PEPFAR funds were allocated to the Research Triangle Institute (RTI) in FY 2007 to improve care provided

to victims of rape, through the establishment of seven new Thuthuzela Care Centers (TCCs). These multi-

disciplinary centers provide comprehensive care services to women and children rape survivors, including

post-exposure prophylaxis (PEP), HIV and AIDS counseling and testing, and referral to HIV care and

treatment services. These centers also assist men and boys, who are increasingly becoming victims of

rape. In FY 2008, funds will no longer be provided to RTI as the ceiling of this contract can not be

increased. This activity will be re-competed and the RFP will be issued by December 2007.

This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. Therefore there is no need to continue funding this

activity with FY 2008 COP funds.

SUMMARY:

The goal of this project is to prevent the acquisition of HIV and AIDS among victims of rape and sexual

violence through the establishment and operations of nine new Thuthuzela Care Centers (TCCs).These

multi-disciplinary centers provide comprehensive services to women and children rape or assault survivors,

including in this case a primary emphasis on post-exposure prophylaxis (PEP), with secondary emphases

on HIV and AIDS counseling and testing, and referral to HIV care and treatment services. These centers

also assist girls and boys who are increasingly becoming victims or perpetrators of rape. The major

emphasis area will be on training and technical assistance with minor emphasis on commodity

procurement. Target populations will include infants, girls, boys, men, women, doctors, nurses and

pharmacist as well as the TCC core team. Commodities to be procured include rape kits, medical

equipment, and comfort kits.

BACKGROUND:

This project is a continuation of work supported through PEPFAR funds in FYs 2006 and 2007 that were

used to evaluate and upgrade existing TCCs in keeping with the National Department of Health's (NDOH)

National Management Guidelines for the Care of Rape Victims. In FY 2008, this project will focus on

maintaining established TCCs (20 total) in provinces where they do not currently exist and in other locations

where need is identified. This activity is linked to the USAID Governing Justly and Democratically (GJD)

office's program to support the Sexual Offences and Community Affairs (SOCA) Unit of the National

Prosecuting Authority (NPA) of the Department of Justice and Constitutional Development (DoJCD) in its

endeavor to eradicate all forms of gender-based and sexual violence against women and children,

especially the crime of rape. The DoJCD/NPA/SOCA Unit has responded to the ongoing problem of sexual

offences, and specifically rape, in the country by seeking to upgrade and expand the TCC network from 10

to 80 TCCs nationwide. The TCCs are a bold approach to rape prevention, care and treatment for victims of

sexual violence and assault involving the health, justice, and civil society sectors in this endeavor. This

project will advance the Women's Justice and Empowerment Presidential Initiative (WJEI) which seeks to

establish a total of 30 TCCs to help the SAG achieve its goal of 80 TCCs nationwide. For victims of rape,

the benefit of being assisted through a TCC is that the rape survivor can obtain all of the services needed at

a single location, including medical assistance, access to justice by working with the local police and

prosecutors, and access to counselors and emergency support services. Most TCCs are located within

hospitals or near health care facilities, where there is a growing recognition of the links between violence

against women or children and HIV and AIDS. The risk of HIV infection as a result of rape is significant in

South Africa. Perpetrators seldom use condoms, placing the majority of women and children who are

victims of this crime at risk. PEP represents an important intervention that can make a substantial

contribution toward preventing HIV acquisition in particular and improving the healthcare of rape victims in

general.

The TCC Model: According to the TCC model, when rape victims arrive at the police station to report a

rape, they are removed from the crowds to a quiet room to take a statement. They are then transported to

the nearest TCC where they are welcomed by a site coordinator. A dedicated nurse or doctor is then

summoned to conduct the forensic medical exam. The Victim Assistance Officer (VAO) and the doctor or

nurse explains to the victim what procedures need to be performed and help the victim understand why she

must sign consent forms. The police detective on call to the centre is summoned and assigned to the case.

Case managers are responsible for coordinating sexual offense cases and assisting the victim to

understand what information the police investigator needs to investigate the crime. If the victim decides to

pursue charges, the case manager opens a file and tracks the status of the victim's case. The victim is then

referred to a local NGO or CBO to provide follow-on care and treatment services and support, as

appropriate, throughout the legal process. This is the model. However, an audit conducted by RTI using FY

2006 PEPFAR funds found that TCCs are not always 100% compliant with this model (the highest score

was 87.5% compliance). Upgrading current TCCs as well as operationalizing new ones consequently

became an integral part of the program.

