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Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N  = 1,328 SGM respondents were included. Over 40% ( n  = 537) reported depressive symptoms, while 17% ( n  = 222) reported CSA, 5% ( n  = 67) reported IPV, and 16% ( n  = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng., Competing Interests: Authors NoteNicholas Metheny is also affiliated to University of Cape Town, Cape Town, South Africa. Declaration of Conflicting InterestsThe author(s) declared a potential conflict of interest (e.g., a financial relationship with the commercial organizations or products discussed in this article) as follows: Dr. Metheny received compensation as a consultant from the Gauteng Region City Observatory.

There are over 1.4 million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs). Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5-5). Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]). Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions., (© 2024. The Author(s).)

South African adolescents experience a high prevalence of violence victimization alongside the health and economic burdens of HIV/AIDS and poverty. Polyvictimization is a useful theory and framework that allows for a nuanced understanding of lived adolescent experience patterns. Polyvictimization examinations are further enriched by person-centered analytical approaches. This study used latent class analysis to differentiate a sample of South African adolescents from highly deprived communities by their polyvictimization profiles and contextual violence risk and protective factors. Adolescents were sampled twice (2010/2011; 2011/2012), and data reflected their lifetime (sexual abuse) or recent (all other forms of assessed abuse/violence) violence victimizations, as well as individual, household, and community characteristics. Model fit indices supported a seven-class model with adolescents in high, moderate, and low polyvictimization classes. Adolescents in the high polyvictimization classes experienced a heavy burden of poverty and multiple forms of violence across contexts and were distinguished by HIV/AIDS and disability. Adolescents in the low polyvictimization class experienced relatively little violence, despite living in violent communities, and low household and individual burdens of HIV/AIDS and disability. Findings emphasize the importance of considering adolescent violence through a contextually sensitive polyvictimization lens to understand the complex web of violence that adolescents experience. This work supports previous research in low-resource South African settings highlighting the interconnected nature of violence, poverty, disability, and HIV/AIDS. Future research should explore these complex violence patterns and their effects, while program and policy actions must target and prevent adolescent violence especially for those impacted by poverty, disability, and HIV/AIDS., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Background: The INSPIRE framework was developed by 10 global agencies as the first global package for preventing and responding to violence against children. The framework includes seven complementary strategies. Delivering all seven strategies is a challenge in resource-limited contexts. Consequently, governments are requesting additional evidence to inform which 'accelerator' provisions can simultaneously reduce multiple types of violence against children., Methods and Findings: We pooled data from two prospective South African adolescent cohorts including Young Carers (2010-2012) and Mzantsi Wakho (2014-2017). The combined sample size was 5,034 adolescents. Each cohort measured six self-reported violence outcomes (sexual abuse, transactional sexual exploitation, physical abuse, emotional abuse, community violence victimisation, and youth lawbreaking) and seven self-reported INSPIRE-aligned protective factors (positive parenting, parental monitoring and supervision, food security at home, basic economic security at home, free schooling, free school meals, and abuse response services). Associations between hypothesised protective factors and violence outcomes were estimated jointly in a sex-stratified multivariate path model, controlling for baseline outcomes and socio-demographics and correcting for multiple-hypothesis testing using the Benjamini-Hochberg procedure. We calculated adjusted probability estimates conditional on the presence of no, one, or all protective factors significantly associated with reduced odds of at least three forms of violence in the path model. Adjusted risk differences (ARDs) and adjusted risk ratios (ARRs) with 95% confidence intervals (CIs) were also calculated. The sample mean age was 13.54 years, and 56.62% were female. There was 4% loss to follow-up. Positive parenting, parental monitoring and supervision, and food security at home were each associated with lower odds of three or more violence outcomes (p < 0.05). For girls, the adjusted probability of violence outcomes was estimated to be lower if all three of these factors were present, as compared to none of them: sexual abuse, 5.38% and 1.64% (ARD: -3.74% points, 95% CI -5.31 to -2.16, p < 0.001); transactional sexual exploitation, 10.07% and 4.84% (ARD: -5.23% points, 95% CI -7.26 to -3.20, p < 0.001); physical abuse, 38.58% and 23.85% (ARD: -14.72% points, 95% CI -19.11 to -10.33, p < 0.001); emotional abuse, 25.39% and 12.98% (ARD: -12.41% points, 95% CI -16.00 to -8.83, p < 0.001); community violence victimisation, 36.25% and 28.37% (ARD: -7.87% points, 95% CI -11.98 to -3.76, p < 0.001); and youth lawbreaking, 18.90% and 11.61% (ARD: -7.30% points, 95% CI -10.50 to -4.09, p < 0.001). For boys, the adjusted probability of violence outcomes was also estimated to be lower if all three factors were present, as compared to none of them: sexual abuse, 2.39% to 1.80% (ARD: -0.59% points, 95% CI -2.24 to 1.05, p = 0.482); transactional sexual exploitation, 6.97% to 4.55% (ARD: -2.42% points, 95% CI -4.77 to -0.08, p = 0.043); physical abuse from 37.19% to 25.44% (ARD: -11.74% points, 95% CI -16.91 to -6.58, p < 0.001); emotional abuse from 23.72% to 10.72% (ARD: -13.00% points, 95% CI -17.04 to -8.95, p < 0.001); community violence victimisation from 41.28% to 35.41% (ARD: -5.87% points, 95% CI -10.98 to -0.75, p = 0.025); and youth lawbreaking from 22.44% to 14.98% (ARD -7.46% points, 95% CI -11.57 to -3.35, p < 0.001). Key limitations were risk of residual confounding and not having information on protective factors related to all seven INSPIRE strategies., Conclusion: In this cohort study, we found that positive and supervisory caregiving and food security at home are associated with reduced risk of multiple forms of violence against children. The presence of all three of these factors may be linked to greater risk reduction as compared to the presence of one or none of these factors. Policies promoting action on positive and supervisory caregiving and food security at home are likely to support further efficiencies in the delivery of INSPIRE., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: CD reports personal fees from University of KwaZulu-Natal during the conduct of the study. ET reports funding from UK Medical Research Council (MRC) and the UK Department for International Development (DFID), the European Research Council (ERC), UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub, the International AIDS Society through the CIPHER grant. The views expressed in written materials or publications do not necessarily reflect the official policies of the International AIDS society. Research reported in this publication was supported by the Fogarty International Center, National Institute on Mental Health, National Institutes of Health. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. FM reports grants from Economic and Social Research Council, grants from GCRF/ESRC during the conduct of the study and has previously consulted for the World Health Organization. LDC reports grants from the Global Challenges Research Fund (GCRF), the European Research Council, the Gates Foundation Grand Challenges, the HEFCE-GCRF Support Fund, the Medical Research Council, DFID, National Institute for Health Research. AB reports that he is a lead author of the "INSPIRE: Seven strategies for ending violence against children" technical package, and co-chair of the multi-agency INSPIRE Implementation Working Group. WER, YS, HT, SZ, LC, MO, and LS have nothing to disclose.

