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Current projects 

The gendered experiences of interpersonal violence against disabled people in South Africa
This qualitative study aims to look at a hugely neglected human rights and public health problem – violence against people with disabilities. We know that interpersonal violence in South Africa is the second largest public health burden after HIV, and its impact is wide-ranging, including adverse physical, emotional, and sexual health implications, including HIV. South Africa is known for its high levels of violence including homicides of men, women and children, and rampant gender based violence such as rape and intimate partner violence. However, we are unaware of the lifetime nature and forms of violence disabled people experience and the impact this has on their lives. We also don’t know how disabled men and women experience violence differently. The aim of this study will be to make visible disabled people’s experiences of interpersonal violence in South Africa and its impact. Through conducting in-depth interviews with 30 disabled men and women in the Western Cape and KwaZulu Natal, the research will (1) explore the nature and forms of violence experienced by disabled people in their lifetime (2)  describe the gendered vulnerabilities to and experiences of violence, in particular intimate partner violence (IPV) and rape; (3) identify the barriers and facilitators to support services and the coping strategies disabled people employ and (4) engage with disabled people to determine what responses and services are needed to prevent and protect them from violence.
Email: iheijden@mrc.ac.za
Capacity Assessment of Mental Health Services for Rape Victims in Primary Health Care: A Rapid Appraisal of Services in the Western Cape Province
This PEPFAR-funded study aims to conduct a rapid appraisal of mental health services for rape victims in the period of taking PEP at sexual assault service facilities in the Western Cape. Data from interviews with various service providers and rape survivors will help us to:
  • Map the capacity to provide mental health services to rape survivors at primary level services;
  • Explore the nature of mental health care provided to rape survivors during the period of taking PEP medication; and
  • Explore the rape survivor-identified barriers and facilitating factors to the use of mental health services in the period of taking PEP medication.

We expect to gain an understanding of mental health support for rape survivors during the PEP period from the perspectives of service providers and rape survivors. This understanding will inform the development of a training programme and recommended intervention focused on providing mental health support. This project has ethics clearance from the Medical Research Council and the Centres for Disease Control and Prevention South Africa, and it has been approved by the Department of Health.
Email: Naeemah Abrahams (nabraham@mrc.ac.za) or Anik Gevers (anik.gevers@mrc.ac.za)

SVRI Forum 2013: Evidence into Action, 14 – 17 October 2013, Bangkok, Thailand: The SVRI is proud to announce our 3rd international conference on sexual violence research. The aim of SVRI Forum 2013 is to promote promising practices for preventing and responding to sexual and intimate partner violence. The Forum 2013 will be co-hosted by Partners for Prevention. Abstract submissions are now open! Please visit the SVRI Forum 2013 website for important dates and news or contact us at: svri@mrc.ac.za.

