Care and support for people living with HIV/AIDS

What makes people vulnerable?Figure 20 shows that many of the abused children not only endure psychologicaltrauma but acquire an infection that will most likely kill them in the prime of their lives.The red part of the graph shows the percentage of children who were probablyinfected during the rape – they tested negative when they first arrived and seroconvertedto HIV-positive status just a few weeks later, once their body had had time tomake the antibodies that most HIV tests use for detecting infection. The pink part ofthe graph shows children who were HIV-positive on arrival. While most of these infectionsprobably preceded rape, some children did not come to the clinic until weeksor months after the rape and may well have acquired the virus from their abuser.Box 10. Child-friendly courts in ZimbabweIn common with many other countries, Zimbabwe has seen very low rates of convictionin cases of sexual assault and rape, and the rates have been lowest for children.As early as 1992, the judicial authorities began to investigate why this was so.They found that children faced with hostile questioning and in the presence of theadult who had abused them very often broke down in court or simply refused tospeak. Intimidated and embarrassed, abused children could not describe the sexualacts they had been subjected to and could not adequately testify. Without their testimony,the accused was often acquitted on technical grounds. These findings led in1994 to the formation of a national committee to design child-friendly courts.One of the first changes to be made was extensive training of the police who takethe initial testimony from a child and of those who examine abused children medically.Social welfare officers were also involved from the earliest stages of a complaint,in counselling children and working to reduce the trauma. Support and cooperationwith police and social welfare officers have been critical to the success of thechild-friendly courts initiative.The next step was to make the court hearings less intimidating. Children now givetestimony in a separate room, linked to the court through closed-circuit television, sothat they do not have to face their abuser. An intermediary sits in the room with thechild, along with a family member or other person who can help the child feel moreat ease. It is the trained intermediary who relays the court’s questions to the child, ingentle language that the child will easily understand. The child also has male andfemale dolls available, so that he or she can demonstrate what happened rather thanhaving to describe it.Zimbabwe now has a child-friendly court in every province. Officials say that morepeople are now bringing cases to trial, and the percentage of convictions is on the rise.Sexual abuse in childhood has many long-term consequences, apart from theimmediate risk of HIV and other sexually transmitted infections. Some of thesehave implications for the further spread of HIV. For example, evidence from high-53