How sexual violence survivors in South Africa are now collateral damage of Trump's aid cuts
Donald Trump 's decision to slash international aid has had a crippling impact on HIV services – with a lifeline linking rape and sexual violence survivors to support now becoming collateral damage.
In Sub-Saharan Africa, girls and young women are more than twice as likely as their male peers to contract HIV, driven in part by an increased risk of facing sexual exploitation. Funding to tackle the virus is often also used to fund gender-based violence services.
Take the Networking HIV and AIDS Community of Southern Africa (NACOSA) based in South Africa. NACOSA received 40 per cent of its funding thanks to the DREAMS programme run by the United States Agency for International Development. Standing for 'Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe', the DREAMS programme provided two million young people in 15 African countries with a wide range of initiatives from the more direct – HIV testing, condoms and medication – to less obvious ways to address viral spread, like mentoring, life skills, financial literacy training and free sanitary products.
Although DREAMS was set up as an HIV prevention programme, the close link between sexual violence and the virus meant it ended up providing a crucial link to rape crisis support, regardless of survivors' HIV status. 'Young women are more vulnerable if they are dependent. If they are in poverty [they are] more vulnerable to both gender-based violence and HIV,' explains Sophie Hobbs from NACOSA. Research found some girls were being coerced into sex in exchange for period products.
In sessions to help them to understand what abuse and harassment looks like, girls and young women would often tell their mentors about experiences of abuse – and be linked to emergency contraception and counselling services. 'It would have been disclosed to us, 'my stepdad has been doing this for the longest time and I didn't realise it was wrong',' explains Tarryn Lokotsch, chief executive of the Greater Rape Intervention Program (GRIP) in eastern South Africa, which works with NACOSA and received half of its funding via the DREAMS programme.
'We would be able to link them to care at the hospital, test them for any sexually transmitted diseases, link them to care if they needed it. 'So, the prevention programme fed very nicely into the response programme,' she adds.
The DREAMS funding supported a network of care rooms in hospitals, police stations and magistrates' courts. Care rooms allow people can report assaults privately, rather than, 'standing in a long queue,' Lokotsch says, and, 'having to report what's happened to you with every other person that might just be coming to get a document certified'.
In hospitals, Lokotsch's group provides care packs to help give survivors back a sense of dignity after the ordeal of a forensic examination, which can include having to hand in their underwear as evidence. These packs include toiletries, sanitary products and spare clothes, as well as emergency money to get home safely. 'Basically we are trying to hold the victim's hand from the moment that they report right through to their day in court,' Lokotsch says.
GRIP makes sure survivors who test negative for HIV can begin and complete a full course of Post-Exposure Prophylaxis (PEP) which prevents the virus developing. 'The majority of our rape survivors remain HIV negative only because we've managed to [link them to] PEP medication,' she says. Those testing positive are linked to antiretroviral treatment — care they might otherwise struggle to access.
But all that is at risk.
'You just disappeared'
'This month we did have to close down one of our care rooms,' Lokotsch says. With the rest of the network 'not sustainable forever' with more cuts to come if new funding isn't found. 'We still receive phone calls to ask, where are you guys? We relied on you so much and you just disappeared,' she adds.
Without these support services, 'people are beginning to get a little bit more reluctant to report [gender-based violence], which is really scary', Lokotsch says.
A State Department spokesperson said: '[The US] continues to support lifesaving HIV testing, care and treatment, and prevention of mother to child transmission services approved by the Secretary of State. This includes lifesaving HIV treatment for adolescent girls and young women,' adding that, 'ensuring we have the right mix of programmes to support US national security and other core national interests of the United States requires an agile approach. We will continue to make changes as needed.'
Lokotsch herself is a survivor of sexual violence. After being attacked while on a run, she didn't know where to go, and sought care at a private hospital which wasn't set up to conduct forensic examinations. 'I had people taking photos of me and someone saying they need to do a medical forensic examination, and people are touching you everywhere. It's the most uncomfortable thing in the world and no one is telling you why they are taking photos or what they are doing,' she recalls.
That experience eventually led her to GRIP. Years later, she took over running the service where she works to stop others having the same trauma-compounding experience she had.
In South Africa, emergency contraception and PEP are available in public facilities, but people often don't know they are there. 'In theory, post-violence care services are not interrupted [by the US cuts],' says Dr Ntlotleng Mabena, a public health doctor who worked with NACOSA. 'But in practice, we know that survivors need a safe place to go to before they get to that service.'
Specialist post-violence centres are also not always accessible to people in rural areas. 'In certain provinces there's only one in the region and probably a three-hour taxi ride. Who's going to want to take a three-hour taxi ride after you've been raped?' Dr Mabena asks.
'I didn't know where I was going'
Bongi, a 41-year-old mother of five, met Lokotsch's team in a police station after fleeing a violent relationship. 'I stayed there being violated,' she explains to The Independent, because, 'the person who violated me is the one who gave me food'. She had three kids with him by the time the violence started.
'I didn't know where I was going. I didn't have enough money. I went to the police station,' she says of the day she left with her younger children, after her partner threatened to burn down their house with her inside. For two nights they slept at the police station, and then on the floor of a garage, without being offered help. It wasn't until a police officer finally connected her to GRIP that she was offered comprehensive medical checks, and afterwards, a place in a shelter.
Bongi is HIV positive, but had been on and off treatment for years and did not want to reveal her status over fears it would only lead to discrimination. 'I lied because I didn't get help in the police station,' she said, so when she met the GRIP team she thought: 'Here are some ladies who want to help me. If I maybe speak about my status, I'm not going to get the help that I need.'
Once she realised they would help her no matter what, she resolved to, 'see what I can do so I can get back on medication'.
Dr Isolde Birdthistle at the London School of Hygiene and Tropical Medicine, who has carried out evaluations of DREAMS in a number of places, say the benefits included the social support and empowerment of girls, and in some cases changes in sexual behaviours such as condom use. The biggest effect was on participants knowing their HIV status, Birdthistle explains, which is the first step to link them to treatment or prevention.
Girls also reported feeling less scared to test for HIV and more supported if they had experienced violence, Birdthistle says. While the loss of 'safe spaces' in areas where there are often no formal refuges for victims of violence is also a 'big loss,' she adds.
For Lokotsch, it is the speed of the change in the wake of Trump's aid cuts that is most jarring. 'I do understand the perspective that the South African HIV crisis and [gender-based violence] crisis is not necessarily America's problem,' she says. 'But America did choose at the start of this to lead the fight against HIV. They took that step to lead the fight internationally.
'And then to pull out and decide that they don't want to lead that fight anymore... We could have got some warning.'
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