ACTIVITIES:

Using FY 2008 PEPFAR funds, a partner TBD will continue to support DOJCD/NPA/SOCA efforts to

upgrade and expand the TCC model targeting nine additional TCCs. Part of this funding will continue to go

towards the training of the medical officers (doctors, nurses and pharmacists) on how to provide PEP as

well as to site coordinators and VAOs on how to educate victims on compliance with PEP as well as training

and technical assistance to site coordinators who manage the multidisciplinary team and administer each

TCC. Each rape victim will be encouraged to test for HIV. If the rape is reported within 72 hours, the rape

survivors who test negative will be provided with PEP. They will be placed on PEP for 28 days and tested

again for sero-conversion at three months and again at six months. They will be supported by TCC staff or

affiliated CBOs and NGOs to ensure compliance with medication as well overall well-being.

EXPECTED RESULTS:

Rape victims who test positive for HIV will be given appropriate counseling and will be referred to the

nearest government treatment site for further counseling, care and Antiretroviral Treatment (ART) when

necessary. This project will be sustainable beyond the provision of PEPFAR funds, as the government will

continue to support the TCC system and incorporate operating funds for the TCCs system in the national

Activity Narrative: budget.

This project will assist PEPFAR to meet its goal of averting 7 million new infections by playing a critical role

in increasing access to and improving quality of vital post-rape services, including the provision of PEP.

PEPFAR funds were allocated to the Research Triangle Institute (RTI) in FY 2007 to improve care provided

to victims of rape, through the establishment of seven new Thuthuzela Care Centers (TCCs). These multi-

disciplinary centers provide comprehensive care services to women and children rape survivors, including

post-exposure prophylaxis (PEP), HIV and AIDS counseling and testing, and referral to HIV care and

treatment services. These centers also assist men and boys, who are increasingly becoming victims of

rape. In FY 2008, funds will no longer be provided to RTI as the ceiling of this contract can not be

increased. This activity will be re-competed and the RFP will be issued by December 2007.

This activity was approved in the FY 2007 COP, was funded with FY 2007 PEPFAR funds, and is included

here to provide complete information for reviewers. Therefore there is no need to continue funding this

activity with FY 2008 COP funds.

SUMMARY:

The goal of this project is to improve care provided to victims of rape and sexual violence by establishing or

upgrading a network of operations for Thuthuzela Care Centers (TCCs) nationwide. These multi-disciplinary

centers, piloted by the Department of Justice and Constitutional Development (DoJCD) South African

Government (SAG) provide comprehensive services to women and children rape or assault survivors.

These centers also assist girls and boys who are increasingly becoming victims or perpetrators of rape.

Activities include support to strengthen the HIV-related clinical, psychological, social, and preventive care

services at the TCCs for rape victims in all provinces. Populations served are adults and children, PLHIV,

health care workers and caregivers. The major emphasis area is training with minor emphasis areas in

information, education and communication, commodity procurement, referral systems, linkages with other

sectors and initiatives, and local organization capacity development. This is the second year of support to

the TCCs. Thuthuzela means "to comfort" in isiXhosa. Target populations will include infants, girls, boys,

men, women, doctors, nurses and pharmacists as well as the TCC core team that staffs each center.

Commodities to be procured include rape kits, medical equipment, and comfort kits.

BACKGROUND:

This project is a continuation of work supported through PEPFAR funds since FY 2006. The program

started by evaluating and upgrading existing TCCs in keeping with the National Department of Health's

(NDOH) National Management Guidelines for the Care of Rape Victims. In FY 2008, this project will focus

on maintaining established TCCs in provinces where they do not currently exist and in other locations where

need is identified. This activity is linked to the USAID Governing Justly and Democratically (GJD) office's

program to support the Sexual Offences and Community Affairs (SOCA) Unit of the National Prosecuting

Authority (NPA) of the Department of Justice and Constitutional Development in its endeavor to eradicate all

forms of gender-based and sexual violence against women and children, especially the crime of rape. The

DoJCD/NPA/SOCA Unit has responded to the ongoing problem of sexual offences, and specifically rape, in

the country by seeking to upgrade and expand the TCC network from 10 to 80 TCCs nationwide. The TCCs

are a bold approach to rape prevention, care and treatment for victims of sexual violence and assault

involving the health, justice, and civil society sectors in this endeavor. This project will advance the

