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Rape, HIV and AIDS and Post Exposure Prophylaxis in Zimbabwe
Girl Child Network (GCN)
November 01, 2006

Brief analysis of Rape HIV and AIDS in Zimbabwe
Girl child Network (GCN) estimates that at least 6000 girls are raped annually in Zimbabwe. However, this figure is an underestimation as there is under reporting especially of early forced marriages, the so called economically coerced commercial sex rape in brothels involving underage girls and in any case since victims of rape are minors ( 0-12years) there is a lack of understanding of what rape is amongst them. The youngest married girl in Zimbabwe is aged 10 years, youngest rape survivor is a day old baby found dumped in Chitungwiza and the oldest rape survivor is aged 94 years from Hwange.

One organisation in Harare reported that out of the 3000 children came for medical examination at a hospital in 2005 in Harare only, 7% of those sexually abused were boys whilst 93% were girls.

At any given month GCN rehabilitates an average of 60 sexually abused girls from at least 3 Girls Empowerment Villages. An estimated 25% of girls GCN deals with monthly are HIV positive.

More and more girls report rape in Zimbabwe. On average, it is estimated that at least 8 girls per day report rape in the school, community and in the home. Girls’ level of awareness on child sexual abuse has been enhanced and therefore on average a rural girl now takes up 6-24 months to report rape unlike the previous generations of say the plus 53 age group who never reported rape perpetrated against them as children. Some girls who are in GCN’s 500 girls’ clubs in 45 out 58 of Zimbabwe’s districts report rape of their peers within days or weeks because they have gone through GCN empowerment processes. There is a sharp difference between an empowered girl and one who is not when it comes to preventative strategies on rape. The girl who is empowered is well aware of the fact that rape is reported within 72 hours so as to get Post –Exposure Prophylaxis( PEP).

GCN confirms that rape is being increasingly reported on as a result of empowerment and through girls’ clubs girls have broken silence on rape.

The myth that virgins cure HIV/AIDS has increased incidents of Rapist to Child HIV transmission. Previously the emphasis has been mother/parent to Child HIV transmission. The girls born HIV free stand higher chances of contracting HIV from the rapists due to:

• Forced early child marriages
• Date rape
• Child commercial sex work
• Harmful cultural practices for example pledging of female to avenging spirits and virginity testing. Even with the coming in of mircorbicides young girls cannot benefit from them as much as the world think
• Virginity testing

What is Post Exposure Prophylaxis PEP?

Post exposure prophylaxis ( PEP)
When one is exposed to risk of contracting HIV through contact with an HIV positive person, risk of HIV infection can be reduced by means of anti-retroviral( ARV ) drugs taken over a period of four weeks.

GCN realizes that in the case of young girls exposed to HIV, ARVs do not holistically empower the girl child without on going support services in counseling and clinical monitoring it is quite evident that girl child rape survivors rehabilitated through Girls Empowerment Villages with full medical, nutrition and peer to peer conselling support heal much faster that girls with no such support services.

Depending one one’s resistance, multiple NRTIs can be taken but these could have toxic effects which are minimal. AZT ( 200mg 8 hours 28 days ) and 3TC ( 150mg 12hourly for 28 days) girls under 12 years receive this combination. Every girl child monitor and parents should ask doctors about the correct doses. Combivir can be used and it consists of both AZT and 3TC.

PEP drug effects are rare but there are temporary side effects like nausea, diarrhea, vomiting, muscle pains, etc.

GCN, Rape and Post-Exposure Prophylaxis
Through the Girls At Risk Support Unit (GARSU) GCN has run Girls Empowerment Villages since 2000 after realization that though girls were empowered to break silence on rape in the home, school, and community no justice, therapy and rehabilitation could be achieved if the girl remained in the same abusive environments with the perpetrator. Most rural girls for instance to seek medical examination and justice from provincial or district hospitals and magistrate courts. GCN innovative idea of setting up four strategically positioned Girls Empowerment Villages which service a multi- function of providing a strong referral to service providers and at the same time ensuring that a girl is fully empowered to take up all treatment provided by doctors, attend court sessions and register with a school. GCN admitted the first HIV positive and sexually abused girls raped by their own father in 2000. Since then many sexually abused girls have been assisted through GCN.