Background: The burden of sexual violence has been well described in children of both sexes and in women, but there is minimal literature on adult male rape victims. Studies of adult male rape victims have mainly been conducted among incarcerated males or military personnel, and in high-income countries., Objectives: To describe the epidemiology, occurrence and reporting of rape cases involving male victims, both child (&lt;18 years old) and adult, in South Africa (SA)., Methods: The study consisted of a nationally representative sample of case dockets maintained by the SA Police Service of rape incidents reported in 2012. A retrospective review of the dockets provided sociodemographic information on the victim and suspect, the circumstances of the rape and the medicolegal services provided to the victim. Data on male victims were analysed using Stata 13 to test for significant differences between child and adult male victims., Results: The study comprised 209 male victims, including 120 (57.4%) children and 89 (42.6%) adults. The findings showed that there were significant differences in the occurrence and reporting of rape of male victims by age. Adult males experienced more violent rapes, perpetrators were more likely to be armed and often humiliated the victim, and rapes were more likely to occur in institutional settings. Adult males reported incidents of rape earlier and therefore had visible non-genital injuries during the medical examination. In contrast, more child rapes involved known perpetrators, occurred in a home and perpetrators were more likely to act kindly to the victim after the incident. This parallels the patterns in rape circumstances seen in female adult and child victims., Conclusions: While there is political commitment to understanding sexual violence against women as a societal problem, work on such violence against men lags behind and is little understood. Rape of males needs to be acknowledged, and their vulnerabilities to sexual abuse and rape need to be addressed. Prevention efforts to end violence against women and girls, especially in relation to children, can be used to address violence against men and boys.

Rape is the most demoralizing type of crime violating human rights worldwide. Research has primarily focused on children and women's experiences of rape, even though victims include men and little documentation available concerning their experiences of reporting these incidents. The study aimed to investigate men's experiences when reporting rape to the police. An Interpretative Phenomenological Analysis was used to collect and analyze qualitative data from a purposive sample of eleven men who were rape victims. The findings of the study revealed three superordinate and twenty-two subordinate themes. First, motivation for reporting rape to the police included self-protection from re-victimization, being killed, and prevalent prison cultural practice, seeking justice and answers for rape, moral duty, family support, and encouraging reports of the crime. Second, perceived barriers for reporting rape included fear of stigmatization and ridicule, unknown perpetrators, internalized homophobia, men's preconceived prejudices, perceived justice system delays, fear of being killed, and protecting their reputation. Third, negative experiences when reporting rape included a long waiting period at the reception before opening a case file and the delayed responses of police investigating the rape scene. Also, there was discouragement from the police, disparaging behavior of police, victim-blaming, lack of communication with the victim about case progress and experiences of police homosexual intolerance. The findings show that most men were motivated to report rape to the police despite the perceived barriers and negative experiences they had with the police. Thus, this provides baseline evidence for strategies to be developed to encourage the reporting of rape. Each police station must provide dedicated personnel for professional and sensitive handling of all rape victims, including men. Furthermore, future studies should be conducted to evaluate rape victims' satisfaction with the services provided by the police., Competing Interests: The authors declare that there are no competing interests.

Women, and specifically, adolescents, are at high risk of HIV and STIs during the postpartum period. Biological and behavioral factors contribute to adolescents' susceptibility. However, the influence of behavioral factors, like intimate partner violence (IPV), on postpartum STI acquisition has been understudied. The study's purpose is to determine whether IPV victimization during pregnancy predicts incident STIs in the first 6 months postpartum. Adolescent mothers (14-19 years) were recruited at a township hospital's maternity ward near Durban. Adolescent mothers who were HIV-negative and had no laboratory-diagnosed STIs at baseline (6 weeks postpartum) were included in the analysis ( n = 61). We used a modified Poisson regression with robust standard errors to assess differences in postpartum STI risk by IPV victimization during pregnancy controlling for covariates. At baseline, 25 (41%) adolescent mothers reported IPV victimization during pregnancy. Adolescent mothers who reported IPV during pregnancy were at higher risk of receiving an STI diagnoses at 6 months postpartum (aRR: 4.43; 95% CI: 1.31-14.97). Our findings heighten understanding of HIV risk among a vulnerable subset of adolescent girls: adolescent mothers. Non-combined interventions that help young mothers and their partners navigate partnership dynamics to reduce IPV and STIs are needed to reduce HIV risk.

Background: Violence victimisation and violence perpetration may co-occur in adolescents. Understanding the sociodemographic correlates of the independent and joint profiles of victimisation and perpetration may inform preventive interventions. This study examined the associations of sociodemographic factors with four violence typologies, namely, 1) non-involvement in both victimisation and perpetration, 2) victims only, 3) perpetrators only, and 4) victim-perpetrators. Trends in the prevalence of the four violence typologies over the three survey years were also examined., Methods: We used data from the three nationally representative South African Youth Risk Behaviour Surveys conducted in 2002, 2008, and 2011 and included a multi-ethnic sample of adolescents (n = 30,007; boy: 46.9%, girls: 53.1%; M age = 16 years, SD = .06)., Results: The sample consisted of 8030 (30.8%) adolescents who had non-involvement in both victimisation and perpetration, 8217 were victims only (29.8%), 2504 were perpetrators only (9.0%), and 7776 were victim-perpetrators (24.6%). Logistic regression analyses showed that being a girl increased the odds of non-involvement (OR: 1.47, 99% CI: 1.36-1.58) and being victims only (OR: 1.90, 99% CI: 1.76-2.05). Being a boy increased the odds of being perpetrators only (OR: 0.42, 99% CI: 0.37-0.47) and victim-perpetrators (OR: 0.51, 99% CI: 0.47-0.55). Adolescents who did not have an absent mother had higher odds of non-involvement (OR: 0.78, 99% CI: 0.62-0.97). Lower monthly allowance increased the odds of victimisation only (OR: 0.99, 99% CI: 0.97-1.00), whereas higher monthly allowance increased the odds of perpetration only (OR: 1.05, 99% CI: 1.03-1.08). Trend analysis showed that between 2002 to 2011, there was an increase in the prevalence of non-involvement in adolescents (p < .001), a decrease in the prevalence of victims only (p < .05) and victim-perpetrators (p < .001), and no changes in the prevalence of perpetrators only (p > .05)., Conclusions: Sociodemographic factors are uniquely associated with different violence typologies suggesting the need for tailored interventions to target adolescents with differed risks to violence victimisation and perpetration. Strengthening family relations, particularly between mother and child, may protect adolescents from the experiences of victimisation and perpetration.

