Scarcely half a year after MSF released its alarming report on levels of sexual violence in the platinum belt, new analysis has emerged that drives home its ramifications.

According to the researchers, who conducted their study in the Rustenberg Local Municipality, one in five new HIV infections are caused by rape – affecting nearly 7,000 of the region’s female patients. Half of the women surveyed were not aware that HIV could be prevented with post-exposure prophylaxis (PEP) for up to 72 hours after an assault.

Gender-based violence was also a major factor affecting psychological well-being in the region. A third of women with depression had suffered abuse of some kind, with over 5,000 cases of depression in women being attributable to rape and intimate partner violence.

Additionally, one in three women inducing abortion – just shy of 1,300 cases – were pregnant as a result of sexual assault.

Platinum mining accounts for nearly 60% of Rustenberg’s economy, and over half the people living in the region rely on mining for employment. Rustenberg is growing rapidly, and although the majority of its residents are men, women are increasingly flocking to the area as well. Close to 1,000 women living in communities along the mining belt were surveyed in depth, with the updated study, entitled Untreated Violence, providing insight into the impact sexual violence had on the spread of HIV/AIDS as well as mental and other health conditions.

“Rape can have severe detrimental effects on the survivor’s physical and mental health, and well-being,” write the authors. “Women who have been raped are exposed to mental and physical trauma, unwanted pregnancy, loss of pre-existing pregnancy, or acquisition of sexually transmitted infections (STIs), including HIV.”

Psychological suffering can be severe, they added. “For example, depression as well as alcohol use disorders are five times more common in survivors. Rape can also be fatal – perpetrators may kill their victim and survivors are more than four times more likely to take their own life.”

The findings, MSF spokesperson Angela Makamure said in a statement, would be presented at the current Conference on Retroviruses and Opportunistic Infections in Seattle, USA. The new data follows on from research conducted in the area in 2015.

The original study found, by surveying 800 women aged 18-49, that one in four had been raped in their lifetime, and approximately half had experienced some form of sexual violence or intimate partner violence. “Having established the prevalence of sexual violence, MSF aimed to determine the attributable burden of disease,” the organisation explained.

South Africa’s rate of sexual assault overall is high, but the authors note that an added problem in the mining belt is the lack of access to healthcare and psychosocial support. Within the workplace, just 10% of the mining workforce is made up of women, which increases vulnerability to harassment and violence. In 2016, Sanki Molefe, a miner and head of the Rustenburg women’s structure of the National Union of Mineworkers (NUM), told SAFM that sexual abuse was rife in mining. Women were commonly expected to perform sexual favours in order to get promoted, she said, and those who refused were victimised or harassed in any case.

“For many women, sexual violence has become part of their daily lives,” community health worker Rosina Palai comments. “Violence is routine.” Moreover, the authors note in the report, unemployment rates are high among migrant women, which leaves many dependent on men.

There are extremely low levels of reporting of sexual violence, and a high level of stigma, all of which has far-reaching effects.

“The health consequences of sexual violence [along the mining belt] remain largely unaddressed,” the researchers said in a statement. The organisation called on the South African government to include ambitious targets in its next five-year National Strategic Plan (NSP) on HIV, TB and STIs (2017-2022) for increasing sexual violence survivors’ access to medical and psychosocial services at health facilities.

Unnecessary suffering could have been prevented already if survivors had been able to access a basic package of healthcare services, they argue. But, says MSF epidemiologist Sarah-Jane Steele, this is simply not happening. “Opportunities are missed each day to prevent HIV infection, psychological trauma, and unwanted pregnancy for victims of sexual violence in on the platinum mining belt, because there are too few health facilities with the capacity to provide essential care,” she explains.

“It is not unrealistic to expect, at a minimum, that every sub-district in the country has a health centre that can provide an essential package of care to mitigate the consequences of rape and other sexual violence,” Steele adds.

Key interventions include providing post-exposure prophylaxis (PEP) to prevent HIV and other sexually transmitted infections, psychosocial support including trauma counselling, emergency contraception, other basic medical services (e.g. first aid), and the option of forensic examination, she believes.

Equally important, say the researchers, is that health promotion be prioritised, increasing access not only to services but also empowering information. “The situation could be helped by a two-pronged approach of establishing more health facilities as points of entry for sexual violence care services, while raising awareness in communities about the benefits of accessing care,” they argue.

“There is urgent need to improve access to medical services for sexual violence survivors, and provide a more patient-centred response to sexual violence – both in Rustenburg, and across South Africa,” the authors write. “Shifting from widespread stigma and untreated violence to the practice of seeking and providing care will prevent unnecessary infections of HIV and other sexually transmitted diseases, and limit unwanted pregnancies.

“At the same time, improved access to services will provide psychosocial support and facilitate the process of seeking legal recourse for those who choose to do so.” DM

Photo: Lonmin’s Marikana operation at dawn, Sunday May 13, 2013. North West Province, South Africa. (Photo: Greg Marinovich)