Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"Health care providers in Uganda and Rwanda have a high level of knowledge about sexual violence and HIV, but few are equipped to provide comprehensive services"
Jill Keesbury, Lynne Elson, and Sherry Hutchinson

Background
Sexual violence (SV) is increasingly recognized as an important driver in Africa's HIV epidemic due to the convergence of high HIV and SV prevalence rates in the region. To mitigate the HIV risks associated with SV, PEPFAR has launched a special initiative to test the feasibility of integrating comprehensive SV services into existing HIV programs. This initiative is being piloted in 18 health facilities across Rwanda and Uganda. Interventions work to strengthen clinical care for SV, including postexposure prophylaxis (PEP), and develop links with legal and community support services.

Methods
A pre-intervention assessment that assessed readiness to provide clinical SV services was conducted between October and November 2009. It consisted of a quantitative facility inventory (FI) in 17 sites, and focus group discussions (FGDs) with service providers in 14 facilities. Separate FGDs were held for doctors and nurses. FI data were entered into EpiInfo and analyzed with SPSS 13.0; FGDs were manually coded and analyzed.

Results
All respondents in both countries had a good level of knowledge of the risk of HIV infection associated with SV and were aware of the need for PEP. While 16 facilities had HIV test kits and PEP in the facility, only four had these supplies available in the room where SV services were provided. Only one facility had the essential equipment, guidelines, or record-keeping capacity needed to provide basic SV services. The primary challenge identified in providing PEP was the delayed reporting of victims, the majority of whom are women and girls, due to fear of stigma and bureaucratic procedures. While all providers mentioned giving counseling, they reported rarely seeing a victim again for ongoing adherence counseling and follow-up testing.

Conclusions
Although service providers in Uganda and Rwanda are aware of the HIV risks associated with SV, very few are equipped to provide the essential services.

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