South Africa's rape victims, having survived one ordeal, face the harrowing possibility of death through AIDS. Their one hope is an expensive drug treatment, which the government denies them.
You don't have to be a rocket scientist to crunch the numbers: as many as 1.5 million rapes occur every year in South Africa and the World Health Organization believes one in every nine adults in the country may be infected with HIV, the virus that causes AIDS. Clearly, rape carries a potential death sentence for those who survive it.
Doctors believe survivors have one hope: a drugs treatment – AZT (zidovudine) – that must be administered within 72 hours for 28 consecutive days. But the government refuses to offer it free of charge. It has argued that the treatment is expensive, toxic and there are no studies proving it prevents HIV infection in cases of rape.
At the same time government health workers are freely provided with the identical treatment if they are injured by syringes which are likely to transmit HIV-contaminated blood. This has led human rights and women's groups to charge that the government violates its own Bill of Rights and discriminates between two groups of people exposed to the risk of HIV through factors beyond their control.
In contrast, a parliamentary committee in neighbouring Namibia has recently recommended provision of a cocktail of three AIDS drugs, including AZT, to rape survivors. It admitted the step would be costly but said a 28-day dosage of three drugs would cost the health service US$158 – less than a day's hospital care for an AIDS patient. Medical experts hold differing opinions on whether all the drugs are necessary in the case of rape, or whether AZT alone will suffice.
The South African Medical Association recommends that rape victims have access to drugs at government expense. "We believe that the state and society have a responsibility to ensure that rape survivors receive maximum priority with regard to medical treatment and moral support," says Dr Fazel Randera, chairman of the Association's Committee for Human Rights, Law and Ethics.
At present, women who report rape receive neither. Few are informed they are at risk of HIV infection, that there is a potential treatment and how to obtain it. Costing up to US$820 on the private market – five months' wages for the average South African – the drugs are beyond the means of the overwhelming majority of people.
No one knows the true figures for this twin scourge of HIV and rape. As many as 3.6 million South Africans are currently infected, according to the United Nations agency UNAIDS. Rape crisis centres estimate that 900,000 women and 600,000 children are raped each year. After the South Africa police released figures in late 1999 estimating that 1.8 million rapes had occurred that year, president Thabo Mbeki charged the figure was speculative and forced a retraction.
"There is serious anecdotal research that few rape cases are reported," says activist Bronwyn Pithey of the Cape Town organisation Rape Crisis. "But 50,000 rapes were reported in 1999, and that is too much. Given the high incidence of rape and of HIV positive people in this country we are obviously concerned about the risk of HIV infection. If we are using the estimate that 20 percent of the population is infected, then one in five rapists will have HIV."
Although rapists – and their victims – come from all classes and races, poor women are thought to be more vulnerable.
In Johannesburg, black township women are five times more likely to be raped than white women. Unfortunately, many men and boys hold casual, even contemptuous, attitudes toward rape. One survey of 1,500 township students found that 25 percent of boys (between 12 and 22) consider gang rape "fun". Another 16 percent called it "cool".
The explosive mixture of rape and AIDS made headlines in May 1999 when the weekly Mail and Guardian published journalist Charlene Smith's account of how she was raped in her Johannesburg home, and her subsequent struggle to obtain AZT.
"How could I forget, Nkosazana Zuma (then health minister), a woman too, won't allow the government to give AZT to rape victims. The rapist bestows a death sentence and the state, by refusing to give cheap medication, becomes executioner," Smith wrote.
Campaigners' hopes were dashed when Mbeki declared in October 1999 that AZT – licensed by the country's Medicine Control Council for over 10 years – is a danger to health. AZT is used worldwide to treat HIV-infected people, alone and in combination with other drugs. In France and the United States doctors provide drugs to rape survivors at state expense.
The South African medical director of Glaxo Wellcome, which manufactures the drug, says Mbeki is "misinformed" and that the drug has "extended and improved the quality of life of millions of people living with HIV/AIDS" worldwide.
Public confusion over Mbeki's position, a media outcry and heavy criticism from doctors and AIDS activists led health minister Manto Tshabalala-Msimang to clarify government policy. "The decision not to use AZT and drugs like it in the public sector was made on the twin foundations of affordability and appropriateness of treatment," she said.
Tshabalala-Msimang also rejected a petition initiated by Smith and the organisation People Opposed to Women Abuse (POWA) demanding free drugs treatment for rape survivors. "I just cannot see my way clear to providing free anti-AIDS drugs to rape survivors on a nation-wide basis," she said.
But POWA spokesperson Palesa Maketha is not satisfied. "They cannot just say that AZT is toxic and expensive and not come up with an alternative. The reality is that women are being raped and exposed to the virus."
Many health workers just ignore government policy. Dr Tyrone Richards at the Johannesburg Rape Crisis Centre gives three days' worth of AZT free to women who have been raped. A nearby clinic provides further full treatment at a reduced price.
"I know that if my wife or daughter were raped I would want them to get AZT," asserts Richards.
Although little research has specifically examined the impact of AZT treatment in cases of rape, ample research exists showing AZT reduces HIV infection by 80 percent among health workers injured by contaminated needles.
Women's groups are vowing to continue their campaign for free drugs for rape survivors. "We will have to wait and see," says Pithey. "There is a serious break between [government] promises and budget allocation. It's about priorities and, let's face it, at the moment women and children are not enjoying budget priority."