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Siyayinqoba Beat It! 2004 Episode 14 –

Women beat gender violence

South Africa has one of the highest incidences of sexual violence and rape in the world. This along with the highest incidence of HIV in the world means that sexual violence and rape in South Africa carries the added strain of possible HIV infection. In this episode of Siyayinqoba Beat It! the team looked at post-exposure prophylaxis and how to access it.

Jason Wessenaar: Kgotsong, re a le amohela ho Siyayinqoba Beat It! Support Group. {SeSotho} [Hi, welcome to Siyayinqoba Beat It! Support Group.] My name is Jason. In the Siyayinqoba Support group we all living positively with HIV. Each week issues that affects our lives, from discloser to our partners to living positively and gender issues. USiyayinqoba nguhlelo lwakho lokhu phila kagcono negciwane leHIV. Uma uphila negciwane leHIV {IsiZulu} [Siyayinqoba is your guide to better living with HIV. If you are HIV positive] or you have partner, a friend, afamily member this programme is for you. Today we are talking about gender-based violence and HIV. We are joined by Nombeko Mpongo from the AIDS Training and Information Centre of the City of Cape Town. Nombeko, who is living with HIV, will help us with our discussion about the importance of post-exposure-prophylaxis for the prevention of HIV. Our country has had a bad reputation for sexual violence and rape. It’s something we have to do more about. Nqoba The Siyayinqoba team went to Burgersfort and met Lulu Ndlovu who works with the Rural AIDS and Development Action Research. Lets see what they found out.

Women beat gender violence and HIV

Burgersfort, Mpumalanga

Lulu Ndlovu: My name is Lulu Ndlovu, and I work here in Burgersfort with the Rural AIDS and Development Action Research. We are part of the School of Public Health and I’ve been working here with intervening, working with women who are enrolled in the microfinance, small enterprise foundation. We tried to find out whether we can reduce the rate of HIV infection by giving women financial support. And would they be able to make their own choices, sexually, in terms of using a condom. Women come together to repay their loans and then after that we do the training; gender and HIV training.

Lulu Ndlovu: Tsa maphelo tse di diretswe gore le lena ka mo ditjheleteng le kgone go tshwara. {Sesotho} [These life skills workshops are here to help you survive.] And since we started working with them, these women wouldn’t talk about personal issues, they wouldn’t talk about sex, they wouldn’t mention condoms. And we had to go through a lot of hurdles to get them to open up.

One of the participants: Le seke la dumelang gore monna a gane gore retla re robale ka condom.Hobane khondomo e tshireletsa AIDS, e tshireletsa malwetse a tletseng mo. {Sesotho} [Don’t allow your partners to have sex without using a condom because condoms will protect you form HIV and AIDS and many other STIs.]

Dr Julia Kim (Rural AIDS and Development Action Research): We thought if we could link HIV prevention to a programme that’s already trying to empower women socially and economically then maybe we have a better chance of them being able to implement HIV prevention. So that’s how the microfinance and the HIV side come together.

Lulu Ndlovu: Banna ba ka gare go naga e bare khondomo ha e tshwane le nama ka nama. {Sesotho} [The men around here say condoms are not the same as flesh to flesh.]

Philistus Seopela: Ka matla dintwa tsa ka malapeng, ke ka mo go ba ba nyetsweng.Ka gore monna o re ke go nyetse, otlo mpha direkere mo ha ke di tsome. {SeSotho} [Most of the violence here is between married couples, because the husbands say: “I married you so don’t give me elastics.”]

Lulu Ndlovu: Ke tlogo botsa gore na, wena ka bo wena o tlile waka wa ba mathateng a goba dintwa tsa mo malapeng di diragale mo go wena. {SeSotho} [Have you experienced any violence in your own house?]

Philistus Seopala: Ke tshaba gore batho ba tla re nyatsetsa mo TV.Ke kgetha go sa le botse. Tsela ya go fetola banna ba gore ba dumele condom ke gona gore re seke ra ba lema gore re a ba fa ka mokgwa o ba tsomago nama ka nama. Ke mo re tlileng go ba kgona gore kamoka ba dumele condom. {Sesotho} [I don’t want to talk about it on TV so I choose not to talk about it. The only way to get these men to use condoms is to oppose unprotected sex. That is how we are going to make them use condoms.]