Women's Justice and Empowerment Presidential Initiative (WJEI) which seeks to establish or upgrade at

least 30 TCCs to help the SAG achieve its goal of 80 TCCs nationwide. For victims of rape, the benefit of

being assisted through a TCC is that the rape survivor can obtain all of the services needed at a single

location, including medical assistance, access to justice by working with the local police and prosecutors,

and access to counselors and emergency support services. Most TCCs are located within hospitals or near

health care facilities, where there is a growing recognition of the links between violence against women or

children and HIV and AIDS. The risk of HIV infection is a very real possibility with rape. Perpetrators seldom

use condoms, placing the vast majority of women and children who are victims of this crime at risk.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Strengthening HIV care in the TCCs

Using FY 2008 PEPFAR funds, a partner TBD will continue to support DOJCD/NPA/SOCA efforts to enable

the TCCs to improve the quality of basic HIV-related clinical, psychological, social and preventive care

services offered by the TCCs for rape victims with an emphasis on women and children rape victims. The

TCCs offer a place of refuge and comfort for raped women and children, with an aim to reduce secondary

victimization suffered by rape victims by ensuring that the crime reporting process, medical examination,

initial counseling, quality of HIV-related care services are all done in one place on a 24-hour basis. Care

services that will be provided include counseling and testing, disclosure support, post exposure prophylaxis,

gender-based violence screening, quality and supportive medical examination, psychological care and

counseling by trained providers, personal hygiene, screening for pain and symptoms and HIV-related

conditions such as opportunistic infections and provision of shelter and comfort measures. Qualified health

care workers will also provide messaging on HIV prevention and counsel and refer for the provision of CD4

testing, ART, OI prevention and treatment (including cotrimoxazole prophylaxis, and TB care), nutritional

care and appropriate child survival and child care interventions (growth monitoring, child-specific nutritional

care, immunizations). The program will provide legal counseling, program linkages for the legal protection of

women and children and follow-up legal advice. A particular program emphasis is ensuring that women's

legal rights and child protection is promoted and protected.

ACTIVITY 2:

Using FY 2008 PEPFAR funds, a partner TBD will continue to support DOJCD/NPA/SOCA efforts on

training of medical officers (doctors, nurses and pharmacists) on how to provide PEP. Site coordinators and

Victim Assistance Officers (VAOs) will receive training on how to educate victims on compliance with PEP

as well as training and technical assistance to site coordinators who manage the multidisciplinary team.

Each rape victim will be encouraged to test for HIV. If the rape is reported within 72 hours, the rape

survivors who test negative will be provided with PEP. They will be placed on PEP for 28 days and tested

again for sero-conversion at 3 months and again at 6 months. They will be supported by TCC staff or

affiliated CBOs and NGOs to ensure compliance with medication as well overall well-being. Rape victims

who test positive for HIV will be given appropriate counseling and will be referred to the nearest government

Activity Narrative: treatment site for further counseling, care and Antiretroviral Treatment (ART) when necessary. This project

will be sustainable beyond the provision of PEPFAR funds, as the SAG will continue to support the TCC

system and incorporate operating funds for the TCC’s system in the national budget.

These activities will contribute to PEPFAR goals of providing palliative care to 10 million HIV-infected

individuals and their families, including OVC.

SUMMARY:

The goal of this project is to improve and expand the counseling and testing services provided to victims of

rape and sexual violence by upgrading and expanding a network of Thuthuzela Care Centers (TCCs)

nationwide. These multi-disciplinary centers provide comprehensive services to women and children rape or

assault survivors, including post-exposure prophylaxis (PEP), HIV and AIDS counseling and testing, and

referral to HIV care and treatment services. These centers also assist girls and boys who are increasingly

becoming victims or perpetrators of rape. The major emphasis area is training and network/linkages/referral

with minor emphasis areas on commodity procurement, linkages with other sectors and initiatives, and local

organizational capacity development. Target populations will include infants, girls, boys, men, women,

doctors, nurses and pharmacist as well as the TCC core team. Commodities to be procured include rape

kits, medical equipment, and comfort kits.

