PEPFAR Expert Meeting on Clinical Post-Rape Care for Children in Primary Health Care Centers that Provide HIV Care

These services include the provision of HIV post-exposure prophylaxis, screening and counseling for gender-based violence, and strengthening linkages among health, legal, law enforcement, and judicial services and programs to mitigate gender-based violence. There has also been an increased focus on and concern about sexual violence against children. The PEPFAR Gender Based Violence Initiative, which ended in 2010, strengthened post-rape care services in primary health centers in Uganda and Rwanda. Results from this initiative indicated that a large proportion of patients presenting for care were under 18 years of age, yet the services were not tailored to the special needs of these age groups. Barriers to services for child survivors include issues around confidentiality, inadequate availability of post-exposure prophylaxis, a lack of training for providers in post-rape care protocols for children, and lack of resources. Insufficient collaboration in the response to sexual and gender-based violence between the medical, legal, and policy sectors and with community-based structures is another barrier. There is limited guidance on provision of post-rape care services for persons under 18 years of age. The East, Central, and Southern African Health Community (ECSA-HC) released guidelines for the clinical management of child sexual abuse in July 2011. The World Health Organization (WHO) Africa Regional Office was involved in the development of the ECSA-HC guidelines, but WHO has not produced its own clinical guidelines specifically for children. Local institutions in countries such as Kenya, South Africa, Zambia, and Zimbabwe are addressing post-rape care for children and adolescents, but PEPFAR has not provided systematic information or guidance to its implementing partners on this issue. A one-day expert meeting was convened in Washington, DC, on April 26, 2012, to develop technical considerations on post-rape care for persons under 18 years of age in primary health centers that also provide HIV care. The meeting brought together 28 people, including PEPFAR U.S. Government and Together for Girls representatives, as well as experienced providers with expertise in child protection, sexual exploitation and abuse, care for survivors of violence, emergency pediatrics, child-focused clinical services, HIV prevention, care and treatment, fistula treatment, and distribution of post-exposure prophylaxis for HIV. Participants represented seven countries and 14 organizations. The objectives of the meeting were to develop key recommendations for the delivery of post-rape care in primary health centers for those under 18 years of age and to review and build upon existing guidelines and documents, including the ECSA-HC guidelines and the adult-focused WHO guidelines for medico-legal care for victims of sexual violence. The technical meeting aimed to develop technical considerations on delivery of post-rape care in primary health centers for those under 18 years of age, specifically to inform PEPFAR and for use by other partners and implementers more broadly. The meeting highlighted the need to bridge the gap between the aspirational and the achievable in post-rape care services for children. Participants emphasized the importance of addressing the barriers to services for child survivors, including issues around confidentiality, inadequate availability of post-exposure prophylaxis, a lack of training for providers in post-rape care protocols for children, and lack of resources. The meeting also emphasized the need for collaboration between the medical, legal, and policy sectors and with community-based structures to respond to sexual and gender-based violence. The technical considerations developed during the meeting aimed to provide guidance on the delivery of post-rape care in primary health centers for those under 18 years of age. The considerations included recommendations for the provision of HIV post-exposure prophylaxis, screening and counseling for gender-based violence, and strengthening linkages among health, legal, law enforcement, and judicial services and programs to mitigate gender-based violence. The technical considerations also emphasized the need for training for providers in post-rape care protocols for children and the importance of addressing the barriers to services for child survivors. The meeting concluded with a call to action to implement the technical considerations and to address the barriers to post-rape care services for children. The participants emphasized the need for continued collaboration and coordination among stakeholders to ensure that post-rape care services are accessible and effective for children.