National Study on Female and Child Homicide in South Africa - 2009
The 1st National Study on Female Homicide (see below Completed projects) established that South Africa has an intimate femicide rate that far exceeds documented rates for other countries. Overall homicide rates has been decreasing in South Africa since 1994 and similar trends has been reported for intimate femicide in developed countries. We are however not able to establish a pattern for intimate femicide in South Africa as current crime data does not allow for such disaggregation. The 1st study also alerted us to the problem of child murders (0-17 years) of which very little is known. This current study is designed as a mortuary based study to identify from a national sample all cases of female homicides and child homicides. We will follow up all of the identified cases with police to gain further information about the circumstances of the murder and the identity of the perpetrator. This project aims to establish the incidence of female and intimate homicide for 2009 and this will be compare to the 1999 study, allowing us to establish whether there are similar declining shifts in patterns of female murders as seen in overall murders in SA. Importantly, this project will allow us for the first time to establish how big the problem of child homicides is in South Africa and we would be able to describe the circumstances of these murders. Email: nabraham@mrc.ac.za
An ethnographic study of ethical issues in conducting gender-based violence research in community based studies in South Africa.
The aim of this research is to contribute to understanding about how people from the community perceive discussing violence in a research context and what are their concerns related to this. Through comparing these to those underlying in the World Health Organization guidelines, we will deepen our understanding of the extent to which the safeguards seem to be relevant in addressing community concerns and risks of participation in research and the extent to which those provided in the community study (below) did protect participants with respect to issues of anonymity, confidentiality, safety, informed consent. In the year 2010 a Non-Governmental Organization called GenderLinks, located in Johannesburg, will be undertaking a community-based survey of gender-based violence together with other collaborators including the South African Medical Research Council’s Gender and Health Unit. This survey will collect data in 65 enumeration areas in the Gauteng province which have been randomly sampled.  The ethnographic study will study ethical issues related to and arising from this survey. For the ethnographic study, the co-investigator (Yandisa Sikweyiya) plans to select two (2) enumeration areas and study these in some depth. This study will follow an anthropological type of field work. Email yandisa.sikweyiya@mrc.ac.za
Global Burden of Disease Study: Measuring the Global Health Burden of Inter-personal Violence Against Women and Men
The Global Burden of Disease project is a global research initiative and the primary objective of the GBD project is to calculate the burden of ill-health associated with various diseases, injuries, and risk factors for the years 1990 and 2005 for each region of the world http://www.globalburden.org/. Within the GBD project, intimate partner violence, non-partner sexual violence and childhood sexual abuse are treated as risk factors for injury and disease. Naeemah Abrahams is part of the expert working group and is tasked with estimating the global health burden of non-partner sexual violence. The expert group is lead by Charlotte Watts from the London School of Hygiene and Tropical Medicine and experts from the WHO are also part of this working group.  We are currently in the process of reviewing the literature from every country in the world through systematic reviews seeking studies and datasets on the prevalence and risk factors associated with non-partner sexual violence (rape/sexual assault). nabraham@mrc.ac.za
Child sexual assault: Exploring the needs of the girl child and their care giver in the period after rape.
The objective of the study is to develop an understanding of children’s psychosocial needs post rape and to determine the extent to which the existing services meet the needs of both the child and their primary caregiver. The study is designed as a longitudinal follow-up study using qualitative semi-structured interviews with both sexually abused children and their adult care givers.  Screening tools will also be used with the children to assess psychological symptomatology. A purposive sample of 36 CSA survivors (child and care giver) will be recruited and followed-up from point of contact for a 6 month follow-up period.. Another focus of the study is to explore issues of disclosure among children. The data is currently being analysed.  Email: nabraham@mrc.ac.za
Developing an understanding of Intimate Femicide in South Africa

The results from the National Female Homicide alerted us to the magnitude of intimate femicide (a women killed by an intimate partner) in the country. However, not much is known about why men kill their partners and under which circumstances such killings occur. The aim of this project is to develop an understanding of the context of intimate femicide through the use of qualitative methods. The project is firstly exploring the perceptions and ideas of perpetrators of such crimes. Interviews are being conducted with perpetrators who have been found guilty and currently in a correctional facility. The project aims to also go beyond the victim-perpetrator dyad by exploring ideas held by others in their social network, thereby exploring the social context of both victim and perpetrator which may help our understanding of the vulnerability. Data is currently being analysed. E-mail: nabraham@mrc.ac.za

Publication

  • Mathews S, Jewkes R, Abrahams N. (2011) “I had a hard life”: Exploring childhood adversity in the shaping of masculinities among men who killed an intimate partner in South Africa. British Journal of Criminology. 51(4).
Stigma of HIV and sexual violence

The overall aim of this study is to explore the role of stigma among two groups of participants: those who experienced a sexual assault and those who are HIV positive. We wish to understand the social experiences of these two groups, how they view themselves after a sexual assault and a HIV diagnosis, to gain an understanding of the contribution of stigma and other influences on changes in self-concept, and how this changes over time. The study explored individual’s pathways to seeking healthcare after a sexual assault, and a HIV diagnosis. This qualitative study was done at two sites i.e. Cape Town and Mthatha. The data is currently being analysed. E-mail: naeemah.abrahams@mrc.ac.za

Project publications

  • Abrahams N & Jewkes R. Barriers to Post exposure prophylaxis (PEP) completion after rape: a South African qualitative study. Culture Health and Society 2010 12 (5); 471-484
  • Abrahams N, Jewkes R.(2012) Managing and resisting stigma: a qualitative study among people living with HIV in South Africa. Journal of the International AIDS Society; 15(2):17330.
  • Abrahams N, Jewkes R, Mathews S, Lombard C, Campbell J C & Meel B. Impact of telephonic psycho-social support on adherence to Post Exposure Prophylaxis (PEP) after rape. AIDs Care. 2010 Jul 16:1-9. [Epub ahead of print].
Curriculum development and training manuals for sexual assault care practitioners in South Africa

The Unit received funding from DFID to develop a training curriculum for health professionals providing sexual assault care for the National Department of Health.  The curriculum is a 10 day training course plus two days of practicum. The curriculum has been documented in a 250 page participants’ manual trainers and 200 page trainers’ manual both of which have been written in the past year. These documents are evidence-based, cover a comprehensive approach to rape care and use adult education methods which a great deal of reflection and skills building. A range of supportive materials have also been produced including an assessment booklet for the practicum for the trainer and for the trainee, a course certificate, a 16 page brochure for distribution to survivors of rape in health facilities, a revised draft of the J88 form and a 30 minute DVD with four clips demonstrating good practice talking to and supporting survivors and demonstrations of trauma-focused cognitive behavioural therapy.

