Sexual violence is a common and serious public health problem affecting millions of people each year throughout the world. It is driven by many factors operating in a range of social, cultural and economic contexts. At the heart of sexual violence directed against women is gender inequality. The World Health Organization (WHO) has identified violence, including violence against women, as “a major public health problem in Africa.” Gender-based violence creates conditions conducive to the transmission of HIV to women, since women in violent relationships often experience coercive, violent sex and are unable to negotiate HIV prevention. Furthermore, some women may be unable to leave violent relationships because of their economic and psychological dependence on their abusers. Women’s unequal property rights also contribute to the HIV/AIDS epidemic in the region. Under the laws and customs of many sub-Saharan African countries, women neither inherit nor keep property upon divorce on an equal basis with men. This reinforces their dependence on men, sometimes locking them in abusive relationships. Sexual violence occurs throughout the world. Although in most countries there has been little research conducted on the problem, available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner, and up to one-third of adolescent girls report their first sexual experience as being forced. Sexual and gender-based violence against women and children is common in Zambia, especially in Lusaka and the Copperbelt provinces. It is difficult to determine the true extent because many victims or survivors do not report the violence or underreport it. The Zambian police’s Victims Support Unit had reports of 65 rapes of adults and 626 of children in Lusaka alone from January to August 2008. Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences. Its impact on mental health can be as serious as its physical impact, and may be equally long lasting. Deaths following sexual violence may be as a result of suicide, HIV infection or murder – the latter occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’. Sexual violence can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families and others as a consequence. Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, men who coerce a spouse into a sexual act believe their actions are legitimate because they are married to the woman. The following table shows chosen results in Zambia of a survey cunducted in eight african countries published in the BMC Women’s Health 2007, 7:11
|% who said women do not have the right to refuse to have sex with their husbands or boyfriends
|% who said women sometimes deserve to be beaten
|% who said if a women gets raped ist her own fault
|% who said forcing your partner to have sex, is not rape
|% who said: In my culture it is acceptable for a man to beat his wife
Table 1: Chosen male attitudes in Zambia taken from the a.m. survey
Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of childsexual abuse. The commonly used terms ‘domestic violence’ and ‘intimate partner violence’ (IPV) are often used to cover sexual as well as non-sexual violence and other forms of abuse in this setting. GBV is a complex phenomenon often including a combination of physical, sexual and emotional violence and deprivation or neglect. Domestic violence is not a single behaviour but a mix of assaulting and coercive physical, sexual, and psychological behaviours designed to manipulate and dominate the partner to achieve compliance and dependence. Gender-based violence takes many forms, and can include physical, emotional, or sexual abuse. It can occur in wartime, or in times of peace. While both males and females can suffer from gender-based violence, studies show that women, young women, and children of both sexes are most often the victims. Gender-based violence can include rape and sexual assault, violence between intimate partners, and violence associated with war. Here we concentrate on sexual violence to girls, young women and women. GBV increases gender inequalities and is an important cause of ‘choice disability’. The most pervasive form of gender-based violence is violence committed against a woman by her intimate partner. “Violence against women is perhaps the most shameful human rights violation... As long as it continues, we cannot claim to be making real progess towards equality, development, and peace.” (Kofi Annan). Sexual violence is defined as: any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work. Coercion can cover a whole spectrum of degrees of force. Apart from physical force, it may involve psychological intimidation, blackmail or other threats – for instance, the threat of physical harm, of being dismissed from a job or of not obtaining a job that is sought. It may also occur when the person aggressed is unable to give consent – for instance, while drunk, drugged, asleep or mentally incapable of understanding the situation. Sexual violence includes rape, defined as physically forced or otherwise coerced penetration – even if slight – of the vulva or anus, using a penis, other body parts or an object. The attempt to do so is known as attempted rape. Rape of a person by two or more perpetrators is known as gang rape. Sexual violence can include other forms of assault involving a sexual organ, including coerced contact between the mouth and penis, vulva or anus. Rape is not primarily about sexual satisfaction but mainly about violence and subjugation. Between the perpetrator and the victim is a difference regarding age, maturity and/or power. The difference of power is labeled of dependency, age-difference, inferiority or other factors.
