Delphin KOLIE ^1,2* Aboulaye Sow ^2,3 Graziella Ghesquiere ⁴ Stefaan Van Bastelaere ⁵ Maurice Sandouno ⁴ Thierno S. Diallo ⁶ Sabine Soropogui ⁷ Yaya 1. Barry ⁷ Thierno O. Fofana ² Bienvenu S. Camara ^1,2 SIDIKIBA SIDIBE ² Therese Delvaux ⁸ Alexandre Delamou ²

• ¹ Centre de Formation et de Recherche en Santé Rurale de Mafèrinyah, Conakry, Guinea
• ² Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
• ³ Fraternité Médicale Guinée, Conakry, Guinea
• ⁴ Bureau of Belgium Development Agency, Conakry, Guinea
• ⁵ Belgian Development Agency, Brussels, Belgium
• ⁶ Health District Directorate of Mamou, Mamou, Guinea
• ⁷ Health Directorate of Telimélé, Télimélé, Guinea
• ⁸ Institute of Tropical Medicine Antwerp, Antwerp, Antwerp, Belgium

Gender-based violence, particularly sexual violence, is a significant global public health issue with severe physical, psychological, and social consequences for survivors and their communities. In Guinea, limited data exist on the frequency and management of sexual violence in rural areas. This study aimed to analyze the perceptions, responses, and challenges faced in combating sexual violence in rural Guinea in 2020. Methods: A parallel mixed-methods approach was employed, integrating quantitative and qualitative data. For the quantitative analysis, all reported cases of GBV from public health facilities and directorates of girls and women' promotion were collected in 2020. The qualitative component involved key informant interviews with four main participant groups: survivors of GBV and their support networks, healthcare providers, stakeholders and partners involved in GBV prevention and response, and community leaders. The study revealed a high frequency of reported sexual violence among women, with substantial disparities between the two districts. In Mamou, sexual violence among women constituted 61% of all reported GBV cases, whereas in Télimélé, it accounted for only 8%.Additionally, data on sexual violence were inconsistent, with discrepancies in terminology and significant underreporting of cases. Survivors and their families predominantly sought conciliation with perpetrators' families, motivated by fear of retaliation, social stigmatization, and exclusion. This response was more prevalent in communities with limited law enforcement, where perpetrators were often released after short periods of detention.Participants highlighted several barriers to accessing health services and providing comprehensive care to survivors. These barriers included socio-economic constraints, a lack of skilled healthcare providers, frequent stock-outs of essential medical supplies, and the absence of psycho-social and legal support at the community level.The findings highlight the urgent need to enhance the capacity of decentralized health and social services to deliver integrated, trauma-centered care for sexual violence. There is also a pressing need for stronger enforcement of laws related to sexual violence, enhanced training for healthcare providers, and the harmonization of GBV data reporting tools. Tackling socio-cultural barriers through community education, while enhancing access to legal and psychological support are crucial for reducing the frequency of sexual violence and ensuring timely, quality care for survivors in Guinea.