Rose Mohlala: Bophelo ba ka bo tloga bo fetogile gore ke hlomagane le SEF.Ke kgona go tsebisa bana baka gore go nale kokwana tlhoko e tlileng ka moya e bitswang HIV/AIDS hore bolwetsi bo tsena jwang mmeleng. {SeSotho} [Since joining SEF my life has changed a lot. I’m able to talk to my children about this disease called HIV/AIDS and how it enters the body.]

Lulu Ndlovu: A lona le kgona go I tshireletsa? {SeSotho} [Are you able to protect yourself?]

Rose Mohlala: Lenna ke tloga ke lemogile gore ke a se kgona. Ne ke le motho wa go safara wa go taka, ne ke nale monna, monna wa ka e sale a ntshiya a ntlogela le banna ba bahlano. Ke nopile mo lekane ga atla ke topela di condom tse pedi tse tharo. O thomile a gana pele, re sa di tsebe dilo tse tsa di condom. Jwale gona jwale SEF emphile matla. {SeSotho} [I’m able to protect myself. At first I struggled a lot because my husband left me with five kids. Now I have a boyfriend and when he visits I take out my condoms. At first he refused to use condoms because he was not informed. But now SEF has given me strength. I’ve got the power.]

Dr Julia Kim: And because of the training and because of the confidence that they’ve been getting older women who’ve never talked about sex are now kind of shocking these young people. Overhearing their conversations in the taxi, they’ll sort of jump in and start asking them about HIV: “Are you using a condom”, that sort of thing.

Lulu Ndlovu: They are more vibrant, they are talking more. They want to be heard because they have money now, and they have information.

Support group

Jason Wessenaar: What do you think is the impact of violence, gender based violence, on HIV/AIDS?

Busisiwe Maqungo: I think kum ithetha, icuka izinto ezinitsi for instance siyazi ukuba abafazi abanitsi ababikho empowered ngolohlobo and I most yabomama abawazi amalungelo wabo banelungelo for instance xa umuntu angafuni athi hayi and image xa athi kumuyeni wakhe asebenzise icondom uyazibona izinto ezinjalo, so and especial omama abanitsi abaphangeli baxomekeke emadodeni ngento yemali, so ufumanise ke umuntu they feel obliged into yokuba lento efuna ngumyeni wakhe okanye I boyfriend yakhe emsapotayo financially ingenza nantoni kuye, eye rape it goes a long way kukho ne trauma ezi involved but ingake sijongeni kwanye izinto izucuka i-violence on i-gender. {IsiXhosa} [I think it raises a lot of issues. We know that a lot of women are not empowered and a lot of women don’t know their rights. If they disagree with something, and say no and imagine if they still have to ask their husbands to use a condom; especially when there are a lot of women who are dependent on their men. They feel obliged to give in to their partner’s demands because of the financial support. Rape, it goes a very long way, because there’s a lot of trauma involved, but we should look at other things that cause violence.]

Lihle Dlamini: And when a woman is pregnant and she goes for VCT, and she comes back and she’s married or in a relationship, she becomes scared of disclosing that she’s HIV positive because she might be hit or chased out of the house, because also u- dependent kuBusi [he depends on Busi] and because indoda ithi [the man will say] you’ve been sleeping around. Most women have been chased out of their houses because they have disclosed the status to their partners. {IsiZulu}

Anthony Fernandes: Why can’t you just say: “I love you, and therefore I want to practice safe sex”, you know what I mean? It’s a far better foundation and power play position to say: “I love you, and I wanna be in this relationship, but if we’re gonna do this I wanna practice safe sex, and that’s my thing, that’s how I like to do it.” I just think, especially women and there’s even some men who’s often in a money/powerplay. They don’t have work. They stay with someone for free, they do the housework. Somebody brings them food, somebody gives accommodation. They feel that: “Now, I have to pay them for this thing, and therefore I have to give sex.”

Busisiwe Maqungo: Most women are not fully empowered as to know what their rights, when to say no. I was also in a relationship where I was the one working, the man was not working, but the man was so abusive. But I stayed in that relationship for three years, being abused, working for this man but never wayenga sebenzi. [was he working.] I think zikhona nezinye [there are other] psychological problems. That is why, bendinqginela nawe xawusithi [I agree with you when you said] that they need to be empowered; women need to be empowered. They need to know their rights. {IsiXhosa}

Anthony Fernandes: Find yourself a nice girl, find yourself a nice man, and then all your worries will be gone. I mean, isn’t that what our mothers teach us? Empowerment for me doesn’t need to be that women must stand on their own feet, get their own jobs, be responsible for their own livelihood and all that. But what are they gonna do when they go to the next relationship?