BACKGROUND:

This project is a continuation of work supported through PEPFAR funds in FY 2006 and FY 2007. These

funds were used to evaluate and upgrade existing TCCs in keeping with the National Department of

Health's (NDOH) National Management Guidelines for the Care of Rape Victims. In FY 2008, this project

will focus on maintaining established TCCs and on opening new ones in provinces where they do not

currently exist or in other locations where need is identified. This activity is linked to the USAID Governing

Justly and Democratically (GJD) office's program that supports the Sexual Offences and Community Affairs

(SOCA) Unit of the National Prosecuting Authority (NPA) of the Department of Justice and Constitutional

Development (DoJCD) in its endeavor to eradicate all forms of gender-based and sexual violence against

women and children, especially the crime of rape. The DoJCD/NPA/SOCA Unit has responded to the

ongoing problem of sexual offences, and specifically rape, by seeking to upgrade and expand the TCC

network from 10 to 80 TCCs nationwide. The TCCs are a bold approach to rape prevention, care and

treatment for victims of sexual violence and assault involving the health, justice, and civil society sectors in

this endeavor. This project will advance the Women's Justice and Empowerment Presidential Initiative

(WJEI) which seeks to upgrade or establish at least 30 TCCs to help the SAG achieve its goal of 80 TCCs

nationwide. Victims of rape benefit from TCC assistance because the survivor can obtain all of the required

services needed at a single location. These services include medical assistance, access to justice through

with the local police and prosecutors, and access to counselors, testing, and emergency support services.

Most TCCs are located in hospitals or near healthcare facilities where there is a growing recognition of the

links between violence against women or children and HIV. The risk of HIV infection is a very real possibility

with rape. Perpetrators seldom use condoms, placing the vast majority of women and children who are

victims of this crime at risk.

The TCC Model: The TCC has developed a specific model aimed at protecting rape victims. When rape

victims arrive at the police station, they are removed from the crowds to a quiet room where the police

officer can take a statement. Thereafter, victims are transported to the nearest TCC where they are

welcomed by a site coordinator. A dedicated nurse or doctor is summoned to conduct the forensic medical

exam. The Victim Assistance Officer (VAO) and the doctor or nurse on duty explain the procedures and

help the victim understand why consent forms must be signed. The police detective on call is summoned

and assigned to the case. Case managers are responsible for coordinating sexual offence cases and assist

the victim to understand what information the police investigator needs to investigate the crime. If the victim

decides to pursue charges, the case manager opens a file and tracks the status of the victim's case. The

victim is then referred to a local non-governmental or community-based organization for follow-on care and

treatment services and support, as appropriate, throughout the legal process. However, an audit conducted

by Research Triangle Institute (RTI) using FY 2006 PEPFAR funds found that the ten of the existing TCCs

are not 100% compliant with this model (the highest score was 87.5% compliance). Consequently, FY 2008

funds will be used to upgrade current TCCs as well as making new ones operational and compliant with the

model.

Activity 1: Strengthening Counseling and Testing Services in the TCCs

Using FY 2008 PEPFAR funds, a partner TBD will continue to support DOJCD/NPA/SOCA’s efforts to

improve the quality of counselling and testing (CT) provided to victims of rape and sexual assault. The

emphasis is on women and children rape victims. The TCCs will offer CT services to victims as part of an

integrated package of assistance provided by the TCC Core Team, which includes medical officers

(doctors, nurses and pharmacists), a Victim Assistance Officer (VOA) and a Site Coordinator who will be

trained on how to provide CT services as part of a multidisciplinary team. This activity will provide victims of

rape or sexual assault with access to HIV prevention and care services including elements of the preventive

care package, on-site psychosocial support, and stigma reduction strategies for PLHIV. This includes

counseling and referring for HIV testing services, disclosure support, basic screening for pain and HIV-

related conditions such as opportunistic infections, HIV prevention messaging and access to condoms,

referrals for the clinical monitoring and care that includes antiretroviral treatment, opportunistic infection

prevention and treatment (including cotrimoxazole prophylaxis), TB care, nutritional care and appropriate

child survival and child care interventions. Rape victims who test positive for HIV will be given appropriate

counseling and will be referred to the nearest government treatment site for further counseling, care, and

antiretroviral treatment when necessary. Strategies to reduce stigma directed towards PLHIV will be

integrated in partnership with the TCC VOA. Outcomes include improved access to HIV and AIDS care,

counseling and testing as well as stigma reduction and strategies to prevent the further spread of the

disease.

This project will be sustainable beyond the provision of PEPFAR funds, as the government will continue to

support the TCC system and incorporate operating funds for the TCCs system in the national budget. This

project will assist PEPFAR to meet its goal of providing CT to 10 million HIV-infected individuals and their

families.