In 2008 the curriculum was piloted with the training of 144 health care providers from 8 provinces in 4 two week training courses. Evaluation of the training has three parts. First all trainees had to complete a MCQ before and after the course to test knowledge. Through this we established effectiveness in significantly increasing knowledge. Secondly, all were asked to complete a questionnaire that measured gender attitudes and attitudes and confidence at work. This was done before training, immediately afterwards and three months later. Finally qualitative interviews were conducted with providers trained in two facilities before and after training and also with a further group of 15 providers some months after training, the aim being to explore the extent and nature of health system barriers to service improvement after training. E-mail: rjewkes@mrc.ac.za

Project publications

  • Jina R, Jewkes R, Christofides N, Loots L (eds) Caring for survivors of sexual assault. A training programme for health care providers in South Africa. Participants’ manual. Department of Health, Pretoria. 2008.
  • Jina R, Jewkes R, Christofides N, Loots L (eds) Caring for survivors of sexual assault. A training programme for health care providers in South Africa. Facilitators’ manual. Department of Health, Pretoria. 2008.
  • Sexual assault and rape: a survivor’s guide. Booklet published by Department of Health, Pretoria. 2008
  • Christofides N, Jewkes R, Jina R. ‘Meeting the survivor’s immediate psychological needs’; ‘Introducing the ‘Survivor information booklet’; ‘In vivo (real life) exposure’; ‘Imaginal exposure - reliving the memory of the rape’.  DVD.  Medical Research Council. May 2008.
Tracking justice

This study aims to describe the circumstances in which rape occurs in Gauteng Province and the factors that influence attrition of rape cases through the criminal justice system. This is a cross-sectional study of a representative sample of rape cases reported to the police in 2003 in Gauteng province. Data has been collected from 70 police stations and a total sample of 2068 rape dockets was identified from these for inclusion in the study. Data was abstracted from the dockets on the characteristics of rape victims and their perpetrators, the circumstances in which the rape occurred, the responses of the victim and perpetrator during and after the rape, the legal processes followed and legal outcomes. The nature of injuries has been documented from the J88s. This research was led by the Tshwaranang Legal Advocacy Centre and Centre for the Study of Violence & Reconciliation. E-mail: rjewkes@mrc.ac.za

Project publications

  • Jewkes RK, Christofides N, Vetten L, Jina R, Fuller R, Loots L Medico-legal findings, case progression and legal outcomes in South African rape cases: a cross-sectional study. PLoS Medicine 6(10): e1000164. doi:10.1371/journal.pmed.1000164
  • Vetten L,  Jewkes R, Fuller R, Christofides N, Loots L, Dunseith O. (2008) Tracking Justice: The Attrition of Rape Cases Through the Criminal Justice System in Gauteng. Tshwaranang Legal Advocacy Centre. Johannesburg (pdf format, 659 kb).
  • Sigsworth R, Vetten L, Jewkes R, Christofides N. Policing rape in South Africa. Agenda  (in press)
  • Sigsworth R, Vetten L,  Jewkes R, Christofides N. (2009) Tracking Justice: Rape Survivors in the Criminal Justice System in Gauteng: Attrition at the Police Investigation Stage. Technical Report. Centre for the Study of Violence and Reconciliation. Johannesburg.
Study of rape perpetration and its intersections with HIV

This study is being undertaken in collaboration with the School of Education Studies at the University of KwaZulu Natal (Robert Morrell) and Emory University (Kristin Dunkle). The aim of the study is to describe the epidemiology of rape perpetration; factors associated with raping; to describe the associations between rape and HIV sero-status and risk behaviours. In 2008 we implemented the data collection for the study, working in 222 census enumeration areas in three districts in the Eastern Cape and KwaZulu Natal (OR Tambo, Ugu and Ethekwini), where we sought to interview 4440 households. Informants were men aged 18-49. This survey includes a range of questions on aspects of men’s backgrounds, particularly their experiences in childhood, other violent and criminal practices and other aspects of men’s behaviour, such as caring and child rearing practices. Our questionnaire is being shared with collaborators in Brazil, Mexico, Chile and India who have funding for a multi-country study that will replicate large areas of our data collection which will enable us to have access to a multi-country data set for comparative analysis of data on men and masculinities.