Jason Wessenaar: One of the other issues we need to look into of the African culture, is that when a woman gets married, she is told that: “No matter what, you stay there, no matter it’s violent or what.” So she’s never told: “When it’s violent, it’s bad, come back home.” Because lobola has been paid for her. The family is like: “You go there.”

Nombeko Mpongo: And when we’re talking about empowering women, I think we need to look at educating men about respect, because they think power is having all the material things, and if you are a woman, and you don’t have anything, and then I overpower you. They need to understand that respecting your woman, respecting the community, and trying to do the best, and be a real man.

Vuyani Jacobs: I have taken a stand within myself, as a man, that any brother of mine, any father, uncle, street person, who either rape a child I know, or rape a child I don’t know or will rape any woman, I’ll be the one in the community that must make sure that this person is taken to jail and he’s named in the community, because community mobilisation protects the victim. Community mobilisation makes the law to work more easier. For many times as a man, I feel terrible. I feel terrible that any person could be raped, and it’s all attributed to being a man. And I feel I don’t have really much space, that’s why I’m taking this kind of stands, to say that this shouldn’t happen in my name, it shouldn’t happen in the name of manhood. It’s weak men that rape, it’s stupid men that rape. And they should be jailed.

Jason Wessenaar: We will talk more about gender Violence after this break.

Jason Wessenaar: Mmuhi re a ho amohela hape mona ho Siyayinqoba Support Group. {SeSotho} [Hi welcome to the Siyayinqoba Support Group.] Uhlelo lwako lokhu phila kagcono neHIV. {IsiZulu} [Siyayinqoba is your guide to better living with HIV.] To talk to us about your right to Post Exposure Prophylaxis or victicms of sexual violence the Siyayinqoba team met with Nombeko Mpongo to hear her experiences.

Women beat gender violence and HIV

Khayelitsha, Western Cape

Nombeko Mpongo: In 1997 I was raped on my way to work, and I didn’t know that time, I wasn’t even sure that I was raped. It took me some time to understand it. And I went for the tests, after, like three weeks. And then they called me and they told me, I tested HIV positive. I went to the police station, I never went to hospital because I felt so bad about being raped, I really felt dirty, and the way I was treated in the police station made me feel filthy.

Professor Lynette Denny (Department of Obstetrics and Gynaecology, University of Cape Town): HIV has changed the landscape of rape from being an horrendous experience where you can acquire infections and become pregnant against your will, to what is really, even if you’re not killed, you can acquire disease that’s going to kill you… Pop an AZT in her blood immediately

Nombeko Mpongo: And this is where I was in 1997 when I was raped. Ndafika ndizo repota icase ne? [I came to report the case, right?] I sat on this bench and a policeman asked me: “Ndahlala esitulweni and then nda buzwa lipholisa pha, ufuna ntoni sisi ndingakuceda ngantoni?” Ndi soyika. Buti ndiray’tshiwe. [“What do you want sisi, how can I help you?” I was afraid. “Brother, I’ve been raped.”] “Oh, it’s another rape case again”, and that was the response, in 1997. But now, what’s happening now, I always take people to the same police station, the rape victims. And now you just tell them, sorry, it’s private I can’t talk in front of people. And then they take you to these rooms inside here, so at least you’re more comfortable here. You report everything, and then they take you to the social workers. The social workers they come from Gugulethu, from Rape Crisis. They take you straight to Thuthuzela Project where you’re got the access of the rape post exposure prophylaxis where you can prevent the infection of HIV. So people must report the rape cases to the police station. It’s never like before, everything is different now. You can prevent HIV infection, you can survive. {IsiXhosa}

Prof. Lynette Denny: If you are physically okay, probably the best thing to do is to go to the police station. However, if you’re right next to a health facility, go to the health facility first. Because it is absolutely in order and in policy, for the health facility to call the police to come and see you at that health facility rather than you having to go the police; so whatever is closest.

Nombeko Mpongo: From the police station, Gugulethu police station, they take you to GF Jooste Hospital where they’ve got Thuthuzela Project. And in this project they help rape victims. They give them proper counselling, and they’ve got access to the antiretrovirals to prevent the HIV/AIDS infection. Unfortunately I was never here, because it was never here at that time.

Nombeko Mpongo: Ndifuna ukunqonda sisi ukuba kuyenzeka ntoni? {IsiXhosa} [I want to know sisi, what is Thuthuzela all about?]

