None of the rape survivors given anti-retroviral drugs by Sunninghill Hospital has become HIV positive, according to Dr Adrienne Wulfsohn who heads the hospital’€™s accident and emergency unit.

Sexual assault survivors who come to Sunninghill’€™s Albertina Sisulu Rape Crisis Centre within 72 hours of being attacked are offered a three-day course of the anti-retroviral drug Combivir if they consent to an HIV test, and test negative.

They are then advised to buy their own Combivir (a combination of AZT and 3TC) for a further 28 days at a cost of R900. Despite the poverty of many patients ‘€“ most of whom are from Alexandra, Diepsloot and Zevenfontein — “it’€™s amazing how many of them manage to raise the money”, says Wulfsohn.

“We have been offering anti-retroviral drugs since 1998,” said Wulfsohn. “We have seen about 630 patients. About 68 to 70 percent of the patients return six weeks after their assault for a check-up, and about 50 percent return after three months. No one we have seen has sero-converted.”

The crisis centre treats about 50 women and children free of charge each month as part of the Netcare group’€™s service to communities, said Wulfsohn.

Patients are also offered antibiotics to combat sexually transmitted infections, the “morning after” pill to prevent pregnancy and counselling.

Netcare’€™s Garden City Clinic, Milpark, Union Hospital, Unitas and Pretoria East also started offering the drugs for post-exposure prophylaxis (PEP) seven months ago.

“The cost of fully treating a sexual assault case is about R8 500. The Netcare clinics in Gauteng offering this service pro bono cost the group about R2,3-million last year,” says Wulfsohn.

“The Medicines Control Council has not approved Combivir for use after sexual assault, so the patients have to sign a consent form which explains that they may still get HIV.”

It is very difficult to get scientific evidence that anti-retroviral drugs prevent HIV transmission in rape. Researchers struggle to follow up the survivors, it is usually impossible to know the HIV status of their attackers and it would be unethical to deny a “control group” of rape survivors access to potentially beneficial drugs for the sake of science.

In South Africa, the matter has also become politicised. The Democratic Alliance has promised AZT to rape survivors in the Western Cape, while in Mpumalanga, the Greater Nelspruit Rape Intervention Project (Grip), which was providing AZT to rape survivors, was expelled from a state hospital by the ANC’€™s provincial health MEC on the grounds that the drug is toxic.

Meanwhile, Netcare has decided to roll out its sexual assault crisis centres countrywide.