Explaining gender-based violence
Gender-based violence is rooted in the historically unequal power relations (social, economic, cultural, and political) between males and females. The following indicators of gender-based violence and HIV infection are useful for understanding gender-based violence in relation to AIDS. Violence against women and children around the world has been reported to be most common where:
— gender roles are rigidly defined and enforced;
— the concept of masculinity is linked to toughness, male honour, or dominance;
— physical punishment of women and children is culturally tolerated;
— violence is accepted as a means of interpersonal conflict resolution;
— women are economically dependent and have limited access to employment, education, training, money and credit;
— children do not receive adequate care during times when their parents are absent;
— conditions of poverty result in children working, which include conditions that make them vulnerable to sexual exploitation; or where girls and women are at risk of rape in the course of their daily subsistence tasks;
— there are disincentives to reporting sexual violence to judicial authorities;
— there is a low conviction rate for crimes of violence and cases of gender-based violence are inadequately documented, followed up and prosecuted; and
— there are few or no organisations dealing with gender-based violence in research, law, education, social activism, political advocacy, and service
In contrast, violence against women and children has been reported to be at low levels where:
— women have power and authority outside of the family;
— family members intervene to prevent and reduce the likelihood of domestic violence;
— there are all-women collectives;
— there are community sanctions against gender-based violence; and
— women are economically independent from men.
The experience of having been physically abused as a child, or having witnessed violence perpetrated by the father against the mother may predispose the survivor to early sexual debut, multiple partnerships and other high risk activities, or to abuse of partners later in life. In order to address this, research and interventions would have to be designed to identify and target girls at an early age.
Social gender norms
Gender roles are defined by societal norms that are learned from a young age. The relationship between men and women is also learned through societal norms. Constructions of gender categories are closely related to fantasies of power and identity. For example, for a man, having multiple partners may be a status symbol measuring masculinity and success among one’s friends.
Many organisations report what one organisation called a ‘second wife problem’ where men have multiple partnerships because it is considered a traditional right.
Cultural and traditional reasons
In many countries of sub-sahara Africa there are some cultural and traditional habits which lead to gender based violence and make the HIV/AIDS situation worse. Especially affected are young girls. The phenomenon of the sugar-daddies is also to be mentioned as the high rate of rape of step fathers, uncles or cousins. Another myth which is common in sub-sahara Africa is the belief that sex with virgin can cure HIV/AIDS. The high rate of poverty and the high numbers of orphans lead girls and young women into prostitution. Because of this reasons girls and young women are especially vulnerable for HIV/AIDS. They have a five times higher risk of a HIV/AIDS-infection than the males of the same age.
The gender norms described above can be linked to economic sub-structures. These links are exacerbated by HIV/AIDS, which contributes to poverty and marginalisation of women.
Forms and contexts of sexual violence
A wide range of sexually violent acts can take place in different circumstances and settings. These include, for example:
— rape within marriage or dating relationships;
— rape by strangers;
— systematic rape during armed conflict;
— unwanted sexual advances or sexual harassment,
— including demanding sex in return for
— sexual abuse of mentally or physically
— disabled people;
— sexual abuse of children;
— forced marriage or cohabitation, including the marriage of children;
— denial of the right to use contraception or to adopt other measures to protect against
— sexually transmitted diseases;
— forced abortion;
— violent acts against the sexual integrity of women, including female genital mutilation and obligatory inspections for virginity;
— forced prostitution and trafficking of people for the purpose of sexual exploitation.
Most perpetrators of child sexual abuse are known to the children concerned, suggesting that child sexual abuse often takes place at home, school or in the surrounding neighbourhood. Organisations cited an increasing number of children who were abused by their fathers, uncles or stepfathers. A few organisations also noted a number of young and teenaged boys who have been sodomised.
The extend of the problem
Data on sexual violence typically come from police, clinical settings, nongovernmental organizations and survey research. The relationship between these sources and the global magnitude of the problem of sexual violence maybe viewed as corresponding to an iceberg floating in water. In general, sexual violence has been a neglected area of research. The available data are scanty and fragmented. Police data, for instance, are often incomplete and limited. Many women do not report sexual violence to police because they are ashamed, or fear being blamed, not believed or otherwise mistreated. A growing number of studies, particularly from sub-Saharan Africa, indicate that the first sexual experience of girls is often unwanted and forced.
