July 16, 2018 Dr. Daniela Ligiero, CEO, Together for Girls Together for Girls

When Maureen Phiri of Malawi was 11 years old, her family sent her to be a house girl in her neighbor's home.

While living and working for the family, Maureen was repeatedly raped by a neighbor. Fearing the stigma that she would face from her community if she reported the man, she decided to keep the crime a secret and dealt with the emotional and physical trauma all on her own. It wasn't until several years later that she discovered the man who raped her had also infected her with HIV.

I was luckier than Maureen. I too experienced sexual violence as a child, and like Maureen, did not receive immediate post-rape care services. Thankfully my perpetrator did not have HIV and my experience did not lead to an unplanned pregnancy. In fact, I'm one of the few survivors who over the years was eventually able to access the services, help and support I needed to heal from the trauma I experienced.

Sadly, most children who experience sexual violence do not get the support needed to heal like I did.

The Violence Against Children Surveys (VACS), led by the U.S. Centers for Disease Control and Prevention (CDC) as part of the Together for Girls partnership, show that approximately one in four girls say their first sexual experience was forced or coerced. This has devastating, life-altering consequences for girls—particularly when it comes to HIV and unintended pregnancy. Girls who experience sexual violence are three times more likely to get HIV over their lifetime than girls who have not, and about one in three of these girls report a pregnancy as a result of rape. Sadly, the VACS also show that almost no one who experiences sexual violence receives any services to heal from it. In Kenya, just seven percent of girls who experienced sexual violence sought services and only three percent received them. The situation was even worse for boys: two percent tried to get services and less than one percent got care.

Many people around the world are unaware that some of the long-term consequences of rape can be prevented if a survivor quickly accesses post-rape care. HIV can be prevented with post-exposure prophylaxis medication if taken within 72 hours of a rape. Emergency contraception to prevent an unwanted pregnancy is also most effective within 72 hours—although it can be effective up to 120 hours after unprotected sex. Treatment can also address other short- and long-term health consequences, including physical injuries, other sexually transmitted infections, tetanus or Hepatitis B. Receiving psychosocial support is also critically important, and can help anytime—no matter how long it's been since a rape took place.

To raise awareness of both the need to seek comprehensive services after rape and make these health services available in all communities, Together for Girls and partners launched the Every Hour Matters advocacy campaign, with a suite of resources for diverse audiences available in English, Spanish, French and Swahili.

Most recently, Together for Girls launched the Every Hour Matters Youth Engagement Toolkit--a unique new resource created for the campaign to guide youth-serving organizations in delivering vital information on post-rape care to young people in the form of educational workshops. The idea of the toolkit came from our data: although only a very small percentage of survivors disclose, and an even smaller percentage receive services, those who do disclose are most likely to tell a peer or friend. Using the data as our guide, we developed the workshops to train young people on how to respond when a friend discloses they've been raped, and to help guide them toward receiving the timely care they need and deserve.

These EHM toolkits for Kenya and Uganda, created by youth for youth, guide trained young professionals in hosting educational workshops on post-rape care. In addition to providing information on the critical timelines for accessing post-exposure prophylaxis and emergency contraception after rape, the workshops also foster dialogue around gender dynamics, power structures, and stigma surrounding sexual violence, and they teach young people the importance of reacting empathetically to survivors.Though they were created with input from Kenyan and Ugandan youth with those country contexts in mind, these tools can be easily adapted for other countries and regions around the world.

People don’t receive post-rape care for a lot of reasons: sometimes there are no services, other times they are biased, ineffective or re-traumatizing; our cultural norms on sexual violence lead some victims to feel ashamed, and to question or blame themselves for the crime they experienced. However, another important reason is most people don't know that there's a limited window of time to seek certain kinds of health services, and that "every hour matters" for post-rape care.

Ultimately, we want to create a world where everyone can live free from sexual violence, but in the meantime, let’s ensure survivors receive the critical services that they need.

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