Pioneered by the Nairobi Women’s Hospital Gender Recovery Centre, post exposure prophylaxis (PEP) is an integral component of post rape care. This strategy recognizes the risk of pregnancy in females and the further risk of contracting HIV infection based on the probability that the rapist is infected.

Rape increases several-fold the risk of HIV in the survivor because of higher probability of injury. Although PEP does not provide absolute protection from HIV it does reduce the risk of infection.

Survivors receive counseling and support to undergo an HIV test and where the test is negative, a course of anti-retroviral drugs is prescribed over a 28-day period as well as medication to prevent sexually transmitted illnesses. Female survivors in the reproductive age bracket are also offered emergency contraception to prevent pregnancy. However, survivors have only a 72 hour window period in which these interventions can be made with a measure of success.

The service does not end there. Forensic examinations and evidence collection as well as specimen analysis is carried out and followed up with legal documentation using the government approved PRC 1 form that can be attached as clinical notes to the police P3 form and thus avail much-needed evidence. Survivors are also prepared for the criminal justice system.

With the valuable lessons learned from the Gender Violence Recovery Centre model since 2001, and supported by the Nairobi-based Liverpool VCT, Care and Treatment, (LVCT) comprehensive post rape care services have been available at the Kenyatta National Hospital and 12 other public health facilities at district and sub-district level.

The Liverpool VCT partnership is a home-grown example of scaling up the tested and proven strategies that advocates and practitioners against sexual violence have applied to make a difference and turn them into successful mainstream instruments.

At Liverpool VCT, director of services, Dr Ernest Nyamato says while the expansion of services in the last five years is impressive, this is not a measure of universal access to post rape care services in Kenya.

Dr Nyamato gives a scenario where the medical treatment is available but the systems for efficient delivery and follow-up are deficient.

The challenge lies with the 72 hour window for effective treatment and the reality that accessing district hospitals for the majority of rural Kenyans is impeded by distances and unaffordable transport costs and indirect charges related to the such as laboratory tests, prescription drugs and where indicated, surgery. These costs can be prohibitive in a country where more than half the population lives below the poverty line.

“These services need to be unpacked and move further down in the public health system beyond district level to health centres and dispensaries that are closer to the people,” he adds.

Another frustration faced by health workers, survivors and their families is in making the link between the medical intervention and the justice system. Health workers report that while they make every effort to preserve the samples of evidence from survivors during treatment (spermatozoa and medical reports) to be handed over to the police, they have no way of knowing that the integrity of the chain of evidence will be maintained.

“We have no idea what is done to those samples and our reports once they leave our hands,” says Dr Nyamato, “We need to address the crime of rape in a partnership that involves the survivors, medical personnel, the police and the entire justice system.”

These sentiments are echoed by Ms Anne Amadi, deputy director of the Federation of Women Lawyers in Kenya (FIDA-K), who calls for a structured way of making referrals between the medical and the justice system.

“This is where the absurdities of the justice system are played out, because those of us at the other end of the case, have no idea of what has transpired in between and the burden is left to the survivor to bear, especially if a case is thrown out because of bungled up police investigations in which evidence is discredited or tampered with.”

Sexual violence not only devastates the lives of individual women, girls, boys and men who have been abused. It goes beyond the contact between abuser and abused creating a deep ripple effect that infuses and hurts societies at their core as they deal with the repercussions.

Ms Amadi adds that although FIDA-K have partnered with the police to train recruits into the service on gender violence, the impact is yet to be felt. FIDA-K is keen to expand training by to the officers commanding stations and divisions for better impact.

“Although some police stations now have gender desks, they are understaffed and lack resources. There is an assumption that women are best suited for these duties,” she adds, “Where we see success, it is because of the passion of individual officers to see and end to gender violence.”

Dr Nyamato says the way forward is to continue raising awareness of communities on sexual violence: “We must do more to create a preventive culture,” he adds, “This is a call for more advocacy work, experience sharing and dedicated funding.”

The Governance Justice Law and Order Sector (GJLOS) is a reform initiative led by the Kenya government to give its citizens better governance, justice, law and order. Ms Amadi sees the potential of GJLOS role in the provision of free legal aid services at the community level as well as HIV/AIDS prevention and care structures.

“The women’s human rights organizations and NGOs are swamped by the cases needing urgent attention, and it is time government invested in this cause,” she says.

The words of the executive director of the United Nations Development Fund for Women (UNIFEM), Ms Noeleen Heyzer at the start of the 16 Days Campaign against gender violence in New York are relevant in the Kenyan context: “Only when measures to address violence against women are an integral part of national strategies for development will we see a lasting change. It is then that we will be able to reflect not just on progress made, but on real successes to end violence against women.”

---