There is very little evidence whether recalling and answering questions about abuse or interpersonal violence has a positive or negative impact on participants of such research. This is an important ethical dilemma to ensure an appropriate risk-benefit ratio in research with young people is maintained. We assessed reported harms, benefits, and regrets of young adolescents who participated in a sensitive research project, and compared the harms and benefits in those who had and had not been victims and/or perpetrators of abuse or intimate partner violence. Participants were 3,264 adolescents aged 12 to 15 years in 41 public schools in the Western Cape, South Africa, who completed a survey about intimate partner violence, verbal, physical, and sexual abuse, as part of an HIV prevention cluster randomized controlled trial. The majority of participants reported research participation as beneficial (70.3%), while 27.7% reported harms and 14% regrets. Victims of abuse were more likely than non-victims to report benefits (71.9% vs. 67.1%; p = .02) and harms (31% vs. 20.9%; p < .01) and were less likely to report regret (13.1% vs. 16.7%; p = .02). Perpetrators of abuse were less likely than non-perpetrators to report benefits (67.4% vs. 72.8%; p = .01) and more likely to report harms (36.4% vs. 26.1%; p < .01) and regrets (17.4% vs. 13.3%; p = .01). Our findings suggested that research participation was more likely to have a positive rather than a negative emotional impact on young adolescents and that relatively few regretted participating. Victims and perpetrators of abuse were more likely to report benefits than harms, supporting the ethical appropriateness of ongoing research on abuse and violence. We recommend that further research is required to clarify and standardize terminology and instruments to quantify these kinds of evaluations, including measurement of the severity and intensity of reported benefits, harms and regrets, and the longer term impact of participation in sensitive research.

Introduction: Violence is a leading cause of death worldwide for youth age 15-29. A growing body of literature has described assault-injured youth in United States emergency centres, identifying risk factors for re-injury and mortality, and developing targeted interventions. Despite the fact that low- and middle-income countries are disproportionately affected by violence, little research on assault-injured youth exists in these settings., Methods: Survey and chart review of 14 to 24-year-old assault-injured patients and non-assault-injured controls to 24-hour emergency centres in Khayelitsha, South Africa over 15 weeks. Patient enrollment occurred 7pm Friday to 7am Monday. Multivariable logistic regression was used to estimate associations of behavioral and other factors with assault injury., Results: In total 513 patients were enrolled: 324 assault-injured patients and 189 controls (131 medical, 58 unintentional injuries). Overall 28% were female (n = 146) and 72% were male (n = 367). The mean age was 20.5 years. Assault-injured patients of both genders were more likely than controls to give a 30-day history of drinking any alcohol (OR 6.3) and binge drinking (OR 6.7). They were also more likely to report any physical fight (OR 4.4) or any physical fight requiring medical care in the past 6 months (OR 5.08), and lifetime history of arrest (OR 5.1) or conviction (OR 6.7). Drugs and/or alcohol were used by victims prior to 78% of the assaults. Significant differences were not detected between females (76%) and males (79%). Overall, 47% of assault-injured youth and 15% of controls reported a history of a fight requiring medical treatment in the past 6 months., Discussion: Violence is a chronic and recurring disease, suggesting opportunities for interventions during health care contacts. Our population of assault-injured youth demonstrated significant rates of alcohol use and binge drinking, as well as alcohol use prior to the assault. Future secondary violence prevention initiatives should consider targeting alcohol use and abuse., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Globally, rape is regarded as the most demoralizing type of trauma, and it has negative implications for victims and their families. Although rape affects the community in general, there is a paucity of literature on rape victimization of men. As a result, the types of rape experienced by them are not understood, and thus it is often difficult to develop contextually relevant interventions to prevent male rape and to support male rape victims. The objective of this study was to first determine and then describe, the types of rape experienced by men. An interpretative phenomenological analysis (IPA) qualitative approach was used to collect and analyze data from a purposive sample of 11 participants, using semistructured individual interviews. The findings of the study reveal six themes and related subthemes as six types and related subtypes of rape experienced by men as follows: acquaintance rape, including familial rape; stranger rape; gang rape, including corrective-gang rape, drug-facilitated gang rape, pack-hunting rape, women retributive rape (or women vengeance) for violence experienced from men; homophobic rape; prison rape, including transactional rape and gang initiation rape; and armed rape. The findings reveal the different contexts or settings where men are vulnerable to rape. This highlights the possibilities for the development of context-specific sexual violence prevention interventions for men, which include self-defense training and awareness campaigns specific to rape victimization of men. Furthermore, future studies are recommended to expose this pandemic. Activism is advocated to stop the silence around this public and social health issue.

Pregnancy represents a time of increased risk for intimate partner violence (IPV), and an HIV diagnosis further increases the vulnerability of this at-risk group. This study explores experiences of recent IPV using qualitative interviews with N = 12 HIV-positive pregnant women recruited from a clinical setting in South Africa, a location with a high global prevalence of IPV and HIV. Partner dynamics around IPV resulted in HIV shame and stigma and adversely affected engagement in HIV care and HIV treatment behaviors. The results highlight the challenges women face in navigating disclosure of both IPV and HIV, accessing necessary support, and engaging in both HIV-related and pregnancy-related care in the context of an abusive relationship.

Introduction: Sexual harassment has been identified as a major public health problem that is hidden in most institutions/organizations., Objective: This study assessed sexual harassment and victimization of students in a higher institution in South Africa., Methods: A quantitative, cross-sectional descriptive design was used in this study. The target population was registered students of the higher education institution and the sample size was 342. Questionnaire was used for data collection and data were analyzed using Statistical Package for Social Sciences (SPSS) Version 23.0 program. The basic principles of ethics were duly observed and the ethical clearance certificate was obtained prior to data collection., Results: The findings revealed that 27 (17.3%) of the male and 47 (25.5%) of the female respondents (P = 0.047) had personally experienced unwanted touching. Two (1.3%) male and 5 (2.7%) female students admitted that they have been raped. Seventeen (10.8%) of the males and 19 (10.2%) of the females had been coerced to comply with a sexual relationship on campus., Conclusion: This study shows that both male and female students on campus are experiencing different forms of sexual harassment.