A new report from the MRC’s Gender and Health Research Unit tries to understand the prevalence of rape perpetration in a random sample community-based adult men as well as understanding factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV. E-mail: rjewkes@mrc.ac.za

Project publications

  • Jewkes R, Sikweyiya Y, Morrell R, Dunkle K (2009) Understanding men’s health and use of violence: interface of rape and HIV in South Africa. Technical Report. Medical Research Council, Pretoria.
  • Sikweyiya Y, Jewkes R, Morrell R. Talking about Rape: Men’s responses to questions about rape in a research environment in South Africa. Agenda 2007; 74: 48-57.
Men and Gender Equality Policy Project

This is a three year project led by Promundo in Brazil which aims to analyse public policies relating to gender equality and men/boys; to undertake qualitative research on men who adopt non-traditional care giving roles in order to map and understand what influences these; and to develop an international men and gender equality survey. The Gender & Health Research Unit is the South African partner for this initiative with Prof Robert Morrell of the University of KwaZulu Natal. The initiative spans across South Africa, Brazil, Mexico, Chile, UK and India. E-mail: rjewkes@mrc.ac.za

Project publications

  • Barker G, Greene M, Goldstein-Siegel E, Nascimento M, Segundo M, Ricardo C, Figueroa JG, Redpath J, Morrell R, Jewkes R, Peacock D, Aguayo F, Sadler M, Das A, Singh S, Pawar A, Pawlak P. What men have to do with it. Policy policies to promote gender equality. International Center for Research on Women. Washington. 2010
  • Morrell R, Jewkes R (2009) Men who care. A case study of masculinities and gender equity in South Africa. Technical Report. University of KwaZulu Natal. Durban.
Respect 4 U

Respect 4 U
Respect 4 UThis three-year project is led by the University of Cape Town, Department of Child and Adolescent Psychiatry (Alan Flisher), Pacific Institute for Research and Evaluation (PIRE), University of Kentucky (Pam Cupp, Marcia Russell). The Unit is collaborating with them, as is Cathy Mathews (MRC, Health Systems). The project is funded by the NIMH. The aim of the project is to develop and pilot/test an intervention to reduce dating violence for use in schools (aimed at Grade 8).

The intervention is informed by a theoretical model that is derived from existing research addressing the associations between IPV and ideologies of male superiority, a culture of violence, and high levels of alcohol and drug use. The goals of the intervention are to increase social support for girls, change norms that support boys’ right to control girls and insist on sex, increase understanding of substance use in the context of relationships, and improve communication to prevent the use of violence in relationships.

The process of intervention development has included integrating existing relevant evidence-based programmes, team workshops, and consultations with experts in the field and with key informant adolescents. Monitoring and evaluation data collected during pilot testing informed initial revisions before the intervention’s impact was investigated. The initial testing of the intervention with evaluation in four schools will be completed in 2010. Email: respect4u.project@gmail.com and anik.gevers@mrc.ac.za.

A RCT evaluation of a brief woman-focused behaviour change intervention that aims to increase knowledge and skills to reduce substance abuse, sexual risk and victimization in VCT settings
The aim of the study is to use a RCT to test the effectiveness of combining voluntary counselling and testing (VCT) with a woman-focused intervention in helping women reduce their substance abuse, sexual risk, and victimization compared to two control groups ( a VCT only group and an equal-attention (nutrition) group) at 3-, 6-, 9-, and 12-month follow-ups. The study is being led by Research Triangle Institute (RTI) (Wendee Wechsberg) and the Alcohol and Drug Research Unit of the MRC (Charles Parry). The Unit is collaborating. It is funded from the NIAAA in the USA via a R01 mechanism.
Evaluation of Stepping Stones: a gender transformative HIV prevention intervention

