Women's Health Research Unit, Medical Research Council, Pretoria, South Africa. firstname.lastname@example.org
As well as being a violation of human rights, violence against women can be regarded as an 'emerging health problem' of the late twentieth century not because it is new, but because its prevalence and role in the aetiology of ill health has only recently been widely recognized. In this paper we discuss the epidemiology and health impact of violence against women, drawing particularly on data from research in South Africa. Here the prevalence of abuse is between 20% and 30%, which is in keeping with estimates for other countries and research has shown that 1% of women are raped each year. Gender-based violence is an appreciable cause of mortality from homicide and suicide. It is also associated with a range of other health problems, particularly injuries, HIV and sexually transmitted diseases, pregnancy complications and mental health problems. Available estimates suggest that it is associated with considerable costs to the health sector. Roles for the health sector in breaking cycles of abuse are increasingly being recognized and there is a need for appropriate interventions, based on screening, homicide and suicide risk assessment, documentation, information giving and referral to be implemented more widely in health facilities.
Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa.
Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. The overall injury death rate of 157.8 per 100,000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average. With a focus on homicide, and violence against women and children, we review the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
A survey was administered to 304 respondents participating from three areas near Welkom, South Africa. Face-toface interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk. They reported making various behavioural changes to avoid GBV.The respondents were aware of their legal rights pertaining to GBV. HIV/AIDS knowledge levels and attitudes were acceptable. Behavioural changes included condom use, abstinence and being faithful to one partner. Disclosure of HIV was lower than disclosure of GBV.Awareness and knowledge of female condoms were high, yet usage low. Participants reported that they would be able to introduce condoms to a relationship and negotiate usage with relative ease. Perceived levels of GBV and HIV were high, and stigma levels towards the affected women were also relatively high.The awareness and knowledge levels of GBV and HIV of older respondents were lower than younger respondents.The key findings of this study support the notion of using a holistic approach, targeting more than one issue. There is lower stigma levels associated with combined conditions, which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit.
Tulane University Health Sciences Center, School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA. email@example.com
The magnitude and characteristics of sexual violence in two urban areas of Lesotho are described based on a random household survey of 939 sexually active women aged 18-35. Sexual violence is defined as nonconsensual sex ranging from the use of threats and intimidation to unwanted touching and forced sex. Twenty-five percent of women surveyed reported ever being physically forced to have sex; 13 percent reported that forced sex was attempted; 31 percent said that they were touched against their will; and 11 percent reported being forced to touch a man's genitals. Boyfriends were the most common perpetrators of actual and attempted forced sex (66 percent and 44 percent, respectively); known community members were the most common perpetrators of touching the respondent against her will (52 percent). Currently married women and those with more education were less likely than others to report that sex was forced upon them by an intimate partner or by another type of perpetrator. Women living in areas where a program raising awareness about sexual violence was ongoing were more likely to report a history of sexual violence. Given the high prevalence of HIV in Lesotho, programs should address women's right to control their sexuality.
National Institute of Public Health, Copenhagen, Denmark. firstname.lastname@example.org
OBJECTIVES The paper aims to explore what knowledge can be obtained about violence through population-based data and additionally, through inter-country comparisons of violence data. STUDY DESIGN AND METHODS Data on lifetime and 12-month experiences of violence and/or severe threats of violence were obtained from self-administered questionnaires supplementary to nationwide, cross-sectional health interview surveys conducted in Greenland in 1993-94 (N=2,425) and in Denmark in 2000 (N=16,684). The overall response rate achieved for the self-administered questionnaire was 63%(N=1,393) in Greenland and 63%(N=10,458) in Denmark. RESULTS A comparison of violence data shows that overall, the violence prevalence was significantly higher in Greenland than Denmark. Experienced violence and/or severe threats amongst Greenlandic women was almost as prevalent as amongst Greenlandic men--especially so for severe lifetime violence. This was not the case for the Danish sample. Significantly more Danish men than Danish women reported experienced violence and/or severe threats for all age groups. CONCLUSION Comparing violence data across countries enables us to describe actual differences in violence prevalence, as well as to highlight potential methodological discrepancies and cultural and gender differences in understanding and, thus, reporting of violence. This knowledge can be implemented in the development and improvement of existing and new prevention strategies.