Sister Pauliwe Barazo (Thuthuzela Project, GF Jooste Hospital): Njengoba se ubona apha, abantu bethu bafikela apha, abantu be ambulance man and then ke si siyine leform yabo and welcome our patient and then ke ngoku siye naye phakuleya room apho si counselisha khona. Sizohlala apha ke. Sincokhole ngexakhi yakho apha sive ukuba bekhuyenzekhe ntoni? Nini? Noba uye wadlula epolisiteshini okanye uze apha straight. {IsiXhosa} [As you can see, patients arrive here with the ambulance. We sign the form to accept and welcome our patient and thereafter we go to a room for counselling. The person sits here, so we counsel them. We can talk about their problem and what has happened to them. When you come from the police station or you just come here straight away.]

Prof. Lynnette Denny: The experience of rape has been likened to a near-death experience, where the infer-scaffolding of a person’s being is just shattered. And the response to that for many women is to go into denial, and try and make as if everything’s okay. It’s like trying to quickly rebuild your house that’s been bashed down. And now you’ve gotta take drugs, and every time you’re taking a drug it’s reminding you that you’ve just been raped, and it breaks through denial and makes the denial harder, if that’s a psychological response. So we actually suspect that the compliance with post-rape medication is very poor, and that’s possibly one of the reasons; plus, of course, all of the side-effects.

Nombeko Mpongo: It is my right to get the medication, and it is my right to get the treatment. It is my right to save myself from what I don’t want to get. Forget about side-effects, because when you’re raped you don’t even think about side-effects, you just want to get the medication because side-effects are better than living with HIV.

Support Group

Jason Wessenaar: Nombeko, you’ve been raped and as a result you’ve been infected with HIV, and you never got the opportunity to get post exposure prophylaxis. Is there any difference now from the time that you were raped and right now, that woman have an access to post exposure prophylaxis?

Nombeko Mpongo: Yes, compared to what was happening long ago, there’s a huge difference. And thanks to the community mobilisation, and TAC campaigns, that has made a big change. And now when they come to me, I always feel reluctant at first to take them to the police station, cause sometimes you never know that when you go to the police station, there will be someone, there will be a counsellor in that particular police station. You just go straight to Jooste. I know people don’t like Jooste, but there are the people that are having this same thing that can help you, the thing that can help you to prevent the infection of HIV. And there, when they’re doing the counselling, they take you through the whole process if you want them to report the case to the police, they call the prosecutor so that you can be assisted. So it’s much better now. It’s only that people are still scared to go and say: “I’ve been raped, and one-two-three has happened, and I don’t need to be HIV positive.” Still even today, when someone asks: “How did you got infected?” and I say: “Oh my god, I was raped”, and people start looking at me and they say: “Shame”, you know.

Jason Wessenaar: So what you’re saying is that post exposure prophylaxis helps in the prevention of HIV after being raped? But then you also said in the insert that it’s better to have side-effects than to be HIV positive, so you’re encouraging women to report their cases so that you can get post exposure prophylaxis.

Nombeko Mpongo: Absolutely. Before you take this post exposure prophylaxis, this prophylaxis is to prevent HIV, not to cure AIDS or HIV. Then, when you go there, you need to bring someone from your family, or your friend, a very close person to you, so that you can have someone who’s going to cush you and support you, somebody that will understand that you don’t have HIV already, but that you’re trying to prevent the infection of HIV.

Busisiwe Maqungo: Kukho I case apho ifriend yami yayirethwiwe u sista wakhe, but fortunately for her she is treatment literate unayo information. Urey’tshiwe u sista wakhe and the the following day bamuyisa e-clinic baya starigth e-clinic esite C. So ke ukhathswe ngusista wakhe ugqirha abhale ku-folder yakhe emu-prescribela izinto, xa bayo thatha imachiza e-pharmacy xayejonga athi hayi bo ayikho i-Prophylaxis. And she went back she took her sister back to the doctor emuxelela ukuba doctor lomntu urey’tshiwe and nimu testile wa testa negetivu but andiyiboni into ethi-Prophylaxis kwenzaka ntoni, that is when ugqirha waqala uku prescribei AZT ne 3TC. Which is if wayengeko treatment literate ahambe ayothatha lamayeza ngaba kuqubeka ntoni. Asi yinto yakudala yinto ya late last year and if abantu nyani they just go starigth to Thuthuzela I mean izinto zizoba difficult xa umuntu waziyela epolis’theshi ngokwakhe. {IsiXhosa} [There was a case when my friend’s sister was raped. But fortunately for her, she had information. The following day they went to the clinic in Site C. She went with her sister. When they arrived, the doctor took her folder and prescribed medication for her. When she received her medication, she noticed that there were no prophylaxis. She went back to the hospital and she took her sister and she told the doctor that her sister was raped. She was tested and the results were negative. But there was no prophylaxis, that’s when the doctor prescribed her AZT and 3TC. So if she was not treatment literature, she wouldn’t have collected her medication. It is something that happened recently, only last year. If people go straight to Thuthuzela for counselling, thing should be different than going to the police station on your own.]