Objectives: The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender., Methods: Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity., Results: Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender., Conclusions: Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.

Childhood sexual abuse of boys was examined in a longitudinal cohort in South Africa, with data on abuse collected at six age points between 11 and 18 years. Potential personal and social vulnerability of male sexual abuse victims was explored and mental health outcomes of sexually abused boys were examined at age 22-23 years. Reports of all sexual activity - touching, oral and penetrative sex - increased with age and sexual coercion decreased with age. Almost all sexual activity at 11 years of age was coerced, with the highest rates of coercion occurring between 13 and14 years of age; 45% of reports of coerced touching were reported at age 14, 41 percent of coerced oral sex at age 13, and 31% of coerced penetrative sex at age 14. Sexual coercion was perpetrated most frequently by similar aged peers, and although gender of the assailant was less often reported, it can be presumed that perpetration is by males. Boys who experienced childhood sexual abuse tended to be smaller (shorter) and from poorer families. No relationships to measured childhood intelligence, pubertal stage, marital status of mother or presence of the father were found. There was no significant association between reports of childhood sexual abuse and mental health in adulthood and when personal and social vulnerabilities were taken into account., (Copyright © 2018. Published by Elsevier Ltd.)

Research efforts have overlooked anal sex as a risk factor for adolescents' acquisition of HIV despite the high rates of HIV among South African youth. Here, we report findings from a survey conducted in 2012 among secondary school youth, ages 16-24, in Cape Town. 937 adolescents completed a pencil-and-paper survey. Eleven and 31% of female and male youth, respectively, reported ever having anal sex. By comparison, 59% and 78% of female and male youth reported ever having vaginal sex. The percentage of youth reporting lifetime rates of anal sex increased with age: 32% of 20-to-24 year olds had anal sex compared to 16% of 16-to-17-year olds. When the sample was stratified by sex, this difference appeared to be driven by older male, but not female, sexual behavior. Despite noted differences in prevalence rates by sex, both boys and girls who had anal sex were more likely than their same-sex peers who had vaginal sex to report sexual coercion victimization and perpetration experiences and inconsistent condom use. Interestingly, some differences in HIV motivation, information, and behavioral skills were noted for youth who had vaginal sex versus youth who had never had sex; scores were largely similar for youth who had anal sex versus youth who had never had sex however. Together, these findings suggest that anal sex is not uncommon and may be an important marker for other HIV risk behaviors in at least one lower income South African community. Anal sex needs to be explicitly discussed in adolescent HIV prevention and healthy sexuality programing, incorporating age-relevant scenarios about negotiating condoms and other healthy relationship behaviors (e.g., refusing sex when it is not wanted).

Although studies have described the incidence and epidemiology of adolescent homicide victimization in South Africa, little is known about the situational contexts in which they occur. This study aimed to describe the victim, offender, and event characteristics of adolescent homicide and to generate a typology based on the particular types of situational contexts associated with adolescent homicide in South Africa. Data on homicides among adolescents (15-19 years) that occurred in Johannesburg (South Africa) during the period 2001-2007 were obtained from the National Injury Mortality Surveillance System (NIMSS) and police case records. Of the 195 cases available for analysis, 81% of the victims were male. Most of the offenders were male (90%), comprising of strangers (42%) and friends/acquaintances (37%). Arguments (33%) were the most common precipitating circumstances, followed by revenge (11%), robbery (11%), and acts of vigilantism/retribution for a crime (8%). Through the use of cluster analysis, the study identified three categories of adolescent homicide: (a) male victims killed by strangers during a crime-related event, (b) male victims killed by a friend/acquaintance during an argument, and (c) female victims killed by male offenders. The results can serve to inform the development of tailored and focused strategies for the prevention of adolescent homicide.

The current study describes the incidence and epidemiological characteristics of eldercide (homicides among victims aged 60 years and older) in Johannesburg for the period 2001 to 2010. A retrospective population-based study was conducted on cases drawn from the National Injury Mortality Surveillance System. A total of 557 eldercides were recorded by NIMSS for the study period with an average annual rate of 23.1 per 100 000. The average annual rate for males was 42.4 per 100 000 and 8.9 per 100 000 for females. There was little variation in the rates by race. Eldercide victims were predominantly male (77.4%), black (48.3%) or white (43.2%), and were mainly killed by firearms (44.8%) or the use of blunt force (27.8%), in a private residence (66.0%), on a week day (53.8%) and during the day (56.1%). The study also found that the characteristics of eldercide varied across males and females, and across black and white race groups. The high incidence of eldercides points to the need for interventions that give special attention to the risk configurations and circumstances associated with these violent deaths., (Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Sexual abuse has severe negative impacts on children's lives, but little is known about risk factors for sexual abuse victimization in sub-Saharan Africa. This study examined prospective predictors of contact sexual abuse in a random community-based sample of children aged 10 to 17 years ( N = 3,515, 56.6% female) in South Africa. Self-report questionnaires using validated scales were completed at baseline and at 1-year follow-up (96.8% retention rate). Cross-sectional and longitudinal associations between hypothesized factors and sexual abuse were examined. For girls, previous sexual abuse (odds ratio [OR] = 3.44, 95% confidence interval [CI] = [2.03, 5.60]), baseline school dropout (OR = 2.76, 95% CI = [1.00, 6.19]), and physical assault in the community (OR = 2.17, 95% CI = [1.29, 3.48]) predicted sexual abuse at follow-up. Peer social support (OR = 0.84, 95% CI = [0.74, 0.98]) acted as a protective factor. Previous contact sexual abuse was the strongest predictor of subsequent sexual abuse victimization. In addition, peer support moderated the relationship between baseline assault and subsequent sexual abuse. For boys, no longitudinal predictors for sexual abuse victimization were identified. These results indicate that the most vulnerable girls-those not in school and with a history of victimization-are at higher risk for sexual abuse victimization. High levels of peer support reduced the risk of sexual abuse victimization and acted as a moderator for those who had experienced physical assault within the community. Interventions to reduce school drop-out rates and revictimization may help prevent contact sexual abuse of girls in South Africa.