Sexual violence in schools, health care settings, armed conflicts and refugee settings
For many young women, the most common place where sexual coercion and harassment are experienced is in school. In an extreme case of violence in 1991, 71 teenage girls were raped by their classmates and 19 others were killed at a boarding school in Meru, Kenya. The research done in Africa, however, has highlighted the role of teachers there in facilitating or perpetrating sexual coercion. A report by Africa Rights found cases of schoolteachers attempting to gain sex, in return for good grades or for not failing pupils, in the Democratic Republic of the Congo, Ghana, Nigeria, Somalia, South Africa, Sudan, Zambia and Zimbabwe. A recent national survey in South Africa that included questions about experience of rape before the age of 15 years found that schoolteachers were responsible for 32% of disclosed child rapes.
Factors increasing women’s vulnerability
One of the most common forms of sexual violence around the world is that which is perpetrated by an intimate partner, leading to the conclusion that one of the most important risk factors for women – in terms of their vulnerability to sexual assault – is being married or cohabiting with a partner. Other factors influencing the risk of sexual violence include:
— being young;
— consuming alcohol or drugs;
— having previously been raped or sexually abused;
— having many sexual partners;
— involvement in sex work;
— becoming more educated and economically empowered, at least where sexual violence perpetrated by an intimate partner is concerned;
Factor’s increasing men’s risk of committing rape
— Alcohol and drug consumption
— Psychological factors
— Early childhood environments
— Family honour and sexual purity
— Physical and social environment
— Social norms
The consequences of sexual violence
Pregnancy may result from rape, though the rate varies between settings and depends particularly on the extent to which non-barrier contraceptives are being used. Experience of coerced sex at an early age reduces a woman’s ability to see her sexuality as something over which she has control. As a result, it is less likely that an adolescent girl who has been forced into sex will use condoms or other forms of contraception, increasing the likelihood of her becoming pregnant. Gynaecological complications have been consistently found to be related to forced sex. These include vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain and urinary tract infections. HIV infection and other sexually transmitted diseases are recognized consequences of rape. Research on women in shelters has shown that women who experience both sexual and physical abuse from intimate partners are significantly more likely to have had sexually transmitted diseases. Violent or forced sex can increase the risk of transmitting HIV. In forced vaginal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus --- when it is present --- through the vaginal mucosa. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membrane has not yet acquired the cellular density providing an effective barrier that develops in the later teenage years. Those who suffer anal rape --- boys and men, as well as girls and women --- are also considerably more susceptible to HIV than would be the case if the sex were not forced, since anal tissues can be easily damaged, again allowing the virus an easier entry into the body. It is not just young women coerced into sex outside of marriage who are at risk. A young married woman engaging in monogamous heterosexual sex with her husband can also be at risk. In these circumstances traditional messages of prevention are of little relevance as condoms are less likely to be used inside marriage. For example, a study in Zambia found that only 11% of women interviewed believed that a woman had the right to ask her husband to use a condom - even if he had proven himself to be unfaithful and was HIV-positive. In Kisumu, Zimbabwe, research has revealed that the majority of HIV positive women were infected by their husbands. Sexual violence has been associated with a number of mental health and behavioural problems in adolescence and adulthood. In one population-based study, the prevalence of symptoms or signs suggestive of a psychiatric disorder was 33% in women with a history of sexual abuse as adults, 15% in women with a history of physical violence by an intimate partner and 6% in non-abused women. Abused women reporting experiences of forced sex are at significantly greater risk of depression and post-traumatic stress disorder than non-abused women. A study of adolescents in France also found a relationship between having been raped and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption and behavioural problems (such as aggressive behaviour, theft and truancy). Women who experience sexual assault in childhood or adulthood are more likely to attempt or commit suicide than other women. Experiences of severe sexual harassment can also result in emotional disturbances and suicidal behavior.