Population Council Research that makes a difference

Sexual violence is increasingly recognized as an important driver of Africa’s HIV epidemic because of the convergence of high HIV and sexual violence prevalence rates in the region. To mitigate the HIV risks associated with sexual violence, the US President's Emergency Plan for AIDS Relief (PEPFAR) has launched a special initiative to test the feasibility of integrating comprehensive sexual violence services into existing HIV programs. This initiative is being piloted in 18 health facilities across Rwanda and Uganda. The interventions are working to strengthen clinical care for sexual violence, including postexposure prophylaxis (PEP), and develop links with legal and community support services.

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. A pre-intervention assessment that evaluated readiness to provide clinical sexual violence services was conducted between October and November 2009. It consisted of a quantitative facility inventory in 17 sites, and focus group discussions with service providers in 14 facilities. Separate focus group discussions were held for doctors and nurses. The project took place under a larger ongoing USAID-funded Council program to increase access to comprehensive treatment services for victims of sexual violence in Rwanda, Uganda, and South Africa.

All respondents in both countries had a good level of knowledge of the risk of HIV infection associated with sexual violence 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 sexual violence services were provided. Only one facility had the essential equipment, guidelines, or record-keeping capacity needed to provide basic sexual violence services. The primary challenge identified in providing PEP was the delayed reporting of victims, the majority of whom are women and girls, because of fear of stigma and bureaucratic procedures. While all providers mentioned providing counseling, they reported rarely seeing a victim again for ongoing adherence counseling and follow-up testing.

Although service providers in Uganda and Rwanda are aware of the HIV risks associated with sexual violence, very few are equipped to provide essential services. Analysis of the data from this project indicates that both Uganda and Rwanda can do much to improve their sexual violence services, and that providers are willing to meet those demands. Under the PEPFAR Special Initiative on Sexual and Gender-based Violence, implementing partners will work closely with providers at these facilities to ensure that they have the tools to provide such services.

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Related project: Africa Regional Sexual and Gender-based Violence Network