MONROVIA, 23 January 2009 (IRIN) - Health workers in Liberia report at least 100 people seeking care for rape and other forms of sexual violence each month, according to rights groups that compile government figures, heightening government concern that not enough survivors are receiving treatment to prevent HIV infection.

At the SGBV [sexual and gender-based violence] Duport Road Clinic in the capital Monrovia, director Joan Dalton said the situation is "still a nightmare" with the clinic treating five rape victims in January.

One of the government's priorities is to increase the use of the antiretroviral post-exposure prophylaxis (PEP) treatment by survivors of sexual assault and rape to help avoid HIV infection, according to The Global Fund to Fight AIDS, Tuberculosis and Malaria grant coordinator David Logan.

He said he did not have estimates on how many victims of sexual violence who seek medical services start the PEP treatment.

Logan told IRIN rape continues to be a "serious post-war challenge." Liberia emerged in 2003 from 14 years of civil war.

Twenty government-run health centres across the country offer free services, including PEP, to victims of such violence, according to the Ministry of Gender and Development.

Grant coordinator Logan said part of the newly-awarded $78-million Global Fund grant will go toward counselling, PEP treatments and trainings on sexual and violence for health workers.

A nurse in the capital Monrovia's John F. Kennedy Hospital told IRIN the hospital has had an increase in the number of rape victims seeking services in recent years. "Most the HIV-positive girls I am working with told me they were infected through rape," said Kumbah Vincent.

A rape survivor who gave her name as Martha Flomo told IRIN she did not seek medical care after she was raped in 2003. "It was the final round of fighting in Monrovia. I was forced to go to bed with one of the generals. I am sure I contracted the [virus] from him. But HIV prevention? No, that was not on my mind."

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Flomo said that after her community learned about her HIV status, she felt she had to leave. "I had no alternative but to vacate the community and go elsewhere where people did not know I was HIV-positive."

A 2008 government report identified stigma as a "main obstacle [to increase ] PEP and SGBV services by victims."

Flomo told IRIN her only friends are other HIV survivors. "We all meet and talk about whether we can still contribute to society. We are confident that we can play our part in helping to rebuild Liberia – if only we are accepted and allowed."

The creation of a governmental commission in recent years to fight sexual violence and a soon-to-open court http://www.irinnews.org/Report.aspx?ReportId=77406 devoted to such crimes has encouraged survivors to step forward, said Deweh Gray, president of the Association of Female Lawyers of Liberia, known as AFELL. "But for all those who are reporting these crimes, there are others being treated in clinics and hospitals who do not want to file criminal charges. They prefer to stay silent."

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