South African newspapers recently reported that organisations supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria face severe funding cuts.
This follows a decision from the United States-based organisation to limit its funding to the eight areas in South Africa that have recorded the highest prevalence of HIV.
These cuts will also apply to the critical services that non-governmental organisations (NGOs) offer to rape victims in the areas that fall outside these designated areas, including in Limpopo, Northern Cape and the Free State.
In Gauteng, only Tshwane is eligible for funding, and in the Western Cape and KwaZulu-Natal, only the big metros of Cape Town and eThekwini. These include Thuthuzela Care Centres – government’s ‘one-stop’ service, support and counselling centres for rape victims – in the affected areas.
The implications of these funding cuts raise important questions that require urgent attention. The first is, why are services to rape victims dependent on international donor funding, and thus vulnerable to donor policy trends and changes?
Efforts to address gender-based violence, including the allocation of state money spent on campaigns like 16 Days of Activism against gender-based violence, are strongly policy driven. It therefore seems unconscionable that the most important services to those worst affected by rape should be vulnerable to funding cuts and changes in this way.
The Thuthuzela Care Centres’ counselling service is provided by NGO employees, who do the heavy lifting at a far lower rate of pay than their state counterparts. Surely these services should be secured by state funding?
We also need to question the unintended consequences of this decision. It seems sensible to concentrate efforts to tackle HIV in the areas with the highest infection rates, but these areas do not necessarily overlap with those where high rates of rape are reported. And because rape frequently carries the risk of infection with HIV, this means that all-important support to survivors to complete their course of post-exposure prophylaxis may be lost.
These services also matter for many other reasons.
According to research published in 2008 by the South African Stress and Health Survey, rape was the form of violence most likely to result in post-traumatic stress disorder (PTSD), and the most severe and long-term forms of PTSD. But this is not all: depression, anxiety, suicidal tendencies, substance abuse, repeated victimisation, disability, HIV-infection and chronic physical health problems can also develop in the aftermath of rape.
In an ideal world, all victims would have the emotional resources and resilience required to deal with violence. They would also be surrounded by supportive family members and friends, and assisted at all times by officials equipped with empathy and knowledge. This is not the reality for many of the women, girls, boys and men who are raped.
Rape affects not only the emotional and physical wellbeing of survivors, but also their ability to work and – if they are parents – to provide the love, care and attention their children require. Victims may also find that the rape reactivates memories of earlier victimisation or loss. This complicates attempts to deal with rape, and increases the effect of the trauma. Family members and friends may be absent – if not involved in the abuse themselves – while officials can be untrained or indifferent to the victims’ needs and circumstances.
This means that the counselling services to rape victims are essential. But where rape is concerned, no service is better than a bad service. A substantial body of research shows that services do more harm than good when provided by people who have not been adequately trained to respond to rape, who hold victim-blaming beliefs, and who do not receive debriefing and supervision.
A degree of specialisation is required to provide quality services, which also take a range of different forms. These include psychological first aid (an evidence-based approach to assisting victims in the aftermath of trauma) in the acute stage of trauma and assessment of children’s circumstances – including their removal from neglectful circumstances. Counselling and testing for HIV is another important aspect, along with assistance regarding post-exposure prophylaxis to prevent HIV infection.
Other support services include individual, group or family counselling in the medium and long term; and legal help, such as preparation for testifying in court; accompaniment to court; writing reports for court and providing expert testimony. This requires a dedicated investment by the state to ensure that the services are available sustainably – at least at all Thuthuzela Care Centres.
But for now, these services are about to disappear for many rape victims who need support from the Thuthuzela Care Centres. The women who have been providing the services also face an uncertain future.
Rape is an entrenched social problem in South Africa, and post-rape care will remain necessary for the foreseeable future. The Inter-ministerial Committee on Gender-Based Violence must step up to their task and find ways to ensure that rape survivors and the people who care for them are not subject to the shifting priorities of donor decision making.
Romi Sigsworth, Gender Specialist, ISS Pretoria and Lisa Vetten, honorary research associate, WITS Institute for Social and Economic Research