CHRONIQUE DU Docteur Cheick Atab BADJI
Du problème du viol dans notre société découlent de redoutables conséquences médicales évitables mais négligées et qui constituent un véritable problème de santé publique mais aussi de stabilité sociale.
Il est malheureux de constater en cas de viol, la victime est à la fois victime de son agresseur mais aussi de son entourage. Elle est souvent victime de son certificat médical qui est en général la pièce maitresse dans le dénouement judiciaire de l’affaire. En effet, l’entourage semble ne s’intéresser qu’à l’obtention de ce document qui peut aboutir à la condamnation du bourreau. Même les associations féministes qui s’activent sur la question mettent l’emphase presque exclusivement sur l’obtention du certificat médical et restent plus regardantes sur l’issue du procès, c’est-à-dire sur la condamnation ou non du coupable. Cette hantise quasi obsessionnelle fait le lit d’un drame irréversible, fatale mais pourtant évitable. C’est pourquoi je reste foncièrement d’avis que la prise en charge des viols est en général catastrophique. Elle semble s’arrêter qu’à la consultation de confirmation éventuelle des éléments de preuve matérialisée par le certificat médical.
Or, comme dans certains pays, la femme violée doit être considérée comme une victime d’« accident d’exposition au sang », c’est-à-dire susceptible d’être contaminée au VIH lors de cette agression. A ce titre, elle doit bénéficier, dans les 48 heures qui suivent l’exposition d’un traitement antirétrovirale VIH pouvant s’étendre sur un mois, sauf si la sérologie de l’agresseur est connue négative. C’est pourquoi, connaitre le statut de l’agresseur est important pour éviter à cette innocente une contamination gratuite en prenant rapidement les devants. Et dans le cas éventuel où l’agresseur est séropositif des mesures thérapeutiques sont prises avec l’administration de médicaments pour éviter la contamination. Par contre si le statut de l’agresseur n’est pas connu, il est à priori considéré comme positif. Par conséquence, on déroule le même traitement préventif avec des contrôles de sang chez la victime à un mois, deux et trois mois avant d’arrêter ou non les produits selon les résultats obtenus.
Malheureusement, chaque jour voit son lot de viols, régulièrement rapporté par la presse, à longueur de colonnes de journaux. Et c’est être bien optimiste que d’imaginer que très peu de victimes bénéficient de ce protocole de prise en charge qui est pourtant disponible partout dans le Sénégal, sur tous les sites de dispensation des ARV, et surtout c’est gratuit. C’est peut être un problème de communication, mais il est temps de tirer la sonnette d’alarme sur ce manquement grave qui devait être systématique pour tous les cas de viol. Que le présumé agresseur écope d’un long séjour carcéral, même si c’est légitime et juste comme sanction, n’enlève en rien le drame de se retrouver séropositive. C’est pourquoi, je crois qu’il est temps de changer d’approche du point de vue médico-judicaire. Le dossier médical du juge ne doit plus se résumer au certificat médical, il doit dorénavant comporter en plus du document précédent, un certificat de prise en charge médicale. En effet, le certificat médical, classiquement rapporte les éléments de preuve de l’agression sexuelle. Quand il est expressif, il débouche sur la sanction pénale. Or, aussi lourde soit, elle, cette sanction, ne protège pas directement et immédiatement la présente victime, mais par son caractère dissuasif, protège les autres victimes potentielles. Par contre, le certificat de prise en charge donne assurance au défenseur de la société, en l’occurrence le procureur et ses collaborateurs de la police judiciaire, que la présente victime bénéficie d’une vraie prise en charge orientée contre la transmission du VIH, de l’hépatite, la grossesse, la déchéance mentale. Cette approche nouvelle, que nous souhaitons de tous nos vœux, aiderait, à long terme, à juguler les conséquences médicales de ce fléau chez la victime, au nom de son droit à la santé.
Il ne s’agit pas seulement du VIH- Sida, il existe une autre complication pouvant relever des maladies sexuellement transmissibles virales comme la redoutable hépatite B. Elle peut être prévenue efficacement par une vaccination anti hépatite B, dans les 7 à 15 jours suivant l’agression, sauf si le statut de l’agresseur est connu (Ag Hbs) négatif et si la victime est à jour par rapport à ce vaccin, ce qui est très peu probable dans notre pays où la culture vaccinale est peu développée. Beaucoup d’entre nous doivent leur seule vaccination à leurs parents et très peu ont fait d’eux-mêmes les rappels nécessaires ou même s’y intéressent. Or cette hépatite B peut être contactée par voie sexuelle. Elle expose à des maladies graves du foie pouvant aller jusqu’au cancer du foie.
Enfin l’autre complication évitable, c’est la survenue d’une grossesse. Celle-ci peut être évitée si le drame est découvert tôt. Il suffit de donner à la femme dans les trois jours qui suivent l’agression seulement un (ou deux) comprimé bien précis pour éviter la grossesse. Toute la tragédie sociale des viols se trouve dans la grossesse. Vous imaginez ce qui se passe dans la tête d’un enfant né d’un viol ou d’un inceste dans une société comme la nôtre où on parle des yeux, où le non-dit se dit par le regard. C’est bien pire que de naitre avec un handicap physique qui est juste la privation d’une fonction non vitale. Ici, surtout dans les suites incestueuses, l’enfant nait avec un handicap pas physiquement ou biologiquement vital, mais socialement létal. Il a tout, tout en manquant de tout : son identité. Il est important de pousser la réflexion sur la proportion grandissante des suicides, des agressions, du banditisme. Les sociologues et les psychologues ont du beau travail en perspective.
Par Docteur Cheick Atab BADJI
Gynécologue-Obstétricien/ Obst-Gyn
Master en Management de Projets/Projects Manager
Master (c) en santé publique, Suivi et Evaluation de programmes et projets de santé/ MPH Health Projects and Programs Monitoring and Evaluation
Lauréat en Promotion de la Santé/Health Promotion
MBA en Science Politique, Géostratégie et Relations Internationales/ Political Science, Geostrategy and International Relationship
Analyste de politique, offre politique, biopolitique et Géostratégie de la santé mondiale/ Policy, biopolitic and Global Health Geostrategy analyst
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