For girl child rape survivors, a vaccine or any form of treatment to stop progression of the HIV virus greatly saves the lives of girls. The first girl who got PEP from our Girls Empowerment Villages within 72 hours was an eight year old girl in June 2002. By end of 2004 a lot more girls in Chitungwiza and Harare accessed PEP from the referral Provincial hospitals especially Chitungwiza and Parirenyatwa. In 2004 GCN and Doctors Without Borders entered a partnership where PEP was popularized. The more communities appreciate PEP, the more fresh cases of rape are reported on time.

GCN provides emergency temporary shelter for rape survivors and is concerned about the way incidents of rape in the country that put girls at risk contracting HIV are not addressed. GCN is fully cognizant of the fact that PEP is not available in the most parts of the country and advocacy and lobby efforts targeting relevant Government ministries are underway.

Why PEP?
It has been researched ( CDC1997 ) that if one is a health worker and due to needle pricking is exposed to HIV and within a few hours of exposure and continuing for four weeks if ARVs are administered HIV infection risk is greatly reduced. The same young girls exposed to HIV infection through rape can also be assisted the same way reducing infection risk. 

PEP is administered to girls only when:

• They report rape within 72hours. At the just ended AIDS International Conference 2006 in Toronto Canada there was information that PEP could be administered within 14 days.

• PEP is administered through Zimbabwe’s major provincial hospitals like Chitungwiza, Harare central hospital, Mpilo hospital etc. GCN rehabilitates rape survivors in Girls Empowerment Villages and GCN concern is that girls access PEP and follow treatment procedures and Girl Child Monitors are there to ensure adherence to treatment

• There is no clear consensus on the limit for administering PEP. Studies show that PEP given 24 hours after exposure and continued for 28 days is more effective than administering PEP at 72 hours and so GCN always advise and counsels girls, parents and guardians to ask experienced doctors.

How to make PEP effective

• Immediately after rape a girl should be put on PEP. After 72 hours it is too late
• STI and pregnancy tests must be conducted
• Practice safe sex and for children minimize exposure to multiple sexual abuse
• Take medication as prescribed for 28 days
• Every girl must have follow up HIV tests and post rape counseling after every six weeks, HIV results may indicate negative within a year after the rape incident
• Girls who fall pregnant should also take PEP

PEP drugs

• A lot of parents and girls lack full knowledge about drugs prescribed to them. Many of them do not seek further information from doctors, It is a right to know what drugs you are taking and what they can do for you. Healing is faster when the mind is fully aware of medicine being taken
• PEP consists of one, or of a combination of two or three antiretroviral medication taken several times per day for four weeks
• PEP is not yet available nucleoside reverse transcriptase inhibitors ( NRTIs ) and protease inhibitors.

Available in remote parts of the country where harmful cultural practices expose girls to HIV.

GCN is concerned that whereas PEP is critical, its existence is not yet known and yet the number of girls raped is increasing by the day providing more information on PEP treatment, reasons why Zimbabwe should popularize PEP like what has happened with condoms and Neviropine is key to minimise the number of girls in the window of hope getting full blown AIDS

Factors in treatment effectiveness

Counseling, and girl child empowerment
GCN emphasizes to rape survivors that there is no empowerment if a girl is not mentally and physically healthy.

GCN Future Plan of Action on PEP

• To popularise PEP especially in remote parts of the country
• To make GCN and other stakeholders contact accessible in case of emergencies
• To continue lobbying government and the donor community to prioritise PEP programmes
• To simplify PEP educational information for girls and women
• To continue supporting rape survivors on PEP and empower them to be peer educators
• Encourage the media to write on PEP

Without PEP, the window of Hope is not there

Visit the GCN fact sheet

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