Background: Female sex workers (FSWs) are disproportionately affected by violence from multiple partner categories. This increases their vulnerability to HIV., Objectives: To describe patterns of violence and polyvictimization among female SWs in Soweto., Methods: A respondent-driven sampling (RDS) recruitment methodology was used to enrol 508 Soweto-based FSWs using a survey instrument. Raw and RDS adjusted data were descriptively analysed, Spearman's correlation and chi 2 test of association were used to show associations. Polyvictimization patterns are shown within a modified Venn diagram., Results: The median age of FSWs in Soweto was 31 years, and most had an incomplete education (74.2%). The prevalence of exposure to physical/sexual intimate partner violence (IPV) in the past year was 53.8%, 46.8% by clients, and 18.5% by police. Past year prevalence of sexual/physical violence by any perpetrator category was 70.8% and lifetime exposure was 76.0%. Childhood sexual violence was reported by 44.3%. Lifetime non-partner rape was 55.5% and all rape exposure was 62.4%. As a result of engaging in sex work in the past year, 65.2% women had been discriminated against. Client, police, IPV, and childhood trauma were all significantly associated with one another, with IPV being the most common co-occurrence. Polyvictimization was seen in almost two-thirds of FSWs, and increased with exposure to discrimination., Conclusion: In Soweto, FSWs are exposed to high rates of violence in multiple forms across their lifetime. Our findings show that violence continues unabated into adulthood at levels far higher than in the general population and overall at higher levels than previously recorded among SWs in South Africa. We argue that violence against FSWs is rooted in discrimination. The disparate burden of violence on FSWs requires urgent interventions to proactively address and reframe the normalisation of violence against all women.

Studies that provide accurate descriptions of the occurrence of fatal strangulation events are limited, both in South Africa and elsewhere in the world. The current study describes the extent and distribution of female and male homicidal strangulation in the City of Johannesburg for the period 2001-2010. The study is a register-based cross sectional study of homicidal strangulation that draws on data recorded by the National Injury Mortality Surveillance System. Crude, unadjusted strangulation rates, and proportions of strangulation across specific circumstances of occurrence were computed for each year and aggregated in some instances. Results indicated fatal strangulation to be the fourth leading cause of homicide in the City of Johannesburg. A total of 334 strangulation homicides were recorded, representing an average annual strangulation homicide rate of 0.90 per 100,000 population. Gender disproportionality in victimisation was reflected in the average annual rate of 1.03 per 100,000 population for females and 0.74 per 100,000 population for males. The highest rates were recorded among the elderly, and amongst coloured females and white males. Temporal and spatial descriptions indicated that victims were strangled primarily during the day, over the weekday period, and in private locations. When the scene of death was considered by race and age group, results indicated the victimisation of white females and males in private places, and the elderly in private settings. The majority of strangulation victims tested negative for alcohol. The results highlight the need for multi-level prevention strategies that target specific risk groups and situations., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

This article addresses under-acknowledged barriers of structural violence and discrimination that interfere with women's capacity to realize their human rights generally, and their right to adequate food and nutrition in particular. Case studies from Georgia and South Africa illustrate the need for a human rights-based approach to food and nutrition security that prioritizes non-discrimination, public participation, and self-determination. These principles are frustrated by different types of structural violence that, if not seriously addressed, pose multiple barriers to women's economic, public, and social engagement., (© The Author(s) 2015.)

Background: Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa., Methods: Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators., Results: For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed., Conclusions: These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.

Background: Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of forced sex and associated health problems among lesbian and bisexual women in Southern Africa., Methods: This study is based on data collected as part of a collaborative endeavor involving various Southern African community-based organizations. Lesbian and bisexual women in four Southern African countries participated in a cross-sectional survey, for a total study sample of 591., Results: Nearly one-third of participants had been forced to have sex at some time in their lives. Thirty-one percent of all women reported to have experienced forced sex at least once in their life: 14.9% reported forced sex by men only; 6.6% reported forced sex by women only; 9.6% had had forced sexual experiences with both men and women. Participants experienced forced sex by men as more serious than forced sex by women; forced sex by women was more likely to involve intimate partners compared to forced sex by men. Participants who experienced forced sex by men were more likely to report drug problems, mental distress and lower sense of belonging. Forced sex by women was associated with drinking problems and mental distress. Having experienced forced sex by both men and women was associated with lower sense of belonging to the LGBT community, drug use problem and mental distress., Conclusions: The findings indicate that forced sex among Southern African women is a serious issue that needs further exploration. Clinicians should be made aware of the prevalence and possible consequences of forced sex among lesbian and bisexual women. Policies and community interventions should be designed to address this problem.

Participatory mapping was undertaken with single-sex groups of grade 5 and grade 8-9 children in KwaZulu-Natal. Relative to grade 5 students, wide gender divergence in access to the public sphere was found at grade 8-9. With puberty, girls' worlds shrink, while boys' expand. At grade 5, female-defined community areas were equal or larger in size than those of males. Community area mapped by urban grade 8-9 girls, however, was only one-third that of male classmates and two-fifths that of grade 5 girls. Conversely, community area mapped by grade 8-9 boys was twice that of grade 5 boys. Similar differences emerged in the rural site. No female group rated a single community space as more than 'somewhat safe'. Although curtailed spatial access is intended to protect girls, grade 8-9 girls reported most places in their small navigable areas as very unsafe. Expanded geographies of grade 8-9 boys contained a mix of safe and unsafe places. Reducing girls' access to the public sphere does not increase their perceived safety, but may instead limit their access to opportunities for human development. The findings emphasise the need for better violence prevention programming for very young adolescents.

