Deadly Delay:
South Africa’s Efforts to Prevent HIV in Survivors of Sexual Violence

1. Summary
   
2. Recommendations
   
   To the Government of South Africa
   
   Institutional and Programmatic Measures
   Legal and Policy Measures
   To Donors and Regional and International Organizations
   
3. Methods
   
4. Background: HIV/AIDS and Sexual Violence in South Africa
   
   HIV/AIDS in South Africa
   Sexual Violence Against Women and Girls in South Africa
   The Role of Gender-Specific Violence in HIV Transmission
   Preventing HIV After Sexual Violence Through HIV Post-Exposure Prophylaxis
   Antiretroviral Drug Therapy and HIV/AIDS
   Health and Social Service Provision
   
5. PEP Implementation: Human Rights Watch Findings
   
   Lack of Information about PEP
   
   Provincial Efforts to Disseminate Information about PEP
   Lack of Information about PEP among Service Providers
   Lack of Information among Sexual Violence Survivors
   Lack of Information about PEP in Rural Areas
   
   Government Opposition to Antiretroviral Drugs as an Obstacle to PEP Services
   Lack of Guidance Regarding PEP for Children Under Fourteen
   Consent to HIV Testing and to Medical Treatment for Children Under Fourteen
   
   Procedures to Bypass Consent
   Parental/Guardian Refusal to Provide Consent
   Unaccompanied Children
   Recommendations to Facilitate Obtaining Consent
   
   Police Interference with Access to PEP and Related Services
   Arbitrary Denial of PEP Services
   Sexual Violence Against Boys and Men
   Stigma and Discrimination Interfering with PEP Services
   Services for Low-Income Survivors and Rural Dwellers
   Additional Challenges to PEP Implementation
   
   Problems with Ensuring Completion of PEP Regimen
   Problems with Coordination Among Service Providers
   
6. Law and Policy Efforts to Improve Services for Rape Survivors
   
   Prosecution of Sexual Offence Cases
   Law Reform
   
7. South Africa’s Obligations Under International and National Law
   
   International Law
   
   The Right to the Highest Attainable Standard of Health
   The Right to Information
   The Right to Life
   The Right to Measures of Protection
   
   National Law
   
8. Conclusion
   Acknowledgments

March 2004     Vol. 16, No. 3 (A)