Sexual violence: A deeper look

Sexual violence is a common and serious public health problem affecting millions of people each year throughout the world. It is driven by many factors operating in a range of social, cultural and economic contexts

Without doubt sexual violence is the number one global and national public health issue. We currently live in a world that hears or reads reports of some type of tragic violent activity on a daily basis. Although in most countries there has been little research conducted on the problem, available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner and up to one-third of adolescent girls report their first sexual experience as being forced. Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term. Its impact on mental health can be as serious as its physical impact, and may be equally long lasting.  Deaths following sexual violence may be as a result of suicide, HIV infection or murder – the latter occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’. Sexual violence can also profoundly affect the social well-being of victims; individuals may be stigmatized and ostracized by their families and others as a consequence.

Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, men who coerce a spouse into a sexual act believe their actions are legitimate because they are married to the woman. Rape of women and of men is often used as a weapon of war, as a form of attack on the enemy, typifying the conquest and degradation of its women or captured male fighters. It may also be used to punish women for transgressing social or moral codes, for instance, those prohibiting adultery or drunkenness in public. Women and men may also be raped when in police custody or in prison. While sexual violence can be directed against both men and women, the main focus of this article will be on the various forms of sexual violence against women, as well as those directed against young girls by people other than caregivers.
Sources of data: Data on sexual violence typically come from police, clinical settings, nongovernmental organizations and survey research. The relationship between these sources and the global magnitude of the problem of sexual violence may be viewed as corresponding to an iceberg floating in water. The small visible tip represents cases reported to police. A larger section may be elucidated through survey research and the work of nongovernmental organizations. But beneath the surface remains a substantial although unquantified component of the problem. In general, sexual violence has been a neglected area of research. The available data are scanty and fragmented. Police data, for instance, are often incomplete and limited. Many women do not report sexual violence to police because they are ashamed, or fear being blamed, not believed or otherwise mistreated. Data from medico-legal clinics, on the other hand, may be biased towards the more violent incidents of sexual abuse. The proportion of women who seek medical services for immediate problems related to sexual violence is also relatively small. Although there have been considerable advances over the past decade in measuring the phenomenon through survey research, the definitions used have varied considerably across studies. There are also significant differences across cultures in the willingness to disclose sexual violence to researchers. Caution is therefore needed when making global comparisons of the prevalence of sexual violence.
Sexual violence against men and boys: Sexual violence against men and boys is a significant problem. With the exception of childhood sexual abuse, though, it is one that has largely been neglected in research. Rape and other forms of sexual coercion directed against men and boys take place in a variety of settings, including in the home, the workplace, schools, on the streets, in the military and during war, as well as in prisons and police custody.
In prisons, forced sex can occur among inmates to establish hierarchies of respect and discipline. Sexual violence by prison officials, police and soldiers is also widely reported in many countries. Such violence may take the form of prisoners being forced to have sex with others as a form of ‘‘entertainment’’, or to provide sex for the officers or officials in command. Elsewhere, men who have sex with other men may be ‘‘punished’’, by rape, for their behaviour which is perceived to transgress social norms.
Prevention and policy responses to sexual violence against men need to be based on an understanding of the problem, its causes and the circumstances in which it occurs. In many countries the phenomenon is not adequately addressed in legislation. In addition, male rape is frequently not treated as an equal offence with rape of women. Many of the considerations relating to support for women who have been raped --- including an understanding of the healing process, the most urgent needs following an assault and the effectiveness of support services --- are also relevant for men. Some countries have progressed in their response to male sexual assault, providing special telephone hotlines, counselling, support groups and other services for male victims. In many places, though, such services are either not available or else are very limited --- for instance, focusing primarily on women, with few, if any, counsellors on hand who are experienced in discussing problems with male victims.
In most countries, there is much to be done before the issue of sexual violence against men and boys can be properly acknowledged and discussed, free of denial or shame. Such a necessary development, though, will enable more comprehensive prevention measures and better support for the victims to be implemented.
Violent or forced sex can increase the risk of transmitting HIV. In forced vaginal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus --- when it is present ---through the vaginal mucosa. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membrane has not yet acquired the cellular density providing an effective barrier that develops in the later teenage years. Those who suffer anal rape --- boys and men, as well as girls and women --- are also considerably more susceptible to HIV than would be the case if the sex were not forced, since anal tissues can be easily damaged, again allowing the virus an easier entry into the body. Being a victim of sexual violence and being susceptible to HIV share a number of risk behaviours. Forced sex in childhood or adolescence, for instance, increases the likelihood of engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse. People who experience forced sex in intimate relationships often find it difficult to negotiate condom use ---either because using a condom could be interpreted as mistrust of their partner or as an admission of promiscuity, or else because they fear experiencing violence from their partner. Sexual coercion among adolescents and adults is also associated with low self-esteem and depression---factors that are associated with many of the risk behaviours for HIV infection.
Being infected with HIV or having an HIV-positive family member can also increase the risk of suffering sexual violence, particularly for women. Because of the stigma attached to HIV and AIDS in many countries, an infected woman may be evicted from her home. In addition, an AIDS-related illness or death in a poor household may make the economic situation desperate. Women may be forced into sex work and consequently be at increased risk for both HIV/AIDS and sexual violence. Children orphaned by AIDS, impoverished and with no one to care for them, may be forced to live on the streets, at considerable risk of sexual abuse.
Sexual violence has generally been a neglected area of research in most parts of the world, yet the evidence suggests that it is a public health problem of substantial proportions. Much more needs to be done both to understand the phenomenon and to prevent it. These include: the incidence and prevalence of sexual violence in a range of settings, using a standard research tool for measuring sexual coercion; the risk factors for being a victim or a perpetrator of sexual violence; the health and social consequences of different forms of sexual violence; the factors influencing recovery of health following a sexual assault; the social contexts of different forms of sexual violence, including sexual trafficking, and the relationships between sexual violence and other forms of violence

