Refentse Project ("Resilience in the face of adversity"): Post Rape Care

Category 3

Refentse uses an integrated, nurse-driven delivery model of post-rape care that includes the following services: post-exposure prophylaxis (PEP), pregnancy testing, emergency contraception, sexually transmitted infection (STI) treatment, and voluntary counseling and testing (VCT). Refentse integrates clinicians, social workers, police officers, and representatives from the local prosecutor's office to strengthen relationships between the health and criminal justice sectors, and provide comprehensive post-rape care that goes beyond simply providing PEP. Referrals may be initiated at the health facility level to assist patients with police reports if desired. In addition, social workers are made available at the police station to counsel and refer patients to the hospital. The local prosecutor's office provides advice on legal matters.

A study using a combination of qualitative and quantitative methods was conducted from March 2003 to September 2007 to test the effectiveness of this post-rape care model, in Bohlabela District, rural Mpumalanga province, South Africa. It was based at Tintswalo Hospital, Acornhoek, a 450-bed district hospital that functions as a referral site for post-rape care.

Goal of the Practice
  • To create a referral system for sexual violence between the criminal justice system and the health care sector.
  • To assess the referral system and its impact on improving the use of post-rape services, such as post-exposure prophylaxis (PEP) and voluntary counseling and testing (VCT).
  • To determine the services women currently use, the services women want and value, and to identify gaps in service provision for domestic violence.
Core Components
  • Post-exposure prophylaxis (PEP): Pregnancy testing
  • Voluntary counseling and testing (VCT): Emergency contraception
  • Sexually transmitted infection (STI) treatment: Legal and counseling services
  • A community awareness campaign: A designated examining room for post-rape survivors
Noteworthy Results
  • HIV counseling and testing increased from 60% to 87%
  • Drugs given for preventing sexually transmitted infections increased from 88%to 92%
  • Completion of the 28 day course of PEP drugs increased from 20% to 58%
  • The number of post-rape survivors seeking care increased from 8 to 13 per month
Lessons Learned
  • A designated room for examination of post-rape survivors can help to coordinate care, increase privacy and decrease the time the patient spends at the health facility training in post-rape care.
  • HIV counseling and testing services should be available 24 hours a day to serve rape survivors who present to the facility after service hours.
  • A treatment protocol can systematize services, especially since many clinicians do not receive training in post-rape care.
  • Because patients in rural settings have difficulties returning to the hospital, treatment and diagnostic procedures should be completed at the first visit whenever possible.
  • Nurses can play an integral role in post-rape care, especially where doctors are scarce.
Focus Areas
Counseling and Testing
Implemented By
RADAR (Rural AIDS and Development Action Research), Tshwaranang Legal Advocacy Centre
Participating Organization
  • School of Public Health
  • University of the Witwatersrand
  • The Population Council Frontiers in Reproductive Health Program
South Africa
Clinic/Health facility
Target Population
100 - 500
Implementation Years
03/2003 - 09/2007