches, the slaps, the kicks. But this time he went further. He burned her breasts.
Nomsa's eyes were swollen and black, her breasts painful to the touch and every muscle in her body ached. Opening her eyes in the light was a mission. It hurt too much. She didn't know if it was the pain that was unbearable, or the reality that her assailant was the man she loved, her husband and the father of her baby.
Nomsa's story was told on Wednesday by Prudence Mabele, a member of the Positive Women's Network in Pretoria, one of the 200 delegates attending a three-day conference in Johannesburg on gender violence and health, as an example of the violence linked with the transmission of AIDS.
Also on Wednesday, the government announced that it would make AIDS drugs available at state hospitals for survivors of sexual assaults. Up to now, this preventive regimen was only available to doctors and health professionals to treat needle-stick injuries. Survivors of rape have had to go to private clinics and non-governmental institutions to obtain the drugs.
Mabele told Nomsa's story to illustrate what too often occurs to women married to violent spouses.
Nomsa's HIV infection was the catalyst which sparked many of her husband's rages, a disease he had given to her and thus to their son, Thabang.
In addition, he sold the family home in Mamelodi, east of the South African capital of Pretoria, while Nomsa, 37, was at Thabang's hospital bedside.
With the virus taking its toll on Nomsa's body and a sick boy at her side, the prospect of life without her partner seemed daunting. The couple separated for a while, but an overwhelming urge to maintain the family structure and Nomsa's immense love for her husband brought about reconciliation. It was not long before the violence returned and it continued until Nomsa died of AIDS earlier this month.
Jacquelyn Campbell, a professor at the Johns Hopkins University School of Nursing, said that despite the increased risk of HIV infection among women in violent relationships, many South Africans remained unaware of the effects of violence on transmission of the virus. No reliable figures exist on how many South Africans are affected by AIDS-related violence, Campbell said, but added that trauma to the body increases risk of HIV infection and that violent men tend to have multiple sex partners, another risk factor for AIDS.
There are approximately 4.2 million people living with HIV or AIDS in South Africa, which has the highest rate of the infection in the world, according to United Nations estimates. Of that number, 2.3 million are women.
"There is some awareness, but still I don't think that many people have thought about gender violence and its connections to HIV," Campbell said.
Mabele, who works with women living with AIDS, said that many people believe that AIDS is a disease that is only contracted by those who are promiscuous--a characteristic looked down upon in South African society.
"I know of many women who were beaten by their parents and brothers because the family was ashamed to be associated with someone who has AIDS," she said. "Rape and an unfaithful partner are not considered."
South Africa's rape statistics are alarmingly high. Last year about 300,000 women ages 18 and older were raped, while about 225,000 rapes of females from infancy to 17 years old were reported to police, said Dr. Rachel Jewkes, director of the government-funded Medical Research Council's Gender and Health Research Group. The numbers add up to slightly more than 2 percent of the entire female population.
But these figures reflect only a small percentage of rapes that are actually reported to authorities, Jewkes told conference participants Wednesday.
The Medical Research Council's Dr. Kristen Dunkle, presenter of a paper on the relationship between AIDS and violence, said that 50 percent of the 1,395 women she had interviewed at three prenatal clinics in Soweto, a black township in South Africa's richest province, Gauteng, said they been subjected to some sort of assault by their husbands or partners.
"Past experience of intimate partner violence seems to be positively associated with sexual risk-taking among women of reproductive age in Soweto," she wrote, referring to the extramarital affairs, promiscuity and drug abuse that put them at increased risk of HIV infection.
Child rape also is an increasing problem in South Africa, where many people mistakenly believe that sex with a virgin can cure AIDS, Jewkes said. In the last six months, the country's national police services received reports of five infants, ranging from 1 month old to 1 year old, being raped.
KwaZulu-Natal, the country's largest province with the biggest rural population, has been hardest hit by AIDS and the violence that comes with the disease. Conservative statistics from the national Department of Health indicate that one in four people in the province is HIV-positive. With literacy levels exceptionally low and little access to radio and television, government campaigns to inform people about the infection and ways of preventing its spread is making little impact.
A doctor who works at the Sunninghill Hospital Rape Crisis Centre, north of Johannesburg, offered an example of how the government's plan to give anti-AIDS drugs to rape victims could stem the spread of the disease.
Although the clinic is in one of the city's most affluent suburbs, women have been coming from all over the province to get the drugs, said Dr. Adrienne Wulfson, one of South Africa's leading experts on the use of anti-retroviral drugs after rape. The clinic's services are free and the drugs are administered within 72 hours of rape.
Over the last three years, 639 patients at the clinic have followed the drug regimen. Of that number, 471 tested HIV-negative after taking the drugs for the 28 days following their rape, Wulfson said. Eighty-three women tested positive and 85 refused to be tested.
Despite the efficacy of the drugs and the government's offer to provide them to rape victims, it's not yet clear how many women will benefit.
Authorities will not dictate which hospitals should provide the drugs, said Dr. Nono Simelela, head of the national health department's AIDS program, at a press briefing Thursday in Pretoria. Instead, it is up to each hospital to decide whether it has the infrastructure and capacity to start providing the drug, she said.
Wulfson disagreed with the structure of the plan. "There is no reason why the drug can't be made available, because health professionals even in the most rural areas have it . . . to treat needle-stick injuries," she said.
Peroshni Govender is a reporter at the Pretoria News who writes often about AIDS.
Medical Research Council of South Africa:
AIDS Foundation of South Africa:
By Christen A. Smith and Alysia Mann Carey
By Joanna Englehardt and Jennifer Keys Adair
By Tatyana Bellamy-Walker
By Chandani Jayatilleke
By Zoe Alsop
By Louisa Reynolds
By Alana Chloe Esposito