A poster displayed in Maputo’s bustling downtown hospital, at police stations and in schools throughout the metropolitan area of Mozambique’s capital offers a compassionate message to victims of sexual violence – TU NAO ESTAS SOZINHA … “You are not alone!”
Featuring a photograph of a woman with her head down, her face obscured, the compelling poster is an effort targeted to Mozambican women and other victims of gender violence to ensure they receive proper health care and treatment – both physically and psychologically. In this southern African country, like many on the continent, sexual assault and gender violence remain a guarded secret. And with 11.5 percent of Mozambicans living with HIV, victims of sexual violence and assault face the nightmarish prospect that they may contract HIV or another sexually transmitted infection from their attackers.
To address these dual concerns, a public health initiative supported by Jhpiego is under way in the city of Maputo and four other high HIV-prevalence areas to raise community awareness of gender violence, streamline services for victims of sexual violence and train health care workers in infection prevention and treatment protocols. The project is funded through PEPFAR (the President’s Emergency Plan for AIDS Relief) through the Centers for Disease Control and Prevention, in collaboration with the U.S. Agency for International Development.
“This isn’t just a societal or cultural problem, this is a health problem. HIV and other sexually transmitted infections, as well as unwanted pregnancy, they all can be prevented – this is the main point of our message and program,”’ says Alicia Jaramillo, Deputy Director of Jhpiego’s Mozambique office.
As part of its infection prevention initiative at Maputo Central Hospital, Jhpiego staff in Mozambique began working with health care providers at the 1,000-bed hospital in late 2010 to streamline services for sexual assault victims, whatever their age or gender, and prevent HIV and other sexually transmitted infections and pregnancy. The hospital decided to provide victims of sexual assault the same prophylaxis as the health care worker who gets a needle stick.
“Seeing patients come in to seek care after a sexual assault and having the post-exposure prophylaxis already available to health workers, it was very natural for the hospital to offer these kits to victims,” says Jaramillo.
The regimen consists of four weeks of antiretroviral drugs, which are very effective in the prevention of HIV. But there’s a 72-hour window in which the medicine must be given for the best impact. So part of the public campaign – including the “You Are Not Alone” poster – is to encourage women to seek treatment and to do it fast.
“We want victims to know that even after the assault happens, it’s not over. You have a second chance and you can get help,” says Ana Baptista, the workplace safety technical coordinator at Jhpiego who presented her findings of this combined facility and community-based approach at the International AIDS Society Conference in Washington, D.C., this summer.
In reviewing the hospital records of patients reporting sexual assaults, Baptista learned that many of these victims were children. Of the 2,406 victims of sexual assault who sought services at Maputo Central Hospital between June 2005 and October 2011, 58.6 percent were under 14 years of age and 51 percent were students. Thirty-three percent of the sexual assault victims were referred by police.
The statistical review also showed that only 31 percent of victims arrived at Maputo Central Hospital within 72 hours of the sexual assault. This discovery led Baptista and her colleagues to develop a community-based component of the program to raise awareness about sexual violence in the community and encourage women and families to seek treatment immediately.
This year, community health workers are beginning to discuss gender-based violence and referrals for care and treatment as part of their local testing and counseling work to sensitize families to this issue. They too are driving home the message that victims of gender violence are not alone and that help is available.