The writer is former Head, Department of Medical Sociology,
Institute of Epidemiology, Disease Control & Research (IEDCR),
Dhaka, Bangladesh
E-mail: [email protected]

 

Sexual violence: A deeper look

Sexual violence is a common and serious public health problem affecting millions of people each year throughout the world. It is driven by many factors operating in a range of social, cultural and economic contexts

Without doubt sexual violence is the number one global and national public health issue. We currently live in a world that hears or reads reports of some type of tragic violent activity on a daily basis. Although in most countries there has been little research conducted on the problem, available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner and up to one-third of adolescent girls report their first sexual experience as being forced. Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term. Its impact on mental health can be as serious as its physical impact, and may be equally long lasting. Deaths following sexual violence may be as a result of suicide, HIV infection or murder the latter occurring either during a sexual assault or subsequently, as a murder of honour. Sexual violence can also profoundly affect the social well-being of victims; individuals may be stigmatized and ostracized by their families and others as a consequence. Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, men who coerce a spouse into a sexual act believe their actions are legitimate because they are married to the woman. Rape of women and of men is often used as a weapon of war, as a form of attack on the enemy, typifying the conquest and degradation of its women or captured male fighters. It may also be used to punish women for transgressing social or moral codes, for instance, those prohibiting adultery or drunkenness in public. Women and men may also be raped when in police custody or in prison. While sexual violence can be directed against both men and women, the main focus of this article will be on the various forms of sexual violence against women, as well as those directed against young girls by people other than caregivers. Sources of data: Data on sexual violence typically come from police, clinical settings, nongovernmental organizations and survey research. The relationship between these sources and the global magnitude of the problem of sexual violence may be viewed as corresponding to an iceberg floating in water. The small visible tip represents cases reported to police. A larger section may be elucidated through survey research and the work of nongovernmental organizations. But beneath the surface remains a substantial although unquantified component of the problem. In general, sexual violence has been a neglected area of research. The available data are scanty and fragmented. Police data, for instance, are often incomplete and limited. Many women do not report sexual violence to police because they are ashamed, or fear being blamed, not believed or otherwise mistreated. Data from medico-legal clinics, on the other hand, may be biased towards the more violent incidents of sexual abuse. The proportion of women who seek medical services for immediate problems related to sexual violence is also relatively small. Although there have been considerable advances over the past decade in measuring the phenomenon through survey research, the definitions used have varied considerably across studies. There are also significant differences across cultures in the willingness to disclose sexual violence to researchers. Caution is therefore needed when making global comparisons of the prevalence of sexual violence. Sexual violence against men and boys: Sexual violence against men and boys is a significant problem. With the exception of childhood sexual abuse, though, it is one that has largely been neglected in research. Rape and other forms of sexual coercion directed against men and boys take place in a variety of settings, including in the home, the workplace, schools, on the streets, in the military and during war, as well as in prisons and police custody. In prisons, forced sex can occur among inmates to establish hierarchies of respect and discipline. Sexual violence by prison officials, police and soldiers is also widely reported in many countries. Such violence may take the form of prisoners being forced to have sex with others as