National Institute of Public Health, Denmark. email@example.com
STUDY OBJECTIVE To analyse gender differences in associations between physical violence and self rated health and self reported morbidity among a random sample of adults in Denmark. DESIGN AND SETTING Two questions on self rated health and self reported morbidity respectively, were obtained from a cross sectional national health interview survey conducted among 12 028 adults (16 years +) in Denmark in 2000. A question on six different forms of physical violence was obtained from a supplementary self administered questionnaire given to the same sample. The reporting period for experienced physical violence was the past 12 months and for morbidity symptoms, the past 14 days. MAIN RESULTS Men aged 16-24 years were significantly more likely to have experienced violence than women (OR = 3.2, 95% CI = 2.3 to 4.2). Female victims of physical violence were significantly more likely to rate their health as poor (OR = 2.02, 95% CI = 1.41 to 2.89) and to report anxiety (OR = 2.14, 95% CI = 1.35 to 3.37), depression (OR = 2.36, 95% CI = 1.55 to 3.60), and stomach ache (OR = 1.58, 95% CI = 1.01 to 2.47) than female non-victims. Male victims of physical violence were only significantly more likely to report stomach ache (OR = 1.73, 95% CI = 1.03 to 2.89) than male non-victims. CONCLUSIONS Associations between physical violence and poor self rated health and self reported morbidity were found to be significant for women, but not for men. It is probable that gender differences in experiences of violence, as well as gender differences in health related self perception, contribute to a gender specific process of victimisation. Improved knowledge about the relation between gender specific violence and victimisation as a gender specific consequence is essential for targeting violence prevention.
Other papers by authors:
Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey.
ABSTRACT: BACKGROUND: Notions of ideal manhood in South Africa are potentially prescriptive of male sexuality thus accounting for the behaviors which may lead to men being at greater HIV risk. We tested the hypothesis that gender and relationship constructs are associated with condom use among young men living in rural South Africa. METHODS: 1219 men aged 15 to 26 years completed a cross-sectional baseline survey from an IsiXhosa questionnaire asking about sexual behaviour and relationships. Univariate and bivariate analyses described condom use patterns and explanatory variables, and multinomial regression modeling assessed the factors associated with inconsistent versus consistent and non-condom use. RESULTS: 47.7% of men never used condoms, when 36.9% were inconsistent and 15.4% were consistent with any partner in the past year. Condom use patterns differed in association with gender relations attitudes: never users were significantly more conservative than inconsistent or consistent users. Three gender positions emerged indicating that inconsistent users were most physically/sexually violent and sexually risky; never users had more conservative gender attitudes but were less violent and sexually risky; and consistent users were less conservative, less violent and sexually risky with notably fewer sexual partners than inconsistent users. CONCLUSIONS: The confluence of conservative gender attitudes, perpetration of violence against women and sexual risk taking distinguished inconsistent condom users as the most risky compared to never condom users, and rendered inconsistent use one of the basic negative attributes of dominant masculinities in the Eastern Cape, South Africa. This finding is important for the design of HIV prevention and gender equity interventions and emphasizes the need for a wider roll-out of interventions that promote progressive and healthy masculine practices in the country.
Sexuality and the limits of agency among South African teenage women: Theorising femininities and their connections to HIV risk practises.
Gender & Health Research Unit, Medical Research Council and School of Public Health, University of the Witwatersrand, Private Bag X385, Pretoria 0001, South Africa.
In South Africa, both HIV and gender-based violence are highly prevalent. Gender inequalities give men considerable relational power over young women, particularly in circumstances of poverty and where sex is materially rewarded. Young women are often described as victims of men, but this inadequately explains women's observed sexual agency. This paper takes a different approach. We use qualitative interviews and ethnographic observation among 16 young women from the rural Eastern Cape to explore ways young women construct their femininities and exercise agency. The data were collected as part of an evaluation of Stepping Stones, which is a participatory behavioural intervention for HIV prevention that seeks to be gender transformative. Agency was most notable in particular stages of the dating 'game', especially relationship initiation. Constructions of desirable men differed but generally reflected a wish to avoid violence, and a search for mutual respect, sexual pleasure, romance, modernity, status and money. Agency was constrained once relationships were consented to, as men expected to control their partners, using violent and non-violent methods. Women knew this and many accepted this treatment, although often expressing ambivalence. Many of the women expressed highly acquiescent femininities, with power surrendered to men, as a 'choice' that made their lives in cultural terms more meaningful. In marked contrast to this was a 'modern' femininity, centred around a desire to be 'free'. A visible third position, notably emerging after the Stepping Stones intervention, rested not on a feminist challenge to patriarchy, but on an accommodation with men's power whilst seeking to negotiate greater respect and non-violence within relations with men. These multiple and dynamic femininities open up possibilities for change. They demonstrate the need to engage with women, both as victims of patriarchy and active supporters of the gender order. The multiplicity of women's hopes and desires and circumstances of emotional and relational fulfilment provides potential for interventions with women that acknowledge existing gender inequalities, validate women's agency, reduce violence and prevent HIV.
Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa. firstname.lastname@example.org
Despite high levels of awareness of HIV, condom use, particularly consistent use, is suboptimal among young South African women. This paper aims to investigate the factors associated with both any condom use and consistent use by young rural women. In this study 1204 sexually active female volunteers, aged 15-26 years, were selected using a two-stage procedure in which firstly 70 clusters were selected and thereafter up to 20 women per cluster were selected, to participate in a cluster randomised controlled trial of an HIV behavioural intervention. This study is analysing cross-sectional data from a baseline survey thus no causal inferences can be drawn. A structured questionnaire was administered at a baseline interview. An estimated 19.9% of young women reported consistent condom use in the 12 months before the interview, while 44.5% reported inconsistent use. Any condom use was associated with higher condom use self-efficacy (adjusted odds ratio (aOR) 1.59; 95% CI 1.41, 1.77), less association of trust with suggested condom use (aOR 0.86; 95% CI 0.82, 0.91), knowing one's HIV status (aOR 2.86; 95% CI 1.52, 5.39) and having a more educated mother (aOR 1.71; 95% CI 1.26, 2.33). Having had just one partner was associated with a lesser likelihood of any condom use (aOR 0.14; 95% CI 0.10, 0.20). Consistent use, compared with inconsistent use, was associated with having just one partner (aOR 3.25; 95% CI 2.23, 4.73), less relationship conflict (aOR 0.84; 95% CI 0.75, 0.91) and higher gender equity in relationships with a male partner (aOR 1.43; 95% CI 1.15, 1.77). Our findings suggest that gender equity, monogamy and harmonious relationships play a positive role in enabling women to reduce their risk for HIV infection. Such aspects of relationship context could form a significant part of the progressive strategies required for HIV-prevention interventions to be successful.
Gender & Health Research Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa. email@example.com
OBJECTIVE To describe factors associated with HIV infection in men aged 15-26 years. SETTING Rural Eastern Cape Province, South Africa. SAMPLE A total of 1277 sexually experienced Xhosa male volunteers from 70 villages participating in a cluster randomized controlled trial of an HIV behavioural intervention. Xhosas circumcise during manhood initiation rituals. DESIGN Cross-sectional, analysis of the study's baseline interviews. MAIN MEASURE HIV sero-status, sexual practices measured with an interviewer-administered questionnaire. RESULTS About 2% of the men were HIV positive. A logistic regression model showed HIV positivity to be associated with age (OR 1.55; 95%CI 1.22-1.95), having made a woman pregnant (OR 2.93; 95% CI 1.28-6.68), having been circumcised (OR 0.40; 95% CI 0.16-0.98), and having had sex with a man (OR 3.61; 95% CI 1.0-13.0). CONCLUSIONS Our findings provide further evidence to suggest that circumcision is protective. There was much heterosexual risk taking among men but only pregnancy (with its association with sexual frequency) predicted HIV sero-positivity. Although relatively rare, same-sex sexual experiences were a risk factor. Male-male sexual contact is rarely assessed in HIV research in Africa and almost never addressed in general HIV prevention programming. Our findings suggest that it should be given more attention.
Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV.
Gender and Health Research Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa. firstname.lastname@example.org
BACKGROUND This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.
A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings.
Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa. email@example.com
OBJECTIVE To describe the study design, methods and baseline findings of a behavioural intervention trial aimed at reducing HIV incidence. METHOD A cluster randomized-controlled trial (RCT) conducted in 70 villages in rural South Africa. A behavioural intervention, Stepping Stones, was implemented in 35 communities in two workshops of 20 men and 20 women in each community who met for 17 sessions (50 h) over a period of 3-12 weeks. Individuals in the control arm communities attended a single session of about 3 h on HIV and safer sex. Impact assessment was conducted through two questionnaire and serological surveys at 12-month intervals. The primary outcome was HIV incidence and secondary measures included changes in knowledge, attitude and sexual behaviours. Qualitative research was also undertaken with 10 men and 10 women from two sites receiving the intervention (one rural and one urban) and five men and five women from one village in the control arm. They were interviewed individually three times prior to the workshops and then 9-12 months later. RESULTS A total of 2776 participants (1409 intervention and 1367 control) were enrolled at baseline and had an interview, and HIV sero-status was established. HIV baseline prevalence rates in women were 9.8% in the intervention arm and 12.8% in the control arm. In men the prevalence was 1.7% in the intervention arm and 2.1% in the control arm. Demographic and behavioural characteristics were similar in the two arms. In the intervention groups 59.9% of participants attended more than 75% of the sessions. In the control group 66.3% attended the control session. CONCLUSION This is the third RCT to be conducted in sub-Saharan Africa evaluating a behavioural intervention using HIV incidence as a primary outcome. It is of particular interest as the intervention in question is used in many developing countries. There is good baseline comparability between the study arms and the process data on the workshops suggested that the interventions were feasible and adequately implemented.
Changing the debate about health research for development. International Health Research Awards Recipients.
N Abrahams, R Adhikari, I P Bhagwat, N Christofides, M Djibuti, A Dyalchand, G Gotsadze, O Grzmava, L L R Huertas, T Jacobs, R Jewkes, N Kapadia-Kundu, M G O Karnikowski, S Kimboka, A Y Kitua, J U Lens, A López, H Lugina, Malecela-Lazaro, Y Mashalla, A Mishra, S K Mishra, R Mlay, M J Moreno, S Mpanda, F Mwanga, G Ndossi, G Nigenda, A Nkwera, O T Nóbrega, S K Pahari, S A Paz, W Phoolchareon, P Ramachandran, R P Rannan-Eliya, K G Rodrigues, A Salazar, P S Sarma, J Shija, L D Silver, P Tatsanavivat, K R Thankappan, A J A Tuesta, O Vasadze, A C G Vélez, N Webster, C A K Yesudian
Medical Research Council, South Africa.
Reproductive Health Research Unit, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, PO 2013 Bertsham, South Africa.
OBJECTIVE To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate. DESIGN A multicentre, prospective descriptive study. SETTING South African public hospitals that manage gynaecological emergencies. SAMPLE Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included. METHODS A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation. MAIN OUTCOME MEASURES Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients. RESULTS There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation. CONCLUSIONS The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post-abortion care programmes.
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Confl Health. 2011 ;5 :25 22047181
Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study.
Harvard Humanitarian Initiative, 14 Story Street, 2nd Floor, Cambridge, MA 02138, USA. firstname.lastname@example.org.
UNLABELLED ABSTRACT: BACKGROUND The conflict in eastern Democratic Republic of the Congo (DRC) is the deadliest since World War II. Over a decade of fighting amongst an array of armed groups has resulted in extensive human rights abuses, particularly the widespread use of sexual violence against women. METHODS Using a mixed-methods approach, we surveyed a non-random sample of 255 women attending a referral hospital and two local non-governmental organizations to characterize their experiences of sexual and gender-based violence (SGBV). We then conducted focus groups of 48 women survivors of SGBV to elaborate on survey findings. Quantitative and qualitative data underwent thematic and statistical analysis respectively. FINDINGS Of the women surveyed, 193 (75.7%) experienced rape. Twenty-nine percent of raped women were rejected by their families and 6% by their communities. Thirteen percent of women had a child from rape. Widowhood, husband abandonment, gang rape, and having a child from rape were significant risk factors for social rejection. Mixed methods findings show rape survivors were seen as "contaminated" with HIV, contributing to their isolation and over 95% could not access prophylactic care in time. Receiving support from their husbands after rape was protective against survivors' feelings of shame and social isolation. INTERPRETATION Rape results not only in physical and psychological trauma, but can destroy family and community structures. Women face significant obstacles in seeking services after rape. Interventions offering long-term solutions for hyper-vulnerable women are vital, but lacking; reintegration programs on SGBV for women, men, and communities are also needed.
