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MBBCh 3- Themes > BCMH 2: Holistic Care of the Rape Survivor > Flashcards

BCMH 2: Holistic Care of the Rape Survivor Flashcards

1
Q

Define rape.

A

Any person (“A”) who unlawfully and intentionally commits an act of sexual penetration with a complainant (“B”), without the consent of B, is guilty of the offense of rape

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2
Q

Define compelled rape.

A

Any person (“A”) who unlawfully and intentionally compels a third person (“C”), without the consent of C, to commit an act of sexual penetration with a complainant (“B”), without the consent of B, is guilty of the offence of compelled rape.

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3
Q

Define corrective rape.

A

Person A has to cure person B of homosexuality so rape them, common in family members and community

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4
Q

Sexual penetration
Any act which causes penetration to any extent whatsoever by: (3)

A

a.) The genital organs of one person into or beyond the genital organs, anus, or mouth of another person;

b.) Any other part of the body of one person or, any object, including any part of the body of an animal, into or beyond the genital organs or anus of another person; or

c.) The genital organs of an animal, into or beyond the mouth of another person “sexually penetrates” has a corresponding meaning namely “sexual violation”

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5
Q

Consent: Voluntary or uncoerced agreement.

Rape thus implies that the person does not _______ or without ______ agree to an act of sexual penetration,

A

voluntarily
coercion

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6
Q

Thus no intimidation, threat of harm, false pretenses or fraudulent means or the person is: (4)

A
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7
Q

At what age can a person legally consent to sex?

A

16 years and above.

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8
Q

Who cannot legally give consent for sex?

A

Individuals under 12 years old or those who are mentally incapacitated.

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9
Q

Can a spouse say no to sex?

A

Yes, any person who says NO, including a spouse, must be respected.

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10
Q

What is statutory rape?

A

Statutory rape occurs when someone older than 16 years has a sexual relationship with a minor, anyone younger than 16 years old.

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11
Q

Is it considered statutory rape if a teenager between 12 and 16 years old has sex with someone less than 12 years old?

A

Yes, statutory rape occurs despite consent in this scenario.

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12
Q

What does Section 15 & 16 amendment state regarding reporting consensual sex within a certain age group?

A

It states that there is no obligation to report consensual sex within that age group, but it’s important to check the validity of consent.

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13
Q

Would consensual sex between two minors, both older than 12 but younger than 16, be considered statutory rape?

A

No, in the eyes of the law, it would not be considered statutory rape.

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14
Q

How has the criminalization of adolescents having consensual sex been addressed?

A

To enhance disclosure and the therapeutic process, adolescents engaging in consensual sex can no longer be criminalized.

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15
Q

According to the Criminal Law (Sexual Offenses and Related Matters) Amendment Act (Act 32 of 2007), what is the obligation regarding reporting sexual offenses against children or mentally disabled persons?

A

A person who has knowledge or reasonable belief of a sexual offense against a child or a mentally disabled person must report it immediately to a police official. Failure to do so can result in a fine, imprisonment for up to five years, or both.

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16
Q

According to the Children’s Act of 2005 as amended in 2007 (Act 38 of 2005), who is required to report suspected abuse or neglect of a child?

A

Various professionals including medical practitioners, teachers, social workers, religious leaders, and others, who reasonably conclude that a child has been abused or neglected, must report it to a designated child protection organization, the provincial department of social development, or a police official.

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17
Q

What protection is provided to individuals who report suspected child abuse in good faith?

A

Individuals who report suspected child abuse or neglect in good faith are not liable to civil action based on the report.

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18
Q

Under the Older Persons Act (Act 13 of 2006), what is the requirement regarding reporting suspicions of abuse or abuse-related injuries concerning older persons?

A

Any person who suspects that an older person has been abused or suffers from an abuse-related injury must immediately notify the Director-General or a police official. Failure to comply with this requirement is an offense.

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19
Q

What protection does a person have when reporting suspicions of abuse or abuse-related injuries concerning older persons?

