Background Briefing

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Medical Consequences of Sexual Violence, Including HIV/AIDS

Women and girls who have suffered sexual violence have a full range of health needs that must be addressed. These include treatment of injuries that may have occurred in the course of the sexual violence, information and preventative treatment for sexually transmitted infections, (including HIV and hepatitis), information and access to services to prevent or terminate unwanted pregnancies, and counseling to address the emotional and psychological impact of sexual violence.

Sexual violence can result in numerous medical consequences, including internal bleeding, fistulas, incontinence, and infection with sexually transmitted diseases such as Hepatitis B and C and HIV/AIDS. In Sudan the reported HIV prevalence at end 2003 prior to the Darfur conflict was estimated to be 2.3 percent.42 In Chad, the estimated adult HIV prevalence rate at end 2003 was 4.8 percent.43 In 2002 median HIV prevalence rates for pregnant women in Chad (seen as a proxy for the general population) ranged from 7.5 percent in urban areas to 4.7 percent in rural areas.44

There are multiple risk factors on both sides of the border which increase the risk of contracting HIV for women and girls who have been raped, including rape by multiple perpetrators;45 high rates of sexually transmitted infections (STIs are known to increase risk of HIV up to 300 percent);46 and the practice of female genital circumcision (FGC).

Further research is required to assess the provision of services for survivors of sexual violence both in Chad and across the dozens of displaced camps in Darfur, where services reportedly vary widely. However as of February 2005, of the agencies that were providing health services in the refugee camps in Chad, only one of the six agencies had a protocol for rape that included the provision of emergency contraception, comprehensive treatment of sexually transmissible disease and post-exposure prophylaxis of HIV.

Emergency contraception was not universally available, and comprehensive protocols for the management of rape and treatment of STIs were lacking. Post-exposure prophylaxis (PEP) and Voluntary Counselling and Testing (VCT) should be available according to the Inter-Agency Standing Committee (IASC) Guidelines for HIV/AIDS Interventions in Emergency Settings and the Clinical Management of Rape Survivors.47 However only one agency had the ability to offer PEP, and none could offer VCT. Rape kits were not readily available, nor were most staff interviewed by Human Rights Watch comfortable in using them. No abortion services were available for those who were unable to access emergency contraception within the mandatory 72 hours.

[42] Joint United Nations Programme on HIV/AIDS (UNAIDS), “Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections: Sudan” (2004). Given the poor sentinel surveillance and regional variation in Sudan, however, the estimate of 2.3 percent may be an underestimate.

[43] Joint United Nations Programme on HIV/AIDS (UNAIDS), “Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Chad” (2004).

[44] Ibid.

[45] Forced or coerced sex creates a risk of trauma: when the vagina or anus is dry and force is used genital and anal injury are more likely, increasing the risk of injury. Rape by multiple attackers both increases the likelihood of injury, as well as the risk of exposure to an HIV-positive attacker.  World Health Organization, Guidelines for the management of sexually transmitted infections, Geneva, WHO, 2003.

[46] The presence of other sexually transmitted diseases increases HIV transmission risk. See United States Center for Disease Control and Prevention, Fact Sheet: Prevention and Treatment of Sexually Transmitted Diseases as an HIV Prevention Strategy, (retrieved April 8, 2005); World Health Organization, Guidelines for the Management of Sexually Transmitted Infections (Geneva: WHO 2003). Although there is little available public data on STI rates, health workers have documented syphilis in at least two Chadian refugee camps in Sudan, and expressed concern about high rates of syphilis and other STIs in the displaced camps in Darfur. Human Rights Watch interviews with health providers in nine refugee camps in Chad and displaced camps in Darfur, February 2005. The presence of syphilis within the Chadian refugee camps is particularly worrying given the possibility of dual infection. Family Health International, Sexually Transmitted Infections: A Strategic Framework Arlington, June 2001 p 5 at

[47] Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings, Guidelines for HIV/AIDS Interventions in Emergency Settings, IASC 2003, p.80.

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