The Monam group of rape survivors in the northern town of Bossangoa in the Central African Republic (CAR) does what it can to keep going, but morale is low and money tight.

"We've been left to fend for ourselves. We get little help from outside. Many of our members have died," the group's chairwoman, Pelagie Ndokoyanga, told IRIN/PlusNews.

Monam, which means "common good" in the Sango language, was set up in 2006 to bring together female survivors of sexual violence committed in 2001 and 2002 amid the mayhem leading up to the most recent of CAR's numerous coups d'etat that brought Francois Bozize to power in March 2003.

As well as providing a forum for solidarity, revenue-generation and wellbeing for women who have suffered gender-based violence (GBV), Monam also aims to combat such abuse, identify its perpetrators and fight against the stigmatisation of women in general and rape survivors in particular. According to Ndokoyanga, several members of the group were abandoned by their husbands after they were raped.

When an HIV testing and counselling centre was set up in Bossangoa in 2005, many of the first HIV-positive cases were the result of rape.

Among them is Nkokoyanga, who also works with the Bossangoa Association of People Living with HIV.

"It's normal to tell relatives when one is infected, it's not a sin," she said when several dozen members of the association met IRIN/PlusNews. "But they are the first to spread the news."

"Nobody has a job here. I have all my certificates but I never get a job because people know I am HIV-positive," she added.

Both organisations would like to enhance their incoming-generating activities such as market trading, but lack of the necessary capital makes it hard to get such projects off the ground.

With UNAIDS estimating CAR's HIV prevalence at 10 percent, with just three percent of HIV-positive adults on life-prolonging antiretroviral therapy, there is a clear and urgent need to scale up HIV education, testing and treatment, but continued armed conflict and insecurity have made this difficult in many areas of the country.

Many rapes, little data

Accurate, detailed statistics about the number of women who suffer GBV in CAR are unavailable. This is partly because of the stigma attached to such attacks, but also because the government barely functions outside the capital and international humanitarian actors have only recently begun working in the country in significant numbers.

In late February 2007, the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported that "sexual and gender-based violence strikes well over 15 percent of women and girls" in northern CAR.

Such attacks increased during the pre-coup unrest and during rebel clashes in early 2006 and early 2007.

One of the main areas of investigation opened in May 2007 by the International Criminal Court (ICC), following a request by the CAR government, is the "many allegations of rape and other aspects of sexual violence perpetrated against hundreds of reported victims...during a peak of violence in 2002/03", according to an ICC statement.

The court’s prosecutor is also closely monitoring reported incidences of GBV committed after 2005, when two rebellions emerged in the north.

“[Following a failed coup attempt in late 2002] there emerged a pattern of massive rapes and sexual violence perpetrated by armed individuals. Sexual violence appears to have been a central feature of the conflict," the ICC statement said, adding that at least 600 victims of GBV had been identified over the course of just five months.

Those targeted included elderly women, young girls and men, the ICC said.

"There were often aggravating aspects of cruelty such as rapes committed by multiple perpetrators, in front of third persons, sometimes with relatives forced to participate," the statement added, noting that the social impact of such crimes "appears devastating".

Programmes slowly getting off the ground

For now, there is little outside help for those directly affected by GBV. Clients of the Organisation pour la compassion et le développement des familles en détresse (OCODEFAD), a domestic NGO, have given testimony about sexual attacks against them to the Bangui office of the ICC prosecutor.

OCODEFAD was founded by Bernadette Sayo, a secondary school teacher whose husband was killed in front of her in 2002 by DRC rebels allied to CAR's then president Ange-Félix Patassé amid a coup attempt. The gunmen subsequently raped her.

OCODEFAD registered hundreds of women and dozens of men, as well as young children and elderly people, sexually abused during this period of unrest. It was largely thanks to pressure from this organisation and international rights groups that the government in Bangui called on the ICC to open its investigation.

In terms of foreign assistance, one NGO, the International Rescue Committee (IRC), set up a GBV programme in the northern town of Kaga-Bandoro in May 2007, providing free medical care and psycho-social counselling for its clients, raising awareness about GBV in nearby communities and holding discussions with various military groups.

Language, as well as stigma, was an obstacle in the beginning. "It took us a month to get a definition of rape. There's no word for it in Sango," Catherine Poulton, IRC GBV coordinator in CAR, told IRIN/PlusNews.

Since it began, the IRC's programme - which covers households along a 50km stretch of road - has handled 1,040 cases of GBV, dealing with associated problems such as sexually transmitted diseases, trauma and rejection by families.

Another seven GBV programmes are in the pipeline for 2008, involving agencies such as the UN World Health Organization, UNICEF, the UN Population Fund and Comité d'Aide Medicale.

In the case of CAR, where the data is so limited, donors may need to break with the tradition of seeking detailed assessments of a problem before signing their cheques. According to some analysts, one has to assume widespread prevalence; in IRC's experience the data emerged from the programme, rather than vice versa.