A

A person who reports suspicions of abuse or abuse-related injuries concerning older persons in good faith is not liable in respect of any notification given.

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20
Q

Holistic care flow diagram

A
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21
Q

What are the legal and forensic responsibilities of a healthcare provider in cases of varicrious trauma? (5)

A
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22
Q

What clinical duties does a healthcare provider have in cases of varicrious trauma?

A
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23
Q

What are the psycho-social aspects of a healthcare provider’s role in cases of varicrious trauma?

A
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24
Q

Aims of medical care:

A
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25
Q

Post Exposure Prophylaxis: (5)

A
  • Pregnancy – Value based decision
  • STI
  • Tetanus
  • Hepatitis B
  • HIV
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26
Q

Survivor accesses health services:

A
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27
Q

What needs to be done within 5 days of the rape? (6)

A
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28
Q

What are the methods of pregnancy prevention? (3)

A
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29
Q

Which females need to have pregnancy prevention considered?

A

For all females at risk including girls who have not yet started menstruating but have signs of breast development

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30
Q

Inform the survivor
Menstruation
- Next menses might start earlier or later than usual with ___
- Survivor should have a pregnancy test if they do not menstruate within ____ ____ of taking ECs

A

ECs
four weeks

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31
Q

Five days or more after the rape:

A
32
Q

Prevention of tetanus: (2)

A

Tetanus prophylaxis

  • For contaminated wounds
  • Booster for persons > 7 years of age
33
Q

Tetanus prophylaxis

Why don’t we give it to younger children? (2)

A
  • Anti-tetanus toxoid 0.5ml IMI
  • Effective for 10 years
34
Q

What is the risk of Hepatitis B transmission associated with rape?

A

There is a risk of transmission with rape.

35
Q

How much protection does the Hepatitis B vaccination provide against vertical transmission from mother to child?

A

Hepatitis B vaccination provides 70-75% protection from vertical transmission in a mother to child.

36
Q

How soon after exposure should the Hepatitis B vaccination be given to provide protection?

A

The Hepatitis B vaccination should be given immediately after exposure and can provide protection for up to 3 weeks.

37
Q

How many doses of the Hepatitis B vaccine are required for complete protection against future infections?

A

Three doses of the Hepatitis B vaccine are required for complete protection against future infections.

38
Q

When should the second and third doses of the Hepatitis B vaccine be administered?

A

The second dose should be administered 1-2 months after the first dose, and the third dose should be administered 4-6 months after the first dose.

39
Q

What should be done if a blood test reveals titer levels below 10 milliunits after Hepatitis B vaccination?

A

If titer levels are below 10 milliunits, the patient is susceptible to infection, and another vaccine against Hepatitis B should be administered.

40
Q

Summary of prevention:

A
41
Q

What is the approach regarding treatment versus prevention when a child presents with an STI as a minor, indicating likely rape?

A

The focus is on syndromic management, considering the side effects, and the medico-legal significance of testing, as it can prove sexual assault in children.

42
Q

What is the syndromic management approach for STIs, and what are its potential side effects?

A

The syndromic management approach involves considering potential side effects.

43
Q

What is the medico-legal significance of testing for STIs in cases of sexual assault involving minors?

A

Testing for STIs in minors can prove sexual assault, which holds significant legal implications.

44
Q

Are STI tests typically performed for adults?

A

STI tests are not typically performed for adults unless there are specific indications or symptoms.

45
Q

When considering STIs, what differential diagnoses should always be taken into account?

A

In addition to STIs, healthcare providers should consider differential diagnoses such as injuries, discharge, and tumors.

46
Q

What information should be provided to patients regarding STI treatment?

A

Patients should be informed about the potential side effects of treatment. Healthcare providers may also consider offering anti-emetic medication to mitigate these side effects.

47
Q

Syndromic treatment of STIs: (4)

A
48
Q

Summary of HIV treatment for victims:

A
49
Q

What is post-exposure prophylaxis (PEP) used for in the context of HIV?