Purpose: This study uses data collected as part of the Well-Being of Adolescents in Vulnerable Environments study to (1) compare the perceptions of neighborhood-level factors among adolescents across five different urban sites; (2) examine the associations between factors within the physical and social environments; and (3) examine the influence of neighborhood-level factors on two different health outcomes-violence victimization in the past 12 months and ever smoked., Methods: Across five urban sites (Baltimore, New Delhi, Johannesburg, Ibadan, and Shanghai), 2,320 adolescents aged 15-19 years completed a survey using audio computer-assisted self-interview technology. To recruit adolescents, each site used a respondent-driven sampling method, which consisted of selecting adolescents as "seeds" to serve as the initial contacts for recruiting the entire adolescent sample. All analyses were conducted with Stata 13.1 statistical software, using complex survey design procedures. To examine associations between neighborhood-level factors and among our two outcomes, violence victimization and ever smoked, bivariate and multivariate analyses were conducted., Results: Across sites, there was great variability in how adolescents perceived their neighborhoods. Overall, adolescents from Ibadan and Shanghai held the most positive perceptions about their neighborhoods, whereas adolescents from Baltimore and Johannesburg held the poorest. In New Delhi, despite females having positive perceptions about their safety and sense of social cohesion, they had the highest sense of fear and the poorest perceptions about their physical environment. The study also found that one of the most consistent neighborhood-level factors across sites and outcomes was witnessing community violence, which was significantly associated with smoking among adolescents in New Delhi and Johannesburg and with violence victimization across nearly every site except Baltimore. No other neighborhood-level factor exerted greater influence., Conclusions: This study confirms the important associations between perceptions of a neighborhood and adolescent health. At the same time, it demonstrates that not all neighborhood-level factors are associated with adolescent health outcomes in the same way across different urban contexts. Further longitudinal research is needed to examine the direction of causation between adolescent health neighborhood contexts and health outcomes and the reasons for why different urban contexts may exert varying levels of influence on the health of adolescents., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Bullying victimisation has been prospectively linked with mental health problems among children and adolescents in longitudinal studies in the developed world. However, research from the developing world, where adolescents face multiple risks to social and emotional development, has been limited by cross-sectional designs. This is the first longitudinal study of the psychological impacts of bullying victimisation in South Africa. The primary aim was to examine prospective relationships between bullying victimisation and internalising and externalising symptoms in South African youth. Secondary aims were to examine gender and age-related differences in experiences of bullying victimisation. Children and adolescents (10-17 years, 57 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up 1 year later (97 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces and door-to-door sampling included all households with a resident child/adolescent. Exposure to multiple experiences of bullying victimisation at baseline predicted internalising symptoms and conduct problems 1 year later. Additionally, baseline mental health scores predicted later bullying victimisation, demonstrating bi-directionality of relationships between bullying victimisation and mental health outcomes in this sample. Expected gender differences in physical, verbal, and relational bullying victimisation were evident and predicted declines in bullying victimisation over time were observed. In the developed world, school-based anti-bullying programmes have been shown to be effective in reducing bullying and victimisation. Anti-bullying programmes should be implemented and rigorously evaluated in South Africa, as this may promote improved mental health among South African children and adolescents.

Objectives: Although mental health impact of gender based violence has been documented for many decades, the impact of the socio-cultural dimensions and type of perpetrator on mental health outcomes has not been described outside of developed countries. We explore depression symptomatology four to six weeks post-rape in South Africa and examine whether this differs according to the circumstances of the rape., Method: 140 participants recruited from public hospital services in the Eastern and Western Cape provinces were interviewed within two weeks after completing the post exposure prophylaxis (PEP) medication. A structured questionnaire was used to collect data on socio-demographic and sexual assault characteristics including perpetrator. Depressive symptomatology was measured using the Centre for Epidemiological Studies Depression Scale., Results: 84.3% (95% CI: 78.1-90.3) women were found to have high levels of depressive symptoms, but lower levels were found among women raped in circumstances in which there was a lesser likelihood of blame such as those raped by strangers rather than intimate partners (Odds Ratio: (OR) 0.28 (95% Confidence Intervals (CI): 0.11-0.69) and higher levels were associated with experiencing four or more side effects related to PEP medication (OR: 3.79: CI: 1.03-13.94). Receiving support and severe sexual assaults (involving weapons and multiple perpetrators) were not associated with depression., Conclusion: The study does not support the general assumption that more violent rape causes more psychological harm. These results have important implications for individual treatment because it is more generally assumed that multiple perpetrator rapes, stranger rapes and those with weapons would result in more psychological trauma and thus more enduring symptoms. Our findings point to the importance of understanding the socio-cultural dimensions, including dynamics of blame and stigma, of rape on mental health sequelae.

This study aimed to establish the incidence of homicide, associated pathology of trauma and victim profiles in cases admitted to or managed as homicidal deaths at the Pretoria Medico-Legal Laboratory (PMLL) over the period of 2007-2008. A total of 1088 cases were reviewed. Homicides accounted for 22.7% of all cases admitted to the PMLL. The majority of homicide victims were male individuals (87.0%). The most common cause of death was gunshot wounds (42.6%), followed by blunt force trauma (25.1%). Homicides are most likely to occur at the victim's place of residence (28.5%) and only 37.4% of victims survive long enough to receive hospital care. The results of this study seem to concur with international findings for the most part, with a few interesting deviations. Highlighting at-risk groups, as well as dangerous locations and incident times, creates the potential to decrease the occurrence of unnecessary deaths by generating an awareness of the trends.

Background: In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus., Methods and Findings: In a cross-sectional study conducted in 2008, men aged 18-49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26-12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22-7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24-7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17-10.9)., Conclusions: In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male-female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male-male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence.

Attitude change approaches are common in the prevention of intimate partner violence (IPV) among adolescents. This study examined associations between perpetration or victimization and attitudes toward IPV with data from a longitudinal randomized controlled trial (RCT) of an HIV prevention intervention among school students in three sites in South Africa and Tanzania. Data analyses were confined to students from the control group only, and to those with experience with romantic relationships. Boys and those more involved with violence reported more violence-supportive attitudes. For Cape Town (and to some extent Mankweng), the results of prospective prediction are consistent with the notion of a bidirectional attitudes-behavior interrelationship. For Dar es Salaam attitudes predicted behavior prospectively; however, prediction in the opposite direction was not confirmed. These results indicate that attitude change strategies may be useful complementary to structural approaches also in global South settings, although their effectiveness may vary.

Serial rapists have the propensity to cause harm to a significant number of victims, meaning that they are of concern to the police as well as to treatment providers. Despite the serious nature of their offending, there are surprisingly few studies that provide information regarding their characteristics, the types of victim they target, or the nature of the sexual offenses they commit, and those studies that do exist are varied in their findings. This study provides a descriptive analysis of serial rape in South Africa. One hundred and nineteen sexual offenses committed by 22 serial rapists were sampled. Information regarding the victims, the offenders, and the crimes they had committed were extracted from police files. The characteristics of victims and offenders are reported as well as the frequencies for 114 different crime scene behaviors. When compared with samples of serial sex offenders from other countries, differences emerged in victim characteristics and crime scene behaviors, including how the victims were targeted, the sexual behaviors engaged in, and the incidence of physical violence. The implications of these observed differences for practice are discussed.