a form of entertainment, or to provide sex for the officers or officials in command. Elsewhere, men who have sex with other men may be punished, by rape, for their behaviour which is perceived to transgress social norms. Prevention and policy responses to sexual violence against men need to be based on an understanding of the problem, its causes and the circumstances in which it occurs. In many countries the phenomenon is not adequately addressed in legislation. In addition, male rape is frequently not treated as an equal offence with rape of women. Many of the considerations relating to support for women who have been raped --- including an understanding of the healing process, the most urgent needs following an assault and the effectiveness of support services --- are also relevant for men. Some countries have progressed in their response to male sexual assault, providing special telephone hotlines, counselling, support groups and other services for male victims. In many places, though, such services are either not available or else are very limited --- for instance, focusing primarily on women, with few, if any, counsellors on hand who are experienced in discussing problems with male victims. In most countries, there is much to be done before the issue of sexual violence against men and boys can be properly acknowledged and discussed, free of denial or shame. Such a necessary development, though, will enable more comprehensive prevention measures and better support for the victims to be implemented. Violent or forced sex can increase the risk of transmitting HIV. In forced vaginal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus --- when it is present ---through the vaginal mucosa. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membrane has not yet acquired the cellular density providing an effective barrier that develops in the later teenage years. Those who suffer anal rape --- boys and men, as well as girls and women --- are also considerably more susceptible to HIV than would be the case if the sex were not forced, since anal tissues can be easily damaged, again allowing the virus an easier entry into the body. Being a victim of sexual violence and being susceptible to HIV share a number of risk behaviours. Forced sex in childhood or adolescence, for instance, increases the likelihood of engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse. People who experience forced sex in intimate relationships often find it difficult to negotiate condom use ---either because using a condom could be interpreted as mistrust of their partner or as an admission of promiscuity, or else because they fear experiencing violence from their partner. Sexual coercion among adolescents and adults is also associated with low self-esteem and depression---factors that are associated with many of the risk behaviours for HIV infection. Being infected with HIV or having an HIV-positive family member can also increase the risk of suffering sexual violence, particularly for women. Because of the stigma attached to HIV and AIDS in many countries, an infected woman may be evicted from her home. In addition, an AIDS-related illness or death in a poor household may make the economic situation desperate. Women may be forced into sex work and consequently be at increased risk for both HIV/AIDS and sexual violence. Children orphaned by AIDS, impoverished and with no one to care for them, may be forced to live on the streets, at considerable risk of sexual abuse. Sexual violence has generally been a neglected area of research in most parts of the world, yet the evidence suggests that it is a public health problem of substantial proportions. Much more needs to be done both to understand the phenomenon and to prevent it. These include: the incidence and prevalence of sexual violence in a range of settings, using a standard research tool for measuring sexual coercion; the risk factors for being a victim or a perpetrator of sexual violence; the health and social consequences of different forms of sexual violence; the factors influencing recovery of health following a sexual assault; the social contexts of different forms of sexual violence, including sexual trafficking, and the relationships between sexual violence and other forms of violence The writer is former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR), Dhaka, Bangladesh E-mail: [email protected]