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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. - PowerPoint PPT Presentation
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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:
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