Despite a high prevalence of intimate partner violence in South Africa, few epidemiological studies have assessed individual risk factors and differential vulnerability by gender. This study seeks to analyze gender differences in risk for intimate partner violence victimization and perpetration according to childhood and adult risk factors in a national sample of South African men and women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the authors examine data from 1,715 currently married or cohabiting adults on reporting of intimate partner violence. Our analysis include (a) demographic factors, (b) early life risk factors (including exposure to childhood physical abuse, witnessing parental violence, parental closeness, and early onset DSM-IV disorders), and (c) adult risk factors (including experiencing the death of a child and episodes of DSM-IV disorders after age 20). Although prevalence rates of intimate partner violence are high among both genders, women are significantly more likely than men to report being victimized (29.3% vs. 20.9%). Rates of perpetrating violence are similar for women and men (25.2% and 26.5%, respectively). Men are more likely to report predictive factors for perpetration, whereas women are more likely to report predictors for victimization. Common risk factors among men and women reporting perpetration include exposure to childhood physical abuse, witnessing parental violence, and adult onset alcohol abuse/dependence. However, risk factors in male perpetrators are more likely to include cohabitation, low income, and early and adult-onset mood disorders, whereas risk factors in female perpetrators include low educational attainment and early onset alcohol abuse/dependence. The single common risk factor for male and female victims of partner violence is witnessing parental violence. Additional risk factors for male victims are low income and lack of closeness to a primary female caregiver, whereas additional risk factors for female victims are low educational attainment, childhood physical abuse, and adult onset alcohol abuse/dependence and intermittent explosive disorder. Intimate partner violence is a significant public health issue in South Africa, strongly linked to intergenerational cycling of violence and risk exposure across the life course. These findings indicate that gender differences in risk and common predictive factors, such as alcohol abuse and exposure to childhood violence, should inform the design of future violence-prevention programs and policies.

Background: Tremendous challenges remain in the field of HIV education, prevention and care in South Africa. There is conflicting data on the prevalence of HIV in South Africa from two major studies. Antenatal surveillance showed 29.5% prevalence whereas a household HIV survey showed a prevalence nearly half of that, at 16.2%. There is therefore a need for a third estimate in this situation., Objective: To estimate HIV prevalence in the Mthatha area of South Africa., Methods: Retrospective review of HIV testing results among victims of sexual assault who presented for the first time to the Sinawe Referral Centre, Mthatha General Hospital, for the period 2001-2005 (inclusive)., Results: Between 2001 and 2005, 1691 victims of sexual assault presented to the Sinawe Referral Centre. Of these 1435 (84.8%) were tested for HIV at the time of first consultation. One hundred and ninety-seven were found to be HIV positive on the screening test. In a space of five years (2001-2005), there was an increase in HIV prevalence from 0.9% to 6.4%. The highest HIV positive rate (3.7%) was found in the 16-20 year age group., Conclusion: The HIV prevalence rate is 13.7% in the Mthatha area, and just over a half (7%) of HIV-positive rape survivors were aged 16-25 years.

This study investigated homicide-suicide in Durban, South Africa, for the years 2000 to 2001. The incidence was 0.89 per 100,000, higher than the international average. A majority of perpetrators (91%) and victims (87%) were Black African, proportional to their representation in the population. Perpetrators were typically men (in 95% of cases), older than, and intimate partners (in 75% of cases) of the female victims (in 100% of cases). Average ages of perpetrators and victims were 32 and 27, respectively. The security sector was overrepresented as an employment category for perpetrators. A firearm was used in 87% of the homicides and 80% of the suicides. The individuals involved in homicide-suicides in Durban are similar to homicide-suicide perpetrators and victims in industrialized countries. The fact that homicide-suicides in South Africa, as in most countries, involve almost exclusively men killing female intimates confirms the importance of examining and challenging social norms enabling male violence against women.

That war is profoundly gendered has long been recognized by feminist international relations scholars. What is less recognized is that the postwar period is equally gendered. Currently undertheorized is how truth-seeking exercises in the aftermath of conflict should respond to this fact. What happens to women victims of war violence? The difficulties of foregrounding gendered wartime violence in truth telling are illustrated by the South African Truth and Reconciliation Commission. The article explores some consequences of the failure to uncover gendered truth, including its impact on the government's reparations policy, and continued "peacetime" violence perpetrated against women in South Africa.

This study is based on a sample of children from the Cape Town area in South Africa. The study compares the effects of witnessing school or neighborhood violence compared with being victimized in each context on psychological distress. The findings suggest that in the context of the school, victimization has a somewhat stronger effect on distress than witnessing violence. However, in the neighborhood, the opposite was the case. "Unknown locus of control" was also analyzed as a moderating variable. The findings are interpreted in the context of violence in South African society. The study also investigates the overlap between witnessing violence, victimization, and perpetration in the child's school and neighborhood. The vast majority of victims had been witnesses as well as perpetrators. Longitudinal research, which could track involvement in various forms of violence starting at a very early age, is needed to clearly assess the differential impact of each form of violence.

A study was undertaken to research the occurrence of homicide-suicide events in the Pretoria region from January 1997 until October 2001. It is important to attempt understanding this tragic phenomenon from psychiatric and forensic perspectives. This uncommon phenomenon has attracted widespread and sensational media coverage, but little is known about the causal factors and demographic profile of perpetrators and victims, and possible sites of intervention. Case files of the Pretoria Medico-Legal Laboratory (where all cases of unnatural death in Pretoria are investigated) were reviewed and information collected from relevant investigating officers of the South African Police Services. The average annual incidence of homicide-suicide in Pretoria over the period studied was found to be 1 per 100,000 of the population. Two profiles of typical perpetrators seem to emerge: a younger, single, black male shooting his girlfriend and himself at home; and an older, married, Caucasian male shooting his wife and himself at home. Employment in peace forces and unemployment are shown to play significant roles, suggesting need for the availability of psychological support systems to members of peace forces and for intervention regarding unemployment.

The purpose of this article is to describe mortality of women from intimate partner violence (IPV) in South Africa using a retrospective national study in a proportionate random sample of 25 mortuaries. Homicides identified from mortuary, autopsy, and police records. There were 3,797 female homicides, of which 50.3% were from IPV. The mortality rate from IPV was 8.8 per 100,000 women. Mortality from IPV were elevated among those 14 to 44 years and women of color. Blunt force injuries were more common, while strangulation or asphyxiation were less common. The national IPV mortality rate was more than twice that found in the United States. The study highlights the value of collecting reliable data across the globe to develop interventions for advocacy of which gender equity is critical.

