The “Buddy System” as a promising strategy to support

The “Buddy System” as a promising strategy to support PEP compliance among survivors of sexual assault:

evidence from rural South Africa

Tshilidzi Masikhwa

Craig Carty

Tapiwa Mukaro

Fiona Nicholson

Thandi Hadebe

Elona Toska

The Thohoyandou Victim Empowerment Programme

“There’s No Excuse For Abuse!”

To generate an attitude of ZERO TOLERANCE towards all forms of sexual assault,

domestic violence, child abuse and HIV and AIDS

stigmatization in the Thulamela Municipality

(Vhembe District)

The Thohoyandou Victim Empowerment Programme

VHEMBE DISTRICT: CONTEXT

POPULATION: 618,462 (Census 2011)

HIV PREVALENCE: 21,5% (Vhembe District Department of Health, 2013)

UNEMPLOYMENT: 26,8% (Department of Labour, 2011)

MOUNTAINOUS REGION, MAKING TRANSPORT TO AND FROM SERVICE PROVIDERS DIFFICULT

7 POLICE STATIONS

1 REGIONAL & 2 DISTRICT HOSPTALS; 48 CLINICS; 3 HEALTH CENTRES

REGION OF TRADITIONAL, PATRIARCHAL LEADERSHIP: CHIEFS AND KINGS

MALE:FEMALE RATIO: 45,1% to 54,9%

56% OF POPULATION UNDER 18 YEARS OLD

DIFFERING INTERPRETATIONS OF TRADITIONAL IDEOLOGIESHIGH LEVELS OF HIV/AIDS STIGMA

CAPACITY &

AGENCY TO

EXERCISE

RIGHTS

HELP-SEEKING

BEHAVIOURS,

ACCESS TO

TREATMENT &

JUSTICE

COMMUNITY

ENGAGEMENT

& PARTNERSHIP-

BUILDING

RIGHTS-BASED

KNOWLEDGE

&

EMPOWERMENT

CREATION OF

SAFER

ENVIRONMENTS

DIRECTLY OWING

TO STAKEHOLDERS

PRIDE,

COMMUNITY

OWNERSHIP &

SUSTAINABILITY

History of the Buddy System

COST-EFFECTIVE: 380 USD p/m

12 “BUDDIES” – 12 HELP DESKS, 2 RAPE TRAUMA CENTRES

35 – 40 CASES SEXUAL ASSAULT p/m; 100 CASES OF DOMESTIC VIOLENCE p/m

TRAINED VICTIM ADVOCATES

PEER SUPPORT MODELS

1Abrahams, N. et al. AIDS Care. 2010 Oct;22(10):1173-81 2Christofides, N. et al. Medical Research Council, Pretoria 2006

PEP COMPLETION DEFINED AS >94% ADHERENCE TO

THE 28 DAY REGIMEN

• National averages 31,0 – 38,2%1

• Some sites as low as 15%2

INCREASED RATES OF PEP

COMPLETION

TVEP CLIENT COMPLETION RATES: March 2013 –

February 2014

78%

HOW IT WORKS• SURVIVOR OF SEXUAL ASSAULT REFERRED TO TVEP• SURVIVOR IMMEDIATELY ASSIGNED A “BUDDY” • BUDDY ADVOCATES FOR CLIENT:

– COLLECTION OF RAPE KIT– A-1 STATEMENT (POLICE REPORT) – HIV COUNSELING AND TESTING– PROVISION OF THE FULL 28 DAY PEP REGIMEN – PROVIDES ANTI-EMETICS– PROVIDES FOOD PARCELS– PROVIDES A CARE KIT– CHILDREN PROVIDED WITH “COMFORT TOY” AND FAMILY SUPPORT

SERVICES

• BUDDY CONDUCTS HOME VISITS• BUDDY DOES PHONE CALL CHECK-IN• BUDDY PROVIDES ON-CALL SUPPORT 24/7/365• BUDDY FACILITATES FOLLOW-UP APPOINTMENTS & TRANSPORT• BUDDY SUPPORTS THE CLIENT THROUGHOUT THE CRIMINAL

CASE, IF IT GOES TO TRIAL

VICTIM

REPORT

Buddy Assigne

d

Post-rape Care

SURVIVOR

%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%72.3

26.3

PEP eligibility

PEP eligible PEP ineligible

Child

ren

(1-9

yea

rs o

ld)

Adole

scen

ts (1

0-19

yea

rs o

ld)

Adults

(20-

90 y

ears

old

)

0.05.0

10.015.020.025.030.035.040.045.050.0

16.5

43.8 39.7

% TVEP participants

March 2013 through February 2014n=564 cases of sexual assault

n=408 PEP eligible

87.3% (356 of 408) of those PEP eligible started treatment

78% of those initiated completed the 28 day regimen

Child

ren

(1-9

yea

rs o

ld)

Adole

scen

ts (1

0-19

yea

rs o

ld)

Adults

(20-

90 y

ears

old

)

0%

20%

40%

60%

80%

100%

74%91% 88%

% of PEP eligible that initiated treatment

Childre

n (1-9

yea

rs o

ld)

Adoles

cents

(10-

19 y

ears

old

)

Adults (2

0-90

yea

rs o

ld)

tota

l0%

10%20%30%40%50%60%70%80%90%

100% 91%77% 74% 78%

% completed PEP treatment

Associations between TVEP treatments (facilitated by Buddy) and PEP compliance:

Crosstab Analysis

Attending Counseling Session #1 – associated with higher completion (p=0.131)

Attending Counseling Session #2 - associated with higher completion (p=0.622)

Receiving Shelter – not significant (p=0.676)

Any other support (nutrition, care kit, etc.) – significant, but very few people did NOT receive any support (p=0.008)

FOR ADDITIONAL INFORMATION OR TO HELP US WITH RESEARCH & PROGRAMMING, PLEASE CONTACT:

FIONA@TVEP.ORG.ZA

LEGALOFFICER@TVEP.ORG.ZA

CCARTY@THERELEVANCENETWORK.COM

OR VISIT

www.tvep.org.za

THANKS TO OUR VICTIM ADVOCATE BUDDIES, THE TRAUMA CENTRE STAFF,

THE SOUTH AFRICAN POLICE SERVICES, THE

DEPARTMENT OF HEALTH AND SOCIAL

DEVELOPMENT, AND ALL OUR IMPLEMENTING PARTNERS. SPECIAL

THANKS TO OUR FRIENDS IN THE AFRICA REGIONAL

GBV NETWORK WITH WHOME WE SHARE BEST PRACTICES ACROSS SUB-

SAHARAN AFRICA

The Thohoyandou Victim Empowerment Programme