A

PEP is used for the prevention of HIV after exposure.

50
Q

When should PEP be started after exposure to HIV?

A

PEP should be started as soon as possible, ideally within hours after exposure.

51
Q

Is PEP likely to be effective if started more than 72 hours after exposure?

A

PEP is probably not effective if started more than 72 hours after exposure to HIV.

52
Q

Why is it necessary to test for HIV before offering PEP?

A

Testing for HIV before offering PEP is essential to prevent the development of resistance.

53
Q

What counseling is important to provide before and after offering PEP?

A

Pre and post-test counseling is crucial so that the survivor understands the implications of the results and the use of PEP.

54
Q

Can PEP guarantee successful prevention of HIV seroconversion?

A

No, there is no guarantee for successful prevention of HIV seroconversion with PEP.

55
Q

What are the side effects of PEP, and how should they be managed?

A

Side effects of PEP should be managed, and adherence to the prescribed regimen is essential.

56
Q

How long should condoms be used after completing a course of PEP?

A

Condoms should be used for at least 4 months after completing a course of PEP.

57
Q

PEP
First line treatment: one of the following NRTI combinations

Once daily most frequently used: (2)

A
  • Tenofovir (TDF) 300 mg and emtricitabine (FTC) 200 mg OR
  • 3TC 300mg
58
Q

PEP
Twice daily:

A
59
Q

What is a challenge regarding testing for HIV before initiating PEP?

A

The decision to test for HIV immediately may be difficult, especially considering that 25-30% of women may already be HIV-infected.

60
Q

How long can a starter pack for PEP typically be given?

A

A starter pack for PEP is typically given for only 3 days (72 hours).

61
Q

What is the recent recommendation from the CDC regarding the duration of the starter pack for PEP?

A

The CDC now recommends a starter pack for up to 5 days.

62
Q

What is an important consideration regarding the risk of developing resistance to HIV medications?

A

PEP regimens should not result in resistance to HIV medications.

63
Q

What are some potential side effects of PEP?

A

There is a risk of side effects, although current regimens have little risk of toxicity. However, tenofovir or stavudine-based regimens are better tolerated than zidovudine.

64
Q

What is a challenge related to adherence to PEP regimens?

A

Adherence to PEP regimens can be challenging, especially due to poor logistics and the need for follow-up care.

65
Q

What is the recommended duration of condom use for HIV-negative survivors after rape?

A

HIV-negative survivors should use condoms for intercourse for at least three months after rape.

66
Q

Besides providing protection from HIV for the survivor during consensual sex, what is another benefit of using condoms during this period?

A

Using condoms during this period also protects the survivor’s partner during the window period.

67
Q

How can survivors explain the need for condom use to their partners if they are hesitant to disclose the rape?

A

Survivors can explain to their partners that for health reasons, they have been advised to use condoms to avoid pregnancy for some months.

68
Q

Can survivors still transmit disease to their own partner during the three-month period of condom use?

A

Yes, because this is the window period during which HIV may not be detectable by testing.

69
Q

What does the Criminal Law Amendment Act allow regarding testing suspected perpetrators for HIV?

A

The act allows an application to be made to have suspected perpetrators tested for HIV, and the result can be used in sentencing.

70
Q

Why might testing the suspected perpetrator/s not assist in making a decision regarding post-exposure prophylaxis (PEP)?

A

Testing may only occur after 72 hours due to logistics, which may be too late for PEP to be effective.

71
Q

What must be provided to suspects before and after HIV testing according to the Criminal Law Amendment Act?

A

Suspects must be provided with pre- and post-test counseling for HIV, and if positive, they can be referred for further HIV management.

72
Q

Caring for the mental and sexual health:
Aims of physiological care = (7)

A
73
Q

Psychology support:

A
74
Q

Care for health workers:

A
75
Q

Social support:

A
76
Q
A

MBBCh 3- Themes (27 decks)

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