Corrigendum: Accessing care services after sexual violence: A systematic review exploring experiences of women in South Africa

Researchers: Moreoagae B. Randa, Julie McGarry, Sarah Griffiths, Kathryn Hinsliff-Smith.

January 2024

What Is The Study About?

This qualitative review aimed to explore the experiences of women seeking care

from first-contact healthcare facilities in South Africa after sexual violence and during follow-

up care.

Why Is This Important?

Sexual violence against women is a global phenomenon. This is a particular issue in South Africa, where it is estimated with evidence provided that up to half of all women will encounter gender-based and/or sexual violence from a partner during their lifetime.  

Therefore, evidence suggests that addressing the needs of women in South Africa is a priority.

What We Know…

Clinical forensic centres, which are located next to the hospitals, treat victims who have been

exposed to sexual violence. The centres provide positive treatment for victims as well as clinical forensic medical services. The nurses assess, screen, and interview the victims and then proceed to conduct the examination. The forensic medical services provided include a medical examination and the collection of quality specimens for laboratory analysis, which leads to an increase in successful prosecutions of perpetrators and provides communities with confidence.

The impact of sexual violence on the psychological well-being of those who experience harm can be wide-ranging, including behavioural changes, sleep and eating disorders, post-traumatic stress disorder (PTSD), depression and increased risk of attempting or committing suicide. In addition, the physical impact may also extend to significant harms such as unwanted pregnancy and sexually transmitted diseases, including hepatitis B and HIV.

It has also been estimated that up to half of all women in South Africa experience a lifetime history of physical or sexual violence from a partner.

A localised study in one South African Province (North-West, Rustenburg) reported that one in four women aged between 18 and 49 years had experienced rape in their lifetime. One in five of these women contracted HIV. Indeed, a nationwide study in South Africa found that only one in nine women reported being raped to the police, and many instances of rape or sexual violence are not reported for fear of re-trauma and a lack of confidence in the legal system.

Healthcare facilities and healthcare professionals are often the first port of call for many survivors of sexual violence. They are often custodians for the care and welfare of survivors, as they help to navigate the next steps to support and referral as well as providing

necessary medical care. Sexual violence can have long-term, debilitating effects on

the mental health of victims. Nurses’ lack of knowledge in managing patients with mental health disorders has resulted in the underdiagnosis of most mental health conditions in primary healthcare. 

It is worth noting that mental healthcare management for rape survivors diagnosed with PTSD and depression requires about 12 sessions with the therapist when using treatment modalities such as cognitive behavioural therapy (CBT), exposure therapy (ET), cognitive processing therapy (CPT), et cetera and this type of care is mostly given in specialised care services such as hospitals. Hence, it is impossible to manage rape survivors diagnosed with these disorders in TCCs.

What Was Discovered…

The five studies included in this review provide a broad but limited and very sparse view of the experiences of women survivors of sexual violence in South Africa.  Although only five studies were located, the quality of the reporting, including ethical procedures, provides a useful indicator for the current understanding of sexual violence survivors and their experiences of healthcare provision in South Africa. It is clear that there is much work to be conducted to fully understand the needs of adult female survivors of sexual violence in South Africa. A major problem in understanding women’s experiences is that only 1 in 25 women who experience sexual assault actually report it to the police authorities (Holton et al. 2018) in South Africa and as a consequence are therefore highly unlikely to seek medical attention. What is reported in these five studies illustrates that this indeed could only be the ‘tip of the iceberg’.

A holistic and integrated approach is required for women who have experienced sexual violence in South Africa. This needs to start with the police and linking with healthcare

professionals within clinical and therapeutic settings. The administering of PEP for the prevention of HIV infection is a public right for those who have been sexually assaulted. However, it is recognised that there is currently low uptake and adherence. It is therefore imperative that those engaging with survivors, including healthcare professionals, provide the appropriate advice and guidance about PEP adherence, including the administering of anti-nausea medication.

A lack of information from healthcare professionals at the time of administering necessary drugs may be a reason for the low adherence rates in South Africa and the continued high prevalence of HIV and STIs. It is clear that there is a distinct legal process in place for  survivors to report incidents and to seek medical attention at either specialist TCC or at acute settings. However, there is still considerable stigma attached to rape and sexual assault, which is underreported and has the added complication of a possible positive HIV outcome. Evidence is clear that many women, who are HIV-positive, are also rape survivors. This presents a challenge for public health authorities in South Africa for providing support that meets the needs of survivors of both sexual violence and HIV while also ensuring that follow on support is integrated and meaningful to the growing number of survivors who are now encouraged to report assault. South Africa finds itself with a triplicate of dilemmas. It is a country dominated by a history of HIV, a neglected healthcare system with a mixture of public and private provision, and a systemic acceptance of daily accounts of rapes.

The Future/ Possible Solutions…

The voices of the women are often overlooked and neglected. This review indicates that more work is required if appropriate and timely support is to be provided. Sexual violence is a global issue, but healthcare in South Africa is fundamentally seen as a place of medical assistance rather than emotional or psychological support. There is a paucity of evidence, from disclosure through to the conviction of perpetrators, as a whole scale approach to tackling such issues for women. South Africa finds itself with a triplicate of dilemmas. This is a country dominated by a history of human immunodeficiency virus (HIV), a neglected

healthcare system with a mixture of public and private provision, and a systemic acceptance of daily accounts of rapes.