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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.