Nombeko Mpongo: Ja, it’s a very important thing for people. It doesn’t matter how traumatic you are, you must think of your life, what do you want? Because if you keep on taking whatever you get without asking: “What is this? What is it for?” Because you get, for instance, the morning after pill, you get the STI medication, and then most people would think that, I have the drugs to prevent prophylaxis. But sometimes you just got the minor things that can be given anywhere. So, it’s very important to go where it is done properly.

Jason Wessenaar: Post exposure prophylaxis is explained also that it’s not only if you’re raped. If you’ve had sex with somebody that you didn’t know was positive, you didn’t use protection, you can go and get it. I think that was my understanding.

Busisiwe Maqungo: You can go if you had sex with someone? I didn’t know that happens. If you have unprotected sex you can go to the clinic the following day and they give you prophylaxis?

Anthony Fernandes: If I’m negative and I just had unprotected sex with somebody, or I had a doubt even?

Busisiwe Maqungo: Cause I know people who had a condom failure, they are not given prophylaxis.

Anthony Fernandes: Why not, they should be. If you go to the hospital and say that I had a broken condom, I’m pretty sure I was at risk. I want to use a prophylaxis’, they should give it to you, absolutely.

Busisiwe Maqungo: They don’t.

Lihle Dlamini: People that have had a condom failure, and unsafe sex, especially when the other partner is negative and the one is positive, should be given post exposure prophylaxis, but the public hospices are not giving it to people, that’s what is happening. And I think it’s up to us to stand up and force the government, because they should provide the PEP for everyone who needs the PEP, not only for rape survivors and healthcare workers.

Jason Wessenaar: Prof. Denny, explain to us the PEP protocol, what the protocol is all about.

Prof. Lynette Denny: Well, the current protocol in fact only applies to men or women or children who’ve been raped, it does not apply to people who’ve had a high risk exposure in a so-called consensual setting. And the protocol is that, as long as it is within 72 hours of the sexual contact, that the patients are given Combivir, or AZT and 3TC twice daily for 28 days.

Anthony Fernandes: Perhaps people think that it’s a kind of a safety net. You can always go and get that, and then you’re safe. I mean, how often can people go for this test and what about resistance?

Prof. Lynette Denny: They introduced PEP in the context of consensual sex in San Francisco, a number of years ago. And one of the big concerns was: “Oh, well people will just go and have high risk sex, and then go and take their morning after pill.” In fact, most people are not that irresponsible in that way. And most people, if they had consensual exposures, it was a one-off thing and they came in and took it very responsibly.

Jason Wessenaar: Let’s say a woman comes straight to the clinic, not to the police station. Do they have to have reported their rape before they get PEP and secondly, with regards to men who get raped and they don’t necessarily want to go to the police station to report it, would they have access to PEP?

Prof. Lynette Denny: Its critical people know you do not have to report rape to the police to receive PEP. And anyone who says that to you is wrong. And if you read the policy of the Western Cape certainly and it will be nationally, that any person who walks into a health facility and says: “I have been raped”, male, female, old, young, whatever, is entitled to a full examination and to post exposure prophylaxis prevention of other sexually transmitted infections and for pregnancy prophylaxis.

Jason Wessenaar: Reya leboha doctor Lynette, lelona Support Group lelona mono mahayeng {SeSotho} [Thank you Dr Lynette, the support group and the viewers at home. Things to remember:

1. You have the right to use condoms in any relationship; even marriage.
2. Don’t keep abuse to yourself. Talk to a friend or call a helpline.
3. If you have been raped, go to the nearest health facility or police station.
4. You don’t have to report rape at a police station to get PEP Post Exposure Phophylaxis.

We hope that you have enjoyed the show and you are feeling the Siyayingoba spirit: it’s together we can Beat It! If you have any questions and comments about the show, please contact us on the numbers on the screen now. Join us again next week in the Siyayinqoba Beat It support group, till then stay healthy stay positive. Totsiens. {Afrikaans} [Goodbye.]

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