Implementing Post Rape Services in Public Health Settings: Challenges and Opportunities

Background

Survivors in Kenya access health sector services for physiological and psychological support. Liverpool VCT, Care & Treatment, a Kenyan NGO carried out a situation analysis of post rape care services in Kenya in 2002. It established blurred boundaries between forced, coerced and consensual sex. It revealed lack of standards, policy, and care delivery mechanisms in the health sector.

Methods

An intervention study to describe and evaluate a standard of care (clinical evaluation, documentation; clinical management; counselling; referral) was undertaken in 3 district hospitals. A counselling protocol was developed. Health provider targeted training was knowledge, skill and value based. Between 2003 and 2005, data were collected from routine clinical records and in-depth interviews were done with 37 purposively sampled health providers.

Findings

Of 295 survivors, 89% were female, 56% children. 9% adult women were HIV positive at baseline, indicating prior HIV risk. 72% (250) survivors continued PEP, of whom 51% completed. 16% were lost to client flow system. Training improved provider skill, confidence and was described as ‘important'.

Lessons learnt

The standard of care must be based on local health systems, and have guidelines. Training must be value-based and explore health provider gendered constructions of sexual violence and their impact on service delivery. PEP delivery should be utilised to leverage on-going HIV risk reduction with active follow up systems. Counselling is central and requires acknowledging other HIV risk given the blurred boundaries between forced and consensual sex.