HIV0304Pg000


THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                            MARCH 2004  5

sexual violence — the
neglected epidemic

South Africa is thought to have one of the highest incidences
of sexual assault in the world.  About 50 000 rapes were
reported in 2001 alone, although it is thought that this is just
a small percentage of the total number.  One of the main
reasons that rape is so prevalent in South Africa is that the
justice system is so ineffective in dealing with it.  Most rapists
walk free. Of 50 000 reported cases in 2001 only about 5 000
resulted in convictions.  Similar statistics were reported by the
South African police service in 2002, but a very worrying
statistic is that more than 40% of survivors of sexual assault
who reported their cases to the police between February 2002
and March 2003 were girls under 18, with 14% being 12 years
or younger.  This would mean that pre-teens and teenagers are
at much higher risk of sexual assault than the population as a
whole.  In 2000 and 2001 the reported incidence of rape and
attempted rape of children increased, even as the incidence
among adults began to stabilise.  Far too many girls have no
safe haven from sexual violence, and many girls are coerced to
have sex and subjected to sexual harassment by male relatives,
boyfriends, schoolteachers and male classmates.1

In 2002, a government study once again found that only 7.7%
of reported rape cases resulted in convictions and that a large
number of cases were still being withdrawn after having been
registered, despite police instructions not to do so.  

The causes put forward by sociologists in an attempt to
explain the high incidence of sexual assault are many and
varied.  They include societal attitudes in a male-dominated

and patriarchal society, lack of empowerment of women, the
culture of violence as a legacy of the apartheid years, and a
number of ‘rape myths’, among the most hideous of which is
that sex with a virgin is a cure for AIDS.  

An important component of this neglected epidemic is sexual
violence against both men and young boys.  Between
September 2000 and April 2003 a private hospital group that
provides post-exposure prophylaxis (PEP) for survivors of
sexual violence treated 67 male patients out of a total of 1 465
(4.5%).2 Other private clinics have reported similar statistics.
In the 2003 annual report by Judge Hannes Fagan (the
inspecting judge of prisons) he said that South Africa has one
of the highest proportions of prisoners for its population in
the world, possibly the highest in Africa.  Four out of every 1
000 South Africans are in jail and prisons hold 70% more
people than they were designed to accommodate, which is
known to contribute to the spread of HIV/AIDS.  During the Jali
Commission (investigating corruption in prisons) rape was
said to be most prevalent among awaiting-trial prisoners
because of overcrowding and the fact that there are no
separate holding facilities for people who have been accused
of different classifications of crime.  Compounding these
circumstances, most male prisoners do not report rape and
awaiting-trial prisoners have no access to social workers or
other professionals.  During the commission interviews, police
inspectors reported that they could not recall any
prosecutions involving cases of sodomy in prison.   

The HIV Clinicians Society has over the years been very
concerned about this largely neglected field of patient
management.  The Society receives calls on a regular basis
from members seeking guidance on how to deal with victims
of sexual assault.  We believe that to deal with the epidemic
the justice system needs to be strengthened in order that
more cases are brought to court and more rapists convicted of
this heinous crime.  We as doctors, however, have to play our
part in providing the required evidence in a proper manner
which will make the prosecutors’ task so much easier.  The
other issue at stake is the provision of PEP for survivors of
sexual assault.  We believe that the article by Dr Adrienne
Wulfsohn on p. 21 both addresses the issue of appropriate
management of a case of sexual assault and also provides
guidelines as to how forensic specimens should be obtained.
This will empower doctors to deal more adequately with
patients who have been sexually assaulted and play their part
in combating this neglected epidemic.

DES MARTIN
Editor, Southern African Journal of HIV Medicine
President, Southern African HIV Clinicians Society

1. See, e.g. Human Rights Watch, Scared at School: Violence Against Girls in
South African Schools (New York:  Human Rights Watch, 2001).  

2. Human Rights Watch interview with Mandé Toubkin, Johannesburg, 19 May
2003: Mandé Toubkin, ‘Rape: A Social Responsibility Project.  Can It Be
Managed in The Private Health Care Environment?’, Power Point presentation,
2003.

F R O M T H E
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