society’s norms and values and to the ongoing environment of impunity that exists within Eastern DRC. Further study is needed to determine the impact of the military rape epidemic on the valuation of women within Congolese culture. Have the years of rape by armed combatants exacerbated the low valuation of women within Congolese society? To constrain the recent trend of civilian perpetrated sexual violence, the environment of impunity will have to be ended and the status of women as well as women’s rights will have to be advanced. Furthermore, the mentality of entire communities will likely have to be reset to recognize that rape is an unacceptable and punishable crime and to accept women as equal members of society. MEDICAL CONSIDERATIONS DELAYS IN PRESENTATION In this study, there were notable delays before women presented to medical attention and these delays, which were similarly documented by Malteser International(46), have important implications. Many women sought medical care only when their physical symptoms persisted or became very severe. In an ideal setting, post-sexual violence care is recommended within the first 72 hours such that HIV post-exposure prophylaxis (PEP), prophylactic antibiotics for sexually transmitted infections (STIs) and post-coital contraceptives can be given. During the time period studied here, Panzi Hospital only routinely offered prophylactic antibiotics. HIV PEP has since been introduced at Panzi Hospital but women present so late that it, along with postcoital contraceptives, are unlikely to be effective. There is an urgent need for village outreach campaigns to educate local communities about the importance of early post-rape care. Sexual violence survivors need to be aware that HIV PEP and post-coital contraceptives are most effective if given within the first 72 hours and that beyond this period, they are unlikely to be beneficial. Successfully encouraging women to seek early post-sexual violence care will also require that the stigma surrounding sexual violence be reduced and this will also require education and awareness raising at the community level. REFERRAL MECHANISMS A large portion of the women in this study reported that they had received care from an NGO or community based organization prior to coming to Panzi Hospital and in 86% of these cases, the service received was transfer to Panzi Hospital. This finding indicates that local referral mechanisms are functioning, at least to some degree. However, the majority of women presenting to Panzi Hospital are thought to come from Bukavu or other large towns and villages within easy commuting distance to Bukavu. We speculate that the number of women presenting for care represents a small fraction of those who have been directly affected by sexual violence. We further speculate that women who live in remote villages are less often seeking post-sexual violence services. Therefore, in terms of improving access to care, the area with the greatest potential for significant impact is the establishment of satellite clinics and referral mechanisms 40