Rape survivors: plan of action

All of us should understand that rape happens, and that your best chance of recovery and justice lies in knowing what to do. CHARLENE SMITH outlines the steps you or someone close to you need to take.

If you were raped, you must see a doctor as soon as possible. You can go to a hospital, a special rape centre or a district surgeon. Most private hospitals and government hospitals in large centres are equipped to deal with rape cases.

Your GP is not a good call: few of them have rape or forensic training and most doctors do not carry the J88 form which, for purposes of prosecution, needs to be completed at the time of examination. The examining doctor must also have a crime kit for forensic information such as DNA, which needs to be done at the time of first examination. Finally, if you would like to lay a rape charge, only a doctor who is prepared to testify in court should examine you.

If you first go to a police station, the police must organise for you to see a doctor as soon as possible. Before then:

• Don’t change your clothes, bath/shower or douche, or go to the toilet before you see the doctor since this might remove evidence.
• Don't brush your hair because evidence may be contained in it and don't wash off blood.
• Do not clean your teeth or rinse your mouth if you have been forced to perform oral sex.
• Don't put a disposable nappy on a baby who was raped.
• Never put any evidence, including tape or rope used to bind you in a plastic bag because plastic destroys evidence, including fingerprints. Only use paper bags.

The doctor should do the following:

• Speak to you in a private place; you may have a companion or family member present.
• Make notes of all details of the rape such as when and where it happened, how many people were involved, the type of sexual act(s) performed, whether a weapon was used and if you lost consciousness.
• Examine you generally, including a thorough genital examination.
• Make notes and drawings of any injuries you have.
• Complete a J88 form at the time of examination.
• Use a crime kit provided by the police. The crime kit must be sealed properly and taken to the forensice laboratory by the police. If the kit isn't sealed properly, it will not be admitted as evidence.
• Take swabs from your mouth, your genitals both outside and inside (labia, vagina, cervix) and also your anus if you were sodomised (subjected to forced anal sex). This is so that the forensic (police) laboratory can try to collect semen or saliva from the rapist and do DNA tests, which can be used to prove the rapist’s identity. Other samples that may be collected for the same reason are scrapings from under your fingernails and pubic hair.
• Keep all your clothing for forensic investigation.
• Discuss with you and get your permission to do an HIV test. A rapid HIV test is usually done. This is a pinprick test which gives results within 20 minutes. Other tests may also be done to see if you need protection against infections that can be transmitted to you by the rapist. Even if the rapist cannot be found or does not agree to be tested for HIV it is best to take precautions against HIV since up to one in three adults in South Africa is HIV positive and can transmit the virus through sex or injury where bleeding occurs. Sometimes a ‘false positive’ result comes up in a rapid test, if you test positive then ask for an Elisa blood test, this is almost 99% reliable and will give your true HIV status but you will wait anything from a day to 3 days for these results.

 Treatment

• Any injuries you have will need to be treated e.g. cleaning and stitching.
• You must be given emergency contraception (“the morning after pill”) to prevent an unwanted pregnancy.
• Nausea and the feeling of an upset stomach are common in the first few days after any violent trauma, especially rape. If you experience this, ask a doctor for anti-nausea medication. But because you may be on a number of medicines, keep medical consumption down to a minimum so they do not interfere with the anti-retrovirals. Be very careful about taking psychiatric medication because drug or alcohol dependency can become side effects of Post-Traumatic Stress Disorder, so keep any pills to reduce anxiety or help you to sleep to a minimum and ideally only use for the first few days and when and if there are court hearings.
• You must receive antibiotics to prevent sexual diseases such as gonorrhoea. You will need to take the antibiotics for seven days.
• You must demand antiretroviral medication to help prevent HIV infection if you are HIV negative this will reduce your risk of getting HIV dramatically according to the Centres for Disease Control and the World Health Organisation.  It is critical that adults begin antiretroviral medication within 72 hours of first actual or attempted penetration, this includes oral sex.  For children the urgency is far greater and they should start ARV’s or post exposure prophylaxis within six hours, they will receive medication based on their weight.  Rape survivors are given Combivir which is AZT and 3TC combined, to be taken twice a day for one month. It is important to finish the treatment. Discuss any side-effects with the doctor.
• If you have been sodomised you may need an anti-inflammatory cream for the anus. If it is painful to have a bowel motion it will help to take a mild laxative to soften the stool.
• If you have not been vaccinated against hepatitis B, you should get your first vaccination straight away and then two more vaccinations a month apart.
• You will need to return to the doctor for a check-up and then again for check-ups and blood tests (such as repeat HIV tests) at about) for repeat HIV tests at six weeks, three months, six months and one year after the rape.  It is very important that you have these repeat HIV tests at these intervals, because the virus can hide and re-appear later. It is very important that you practice safe sex during this time to protect yourself and your partner.
• If you find that you are extremely anxious and not able to sleep, work or carry out your normal daily activities, understand that it is completely normal for someone who has experienced a life threatening event; it is called Post Traumatic Stress Disorder. Be kind to yourself, take time to heal, do not allow anyone to pressure you to do things at a faster rate than you can cope with.
• Note that it is common for women to have a very heavy period a week to 10 days after the rape. It usually has more to do with psychology and emotions than physical causes and may be the body’s way of trying to cleanse itself, however, if you are concerned about the volume of the flow, then definitely get it checked out.
• Make use of the help from people you trust, a counsellor or support group.  Other rape survivors will very often be the people you can best relate to initially so seek out those who have competently managed to cope and ask for their tips.
• Learn about Post-Traumatic Stress Disorder - a common response after rape and other violent trauma. If you know how to identify symptoms, you will be able to seek help and manage the condition optimally.

(Updated November 2010)
This was compiled by rape survivor and sexual violence expert Charlene Smith and draws on her own ground-breaking research in association with the Centres for Disease Control, United States of America and that of Dr Adrienne Wulfsohn of the Gauteng Health Department. For more information, visit SpeakOut.

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