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA. Holly.email@example.com
Violence against women is a pervasive and serious human rights and public health problem worldwide. As interdisciplinary research teams try to address the effects of this health problem of which the effects transcend all women, nurses are at the forefront. Using a feminist philosophy and methodology to explore violence against women is one way to uncover new knowledge to address this health epidemic. In this paper, we will review the basic concepts of feminism and provide examples of viewing violence research and forensic nursing practice through this theoretical lens. These perspectives provide a foundation for understanding feminism and facilitating nurses' awareness as they consider careers in research and practice. Through this lens, nurses who are helping to ease the burden of violence in our global society may affect change in women's lives.
New Solut. 2010 Jan 1;20 (4):527-535 21342874
Gender-Based Political Harassment and Violence: Effects on the Political Work and Public Roles of Women.
This article shows the significance of the problems of political harassment and violence against women in positions of political responsibility in Bolivia. This phenomenon is seen in both rural and urban areas and transcends borders. It has been shown that these attacks constitute a violation of women's civil and political rights and a threat to the physical and mental health of women leaders in Bolivia. Furthermore, there is no punishment of guilty parties, reparation, or moral or material compensation for the women who are affected. In Bolivia, gender-based harassment and violence is a fundamental barrier to women's political participation. However, this phenomenon is still not addressed by government programs and is not part of the public discourse and debate. In spite of the measures taken to promote women's political participation, several different administrations have been unable to guarantee women the capacity to occupy positions of responsibility without being threatened or harassed. The results of our research led to a bill addressing this problem. Subsequently, Ecuador took this bill as an example and replicated it in a legislative initiative. These results show the importance of research by organizations that represent women in preventing unjust situations and health problems.
Uptake of provider-initiated HIV testing and counseling among women attending an urban sexually transmitted disease clinic in South Africa - missed opportunities for early diagnosis of HIV infection.
Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag 7 Congella, Durban 4013, South Africa. firstname.lastname@example.org
This study assessed the uptake of provider-initiated HIV testing and counseling (PITC) among women attending an urban sexually transmitted diseases (STD) clinic in South Africa. From July 2005 to June 2006, women were offered HIV testing following group information and education on HIV and STDs in the clinic waiting area. Of those who were provided with education, information, and offered HIV testing, uptake was 43.5%(2439/5612). The overall HIV prevalence among those tested was 56.5% and the prevalence of acute HIV infection was 1.2%. Of the 56.5%(3173/5612) refusing to test, the reasons for not testing were having already been tested for HIV (61.8%), being afraid to test or felt unready to test (32.5%), the need to consult with partner (0.9%), and refusing with no explanation (4.8%). In settings where high-risk patients await health care services, such as an STD clinic, failure to implement PITC is a missed opportunity for patients to benefit from counseling, prevention, early diagnosis, and referral into care and treatment for HIV infection.
Université Libre de Bruxelles, Santé publique, Bruxelles, Belgique. email@example.com
The Democratic Republic of Congo (DRC) has been through two recent wars (1996-1998). In addition to a death toll estimated at over four million, more than 50000 persons were subjected to sexual violence particularly in Eastern regions. Rape was used as a weapon of war by men in uniform and fighters from countries with a high prevalence of HIV/AIDS. Experts have estimated the prevalence of HIV/AIDS to be up to 60% among soldiers and fighters in the region. Sexual violence against women has impacted public health by spreading sexually transmissible diseases including HIV/AIDS, causing unwanted pregnancies, leading to the gynaecological complications of rape-related injuries, and inflicting psychological trauma on the victims. Officials in the DRC must set up appropriate structures to cope with the medical, psychosocial and legal effects of sexual violence.
Partner violence and health: Results from the first national study on violence against women in Norway.
Department of Public Health and General Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
BACKGROUND: Violence against women has long been considered a hidden health burden. Questions about violence have not been included in health surveys; hence, little is known about prevalence and the consequences for health in the general population. No national study has been conducted in Norway. AIMS: To estimate the prevalence of partner violence in Norway and the relationship between victimization and somatic health and depression and anxiety and post-traumatic stress symptoms. METHODS: Data collection was performed by Statistics Norway. Among a random sample of women aged 20-55 years, 2,407 women returned the questionnaire (63.3%), of whom 2,143 were ever-partnered. Selected demographic characteristics were obtained from registers. RESULTS: In total, 26.8% of 2,143 ever-partnered women had experienced any violence by their partner during their lifetime, and 5.5% in the year before the study. Low educational level, being unmarried, separated or divorced, currently being unemployed, receiving social security benefits and having no children were significantly associated with reporting partner violence. Exposure to partner violence was associated with poor health, depressive and post-traumatic stress symptoms, gynaecological complaints, injuries, and disability, and remained so after controlling for age, education, unemployment, relationship break-up and low economic status. CONCLUSIONS: Partner violence is common and was associated with a range of somatic and mental health problems. Thus, violence against women by their partners is an important public health concern.
Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women.
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. firstname.lastname@example.org
BACKGROUND This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices. METHODS A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected. RESULTS A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs. CONCLUSIONS The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.
Department of Obstetrics and Gynaecology, National Hospital, Abuja, Nigeria. email@example.com
Violence against women is a human rights violation, which is increasingly becoming a serious public health issue. When it occurs in pregnant women, victims are recognised to be at higher risk of complications of pregnancy. A cross-sectional questionnaire survey was carried out over a 3-month period from May to July 2005 to document the prevalence, knowledge and perception of domestic violence (DV) on pregnant women attending the antenatal clinic of the National Hospital, Abuja, Nigeria. The mean age of the respondents was 31.5 +/- 4.25 years, with a range of 20 - 42 years. Most (85.2%) had attained tertiary education. While most (92.9%) were aware of DV in pregnancy, 125 women (37.4%) had experienced DV. Psychological abuse ranked highest with 66.4%, while physical and sexual abuse accounted for 23.4% and 10.2% of the group. Of this group, 21.2% required medical treatment as a result of DV, and all were aware of possible pregnancy complications, such as abortion, premature labour and depression. Most (81.9%) of the respondents felt DV was illegal. A majority (29.7%) kept their DV secret with a few numbers reporting to family, doctors, clergy or close friends. With higher educational status, the experience of DV was greater, although this was not statistically significant (p > 0.05). Similarly with increasing parity, although this tended to reverse after parity of 3. The prevalence of DV found in Abuja, the centrally located capital city of Nigeria is higher than that from the study in Zaria, northern Nigeria (28%). This is cause for concern, and points to a rising trend in the northern region of the country although the centres are different. Similarly, the husband/spouse was the most common offender; responsible here for 74.2% of cases. This may give justification to recent calls for paternal educational classes for spouses. Increasing public awareness remains the key, through education and public enlightenment campaigns, with more emphasis on the identified perpetrator class.
Department of Forensic Medicine, Medical College, Belle-Rive, Mauritius.
Domestic violence is a pattern of assault and coercive behaviour including physical, sexual and psychological attacks, by a person against his/her own intimate partner. Women are more frequently the victims. After a global overview of the prevalence and nature of domestic violence against women especially in Mauritius, this articles provides a discussion about health problems and risk factors among the female victims with the objective of giving preventive measures to eradicate it from society. NGOs, along with legislative measures, have proven helpful in improving quality of life and preventing violence-related injuries among women. The health sector also plays an important role as part of multi-sector efforts in early detection and prevention of cases of domestic violence. Psychiatrists are in a unique position for early identification of such patients as well as intervention.
The effects of obesity on doctor-diagnosed chronic diseases in Africa: empirical results from Senegal and South Africa.
International Food Policy Research Institute, 20033 K Street, NW, Washington, DC 20006-1002, USA. A.Asfaw@cgiar.org
While inadequate food and communicable infectious diseases have been a concern of researchers and policy makers in Africa, little attention has been given to obesity and chronic, non-communicable diseases. Africa is not usually associated with obesity and chronic diseases. Yet there has been a sharp rise in the incidence of obesity and chronic diseases, a major public health problem in many countries. The paper examines the impact of obesity on the prevalence of four doctor-diagnosed chronic diseases in Senegal and South Africa. The results reveal that obese respondents were 4.7, 2.8, and 4.8% more likely to face the risks of arthritis, diabetes, and heart diseases in South Africa and 6.5 and 7.4% more likely to face the risks of heart disease and asthma in Senegal than their lean counterparts. Obesity imposes a real and substantial danger, affecting the prevalence of chronic diseases. Unchecked it can be a major public health problem, impose a serious challenge to the health sector, and can jeopardize future developments.