South African Victims Face Rapists and H.I.V.

The rapist seemed to have no sense that there could be consequences to what he had done. The morning after, the rapist gave his 17-year-old victim money for a cab home and asked her to make sure she locked his door on her way out, after he left for work.

Two weeks later, she still did not know whether he had murdered her as well. He had been arrested, but he was refusing to take an AIDS test.

In the United States and Europe, she would have received anti-AIDS drugs for free in case her rapist was carrying the H.I.V. virus. In South Africa, she got virtually nothing.

What happened to this young woman happens each year to thousands of girls in South Africa, a country widely believed to have one of the world’s highest rape rates. It also exemplifies two trends: how casual rape can be in a society where girls are nearly powerless and law enforcement is weak; and how even a rape with little violence can carry a death sentence.
In rural KwaZulu/Natal Province, where this rape occurred, there is about a 40 percent chance that a young male rapist is H.I.V. positive. But the public health system does not provide antiretroviral drug therapy for people with H.I.V., except in unusual short-term circumstances and those do not include rape victims. Thus, in this country infection means a virtual certainty of death.

By law, the accused rapist could refuse a blood test. So a doctor working for the prosecutor was trying to trick him out of a blood sample or get a court-ordered DNA test from which he would also steal a bit of blood to test for H.I.V., too.

But in fact, it was probably too late to do anything for the young woman. Too many days had passed.

The victim is a high school student who lives in a one-room mud hut behind a general store a few feet from her father’s grave. As she sat under a tree describing her ordeal, tears ran down her face.

Saturday choir practice at school had broken up just after dark and she proceeded to hitch a ride, a routine and generally safe practice in this rural area. A male classmate stood with her until she got a ride from a man in a bakery delivery van But once under way, she recounted, ”He said I must go to town with him.”

She pretended that her family wanted her to go to town — Mtubatuba — to make a phone call. He lent her his phone card and she called her sister for help, but within seconds the line inexplicably went dead. Her sister ran to a neighbor with a car, but before he could get to town, the young woman was gone.

The driver had taken her to his room behind the Umfolozi Bakery, telling her that he had to turn in his van and that she should wait in his room while he borrowed a friend’s car. She didn’t try to escape, she said because she was lost and scared.

A few minutes later, he came back. ”As I was sitting, he forced me to lie down and told me I must sleep with him. He took off his clothes and pants and raped me.”

Afterwards, he dressed and ”he poured water for me to bath myself and went out to look for his friend again,” she said. He came back saying he hadn’t found him, and raped her again.

He told her to urinate and wash herself again, but she said she refused, and then, exhausted and terrified, she fell asleep. At 3 a.m. he was up and dressed, saying he had to drive again. He left the room leaving behind the cab fare.

After she got home, she went to the police. A bakery van driver was easy to find, and he was arrested and put in jail. The police commander of Mtubatuba station refused to allow an interview with him.

Dr. Steve Gericke, a private practitioner in Mtubatuba, is a part-time forensic surgeon who does autopsies and certifies the injuries of assault and rape victims. He remembered examining the victim because she was a relative of the maid of a physician he knew.

The best medical response to a needle stick or rape by an H.I.V.-positive person is a month’s dosage of three antiretroviral drugs, which cost about $500 in this area. The next-best choice is usually a ”starter pack” — three days’ worth of two drugs — which cost of about $35.

Dr. Gericke keeps one in his office in case he or a nurse is stuck by a needle. But he cannot afford to give them to the two or three rape victims he sees on a typical day.

The government has never clearly enunciated a policy, he said, but the drugs are not normally given out free.

”Yes, rape by an H.I.V.-positive man is a death sentence,” Dr. Gericke said. ”But the treatment is not available.”

There are ”big differentials” in who is treated in South Africa, he said. Two years ago, two raped Belgian tourists got the drugs, he said. But a young local woman he examined the day before who had been raped by four men could not.

To prove his point, he picked up the phone and dialed nearby Hlabisa Hospital.

After identifying himself, he said: ”I’ve got a young girl, a minor — raped. Can I order drugs from you guys?”

The first pharmacist he spoke to had been on the job only three weeks, and didn’t even know what a starter pack was. Dr. Gericke asked for the nurse in charge.

From his end, the conversation went:

”You have nothing?”

”You do, but you can’t supply it? What do you do if someone gets pricked by a needle?”

”Do you give a month’s worth? Or only three days? Oh? Even if the blood tests positive?”

”Well, what can I get for a rape victim? The accused is running around in the bush somewhere. I don’t know what he is. Can I get a month’s worth for her?”

Getting off the phone, he said: ”The answer is no. They keep the starter pack to give to staff for needle sticks. That’s it. She couldn’t give me an answer about how you get a month’s worth. No one that’s raped gets treated.”

Even if the drugs were available cost-free, he said, young women often would not get them in time.

”Forced intercourse is not regarded as a hell of a crime by the average rural Zulu,” he said. ”It’s very accepted.”

Often the families of both sides of a rape come to him, he said, sometimes many days after the event.

”Mr. A. brings his son, Mr. B. brings his daughter,” he said. ”They admit he raped her. They say ‘check her out and treat her,’ ” meaning for pregnancy or injuries. ”They don’t want to go to the cops. There’s a payment between them. That’s how it works. To us, that’s unacceptable, but to them, it’s normal.” But no one gets any drugs.

One middle-aged professional woman who counts several doctors among her friends, was raped in a roadside ditch at 3 a.m. by two men who had hijacked her car. Her 2-year-old daughter was in her arms. Her husband, a few yards away, was told that if he approached, they’d all be shot.

Horrible as that was, the couple described an almost unbelievable ordeal afterward: indifferent police officers who did not offer her or the child a blanket even though they were wet and shivering. An ambulance that drove them for an hour to the wrong hospital. On reaching the right one, being told to ”sit down, be patient, all the doctors are in a meeting — it could be one hour, it could be six.” Finally they met a doctor who tried to refuse to do a rape exam because no policewoman had accompanied them.

”By this time,” said her husband, ”we’d been in the hands of the authorities for hours, and they’d done nothing but produce rises in our blood pressure after the worst night of our life.”

The state doctor gave them drugs — only antibiotics for venereal disease, not antiretrovirals — and a morning-after pill, but refused to give or sell them one of the hospital’s starter packs, saying they were only for staff needle punctures.

Finally, a younger doctor who seemed appalled by the conversation wrote them a prescription for two antiretrovirals, AZT and 3TC. They bought the stock of the local private pharmacy — three days’ worth.

They were able to get the drugs for $350 for a month’s worth, though it was more than they had in savings and a doctor friend had to drive to Durban, nearly three hours away, to get them.

Because of her medical connections, the middle-aged woman was also able to get a highly sensitive early warning test and is reasonably sure she is H.I.V.-negative.

As for the 17-year-old, because she is poor and because knowing the answer would not change her fate, she may never be tested. If she is H.I.V.-positive, she will probably first suspect it in about eight years, when she begins to die.

Death and Denial

This series about the H.I.V. epidemic in South Africa focuses on a Zulu community in the hills of KwaZulu/ Natal Province.

While the crisis affecting Africa has been widely reported, these articles offer a rare portrait of the everyday struggles in one place.

Previous articles have included an overview of the community, an examination of men’s sexual attitudes and prostitution. Later articles will focus on migrant workers.