Objective: To describe the epidemiology and forensic management of suspected rape homicide in South Africa, with the aim of promoting the recognition of this form of violence against women amongst forensic pathologists during post-mortem examination., Methods: A retrospective national study in a proportionate random sample of 25 medico-legal laboratories was carried out to identify all homicides in 1999 of women over the age of 13 years. Data was collected from the mortuary file, autopsy report, police record and during interviews with police., Findings: A rape homicide was suspected in 16.3% (95% confidence intervals (CI): 10.6-22.3) of the female homicides which gave a rape homicide rate of 3.65/100,000 women over 13 years. Rape homicides were more likely to than other female homicides to be crimes where the perpetrator and victim were strangers, where the crime happened in public spaces and the victim older than the perpetrator. In addition to genital injuries, injuries associated with this crime included those of head and face, legs, neck and injuries caused by bites. Victims had larger numbers of injuries, and more often a mechanism of death due to strangulation asphyxiation, or blunt trauma, rather than gunshot., Conclusion: Rape homicide is an extreme form of violence against women and the prevalence in South Africa is higher than that of all female homicides in the United States. The particular pattern of injury found in these cases should be used to develop protocols for autopsies on murdered women to ensure that crucial evidence is not lost and the victims' and their families claim to justice is not compromised.

Objective: To examine the incidence and patterns of intimate femicide-suicide in South Africa and to describe the factors associated with an increase in the risk of suicide after intimate femicide (i.e. the killing of an intimate female partner)., Methods: A cross-sectional retrospective national mortuary-based study was conducted at a proportionate random sample of 25 legal laboratories to identify all homicides committed in 1999 of women aged over 13 years. Data were collected from the mortuary file, autopsy report and a police interview., Findings: Among 1349 perpetrators of intimate femicide,19.4% committed suicide within a week of the murder. Suicide after intimate femicide was more likely if the perpetrator was from a white rather than an African racial background (odds ratio, OR: 5.8; 95% confidence interval, CI: 1.21-27.84); was employed as a professional or white-collar worker rather than a blue-collar worker (OR: 37.28; 95% CI: 5.82-238.93); and owned a legal gun rather than not owning a legal gun (OR: 45.26; 95% CI: 8.33-245.8). The attributable fraction shows that 91.5% of the deaths of legal gun-owning perpetrators and their victims may have been averted if this group of perpetrators did not own a legal gun., Conclusion: South Africa has a rate of intimate femicide-suicide that exceeds reported rates for other countries. This study highlights the public health impact of legal gun ownership in cases of intimate femicide-suicide.

School bullying is a major social problem in most countries and is especially of concern to school administrators and teachers. The typical place in which bullying occurs is at school. For this reason, school administrators and teachers are often held responsible for its occurrence, prevention, and management. However, in spite of concerted efforts to prevent this problem, bullying continues to plague most schools. Previous research and this study suggest that the etiology of bullying is more directly related to conditions at home rather than to conditions at school. Thus, the authors have hypothesized that bullying is associated with physically harming children in their homes and the coping responses that result from this physical harm. This research surveyed a sample of 852 university students in Japan, South Africa, and the United States. The findings suggest there are significant relationships between physical child harm and three types of bullying related behaviors: offending, being victimized, and offending plus being victimized. Using social coping theory, this research suggests that the manner in which physically harmed children cope with their early victimization has a bearing on their subsequent involvement with bullying-related behaviors.

This article evaluates the functioning of the Court for Sexual Offences in Bloemfontein, Free State, South Africa at the hand of the perceptions of those professionals most frequently involved with the Court. The findings suggest that professionals involved with this court tend to be positive in their appraisals of the sex-court system. However, the ability of the sex-court to remain objective and to reduce secondary victimization is called into question. Misconceptions with regard to the Court's current ability to contribute to the rehabilitation of offenders and the emotional recovery of the victims were exposed. The operational difficulties facing sex-court personnel are discussed and directions for future research are identified.

The aims of the study were to examine the relationship between multiple victimisation and drug use, and the role of drug use and other intra-personal, peer, parental and environmental factors in predicting multiple victimisation among adolescents in South Africa. A cross-sectional design was employed. The participants comprised 1474 male and female adolescents aged between 12 and 17 years, from Durban and Cape Town. They completed questionnaire measures assessing demographic characteristics; self, peer and parental drug use; self and peer delinquency; parental child-centredness and rules; and community drug availability and exposure to violence on television. A measure of multiple victimisation assessed whether or not the respondents had experienced two or more different types of violence in their lifetime. There was a significant association between frequency of tobacco, alcohol and marijuana use and multiple victimisation. Significant predictors of multiple victimisation in multiple logistic regression analyses were variables within intra-personal, peer, parental and environmental domains. Victimisation prevention programmes in South Africa should be comprehensive and target adolescents' drug use as well as their other psychosocial risk factors.

Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.9%), child sexual assault (8.0%), and forced first intercourse (7.3%). Age at first experience of each type of violence was modeled by the Kaplan-Meier method, and Cox hazard models with time-varying covariates were used to explore whether child sexual assault and forced first intercourse were associated with risk of violent revictimization in adulthood. Child sexual assault was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.43, 95% confidence interval: 1.93, 3.06) and with adult sexual assault by a nonpartner (risk ratio = 2.33, 95% confidence interval: 1.40, 3.89). Forced first intercourse was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.64, 95% confidence interval: 2.07, 3.38) and nonsignificantly with adult sexual assault by a nonpartner (risk ratio = 2.14, 95% confidence interval: 0.92, 4.98). This study confirms the need for increased attention by the public health community to primary and secondary prevention of gender-based violence, with a specific need to reduce risk among South African adolescents.

Given the high rates of crime in South Africa's townships, nonpolitical violence out-side the home and its psychological impact on women were investigated within two samples, the primary a help-seeking sample and the secondary a community sample. In the help-seeking sample, two thirds of the women reported having experienced several traumatic events outside the home. Those women displayed a median of 9 PTSD (post-traumatic stress disorder) symptoms, with nearly half meeting all criteria for PTSD. In the community sample, 40 women of color were interviewed at a community festival for women, and again two thirds reported having experienced several traumatic events outside the home during the previous year. These women displayed a median of 8.8 PTSD symptoms, with none meeting all criteria for PTSD. South Africa's distinctive culture of violence is discussed as context for understanding issues of community violence and PTSD among women in its minority townships.