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South Africa

Médecins Sans Frontières has worked in South Africa since 1999

South Africa has the largest HIV patient cohort in the world and is helping to lead the way in gaining access to new treatments for multidrug-resistant tuberculosis (MDR-TB).

The South African HIV/AIDS pandemic saw life expectancy in the country fall by ten years between 1992 and 2005, largely due to the failure of the national government to take steps in addressing the problem.

 

Since 2012, as part of its outreach testing services, MSF has annually performed thousands of HIV tests in over 30 high schools. This has not only increased HIV testing coverage in the district, but also demonstrated the feasibility of delivering sexual and reproductive health services on school grounds.

MSF’s project in KwaZulu-Natal province utilises community-oriented strategies to reduce the incidence of diseases and mortality, and to increase integrated HIV testing and tuberculosis (TB) screening, as well as access and adherence to HIV treatment.

MSF initiatives to decentralise drug resistant tuberculosis (DR-TB) care are underway in King Cetshwayo district, and allow patients to receive treatment, including new drugs such as bedaquiline, closer to home.

The Khayelitsha project near Cape Town continues to develop innovative interventions in HIV and DR-TB care, with the aim of influencing local, national, regional and international policies on treatment for these diseases.  

Sexual and Gender-based Violence

One-in-five HIV infections and one-in-three cases of depression among women are attributable to rape and intimate-partner violence (IPV). One-in-three women inducing abortion was pregnant as a result of sexual violence.   

Much additional suffering could have been prevented if survivors had been able to access a basic package of healthcare services  

 

"Opportunities are missed each day to prevent HIV infection, psychological trauma, and unwanted pregnancy for victims of sexual violence in the platinum mining belt, because there are too few health facilities with the capacity to provide essential care."

Sarah-Jane Steele
MSF Epidemiologist

MSF is calling for the inclusion of ambitious targets for increasing access for survivors of sexual violence to medical and psychosocial services at health facilities. 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.

Alongside increased access to services there is also a need for health promotion within communities, as half of the women MSF surveyed in 2015 did not know that HIV can be prevented after rape if PEP is received within 72 hours.

In 2017, MSF continued its support to the provincial health department, expanding access to medical and psychosocial care for victims of sexual violence in Bojanala district. The project is located in South Africa’s platinum mining belt, where one in four women between the ages of 18 and 49 have been raped in their lifetime.

To increase the numbers of patients accessing services and referred to the centres in 2017, MSF positioned social workers in a community-based organisation and a local police station. MSF nurses also supported the provision of sexual and reproductive health services, including choice of termination of pregnancy in two primary healthcare facilities.

MSF continues to advocate increased access to comprehensive services at healthcare facilities for victims of sexual violence nationwide. A report, Untreated Violence: Critical gaps in medical and clinical forensic care for survivors of sexual violence in South Africa, publicised the findings of MSF’s telephone survey of facilities designated across the country to provide care for victims of sexual violence. The survey found that 73 per cent of participating facilities do not provide or do not have the capacity to offer all necessary services.

 

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