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 IDEOLOGIES HIGH 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 1 Abrahams, N. et al. AIDS Care Oct;22(10): Christofides, 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 %

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

March 2013 through February 2014 n=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

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 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