Stepping Stones is a gender transformative HIV prevention behaviour intervention (see training tools page). The Unit has been evaluating the intervention since 2002 among youth in the rural Eastern Cape. It is a cluster randomised controlled trial to determine its impact on HIV and HSV2 incidence, and sexual and violent behaviours. The research also included qualitative research. Data collection has been completed and the main findings have been presented for publication. Data analysis for a range of papers that will deepen our understanding of gender and sexual behaviour is ongoing. Partners in the research were Dr Jonathan Levin, MRC Uganda, Dr Adrian Puren of NICD, Dr Kristin Dunkle of Emory University, Dr Nata Duvvury of ICRW, Prof Mary Koss  of University of Arizona and Dr Kate Wood of the Institute of Education.
The Stepping Stones manual is currently being revised and shortened and the third edition will be published in July 2010. Further analyses of the dataset are being conducted within the Unit particularly focusing on child abuse, HSV2, transactional sex, concurrency, condom use, pregnancy, mental health and the qualitative dataset.
E-mail: rjewkes@mrc.ac.za

Project Publications

  • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N (2008) Impact of Stepping Stones on HIV, HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial British Medical Journal 337:a506
  • Jewkes R, Nduna M, Jama N (2002) Stepping Stones. A training manual for sexual and reproductive health, communication and relationship skills. Edition two. . Published by Medical Research Council, Pretoria.
  • Jewkes R, Wood K, Duvvury N. “I woke up after I joined Stepping Stones”: meanings of a HIV behavioural intervention in rural South African young people’s lives. Health Education Research (in press)
  • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N.  A cluster randomised controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Tropical Medicine and International Health 2006; 11:3-16.
  • Jewkes R, Dunkle K. Nduna M, Shai N. Intimate partner violence, relationship gender power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. The Lancet (in press)
  • Jewkes R, Dunkle K, Koss MP, Levin J, Nduna M, Jama N, Sikweyiya Y. Rape perpetration by young, rural South African men: prevalence, patterns and risk factors. Social Science and Medicine. 2006; 63: 2949-61
  • Dunkle K, Jewkes R Nduna M, Levin J, Jama N, Khuzwayo N, Koss MP, Duvvury N Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape AIDS 2006; 20: 2017-14.
  • Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N. Factors associated with HIV sero-positivity in young, rural South African men, International Journal of Epidemiology 2006; 35: 1455-1460.
  • Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N, Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV International Journal of Epidemiology 2006; 35: 1461-8.
  • Dunkle KL, Jewkes RK, Nduna M, Jama N, Levin JB, Sikweyiya Y, Koss MP. Transactional sex and economic exchange with partners among young South African men in the rural Eastern Cape: prevalence, predictors and associations with gender-based violence. Social Science and Medicine 2007, 65(6),  1235-48.
  • Shai  N, Jewkes R, Nduna M, Levin J, Dunkle K. Factors associated with consistent and inconsistent condom use among rural young women in South Africa. AIDS Care. (in press)

Policy brief

  • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Wood K, Koss M, Puren A, Duvvury N.  Evaluation of Stepping Stones: A gender transformative HIV prevention intervention (March 2007)

Fact sheet

  • Jewkes R, Jama N, Nduna M, Levin J, Dunkle K, Khuzwayo N, Duvvury N, Koss M. Stepping Stones Study: Fact sheet on young people’s health and sexual practices in villages and townships of the rural Eastern Cape. Medical Research Council, Pretoria. 2005.
SHARE Project: Schools Intervention for Healthier Relationships
This project aims to develop and test a suite of interventions to strengthen the capacity of schools and school staff as well as home and adolescents’ caregivers to support teenagers to protect themselves against becoming a victim of, or perpetrating, gender-based violence such as intimate partner violence (“dating violence” or “dating abuse”) and rape. The suite of interventions includes a Grade 8 Life Orientation curriculum including learner workbook and educator training and workbook; positive discipline skills workshop for educators; school values workshop; and a workshop for parents of Grade 8 learners. This suite of interventions will be rigorously evaluated in a randomised controlled trial with 30 schools in three study arms (no intervention vs school intervention only vs school and parent intervention).   Project outcomes will be assessed using qualitative in-depth interviews and quantitative surveys with Grade 8 learners, these learners’ parents, and educators and school staff at the 30 trial schools. During 2012/2013 project activities focus on formative research and intervention development; in 2014 the interventions will be implemented along with monitoring and evaluation research activities; and in 2015 follow up evaluations will be conducted.
For more information about this project, please contact Aník Gevers (anik.gevers@mrc.ac.za)

List of completed projects

National female homicide study

This is a retrospective study of the homicides of women aged 14 and over in South Africa in 1999, which involved data collection from mortuary death registers which were followed up via their police case numbers. The main study finding was that, in South Africa a woman is killed every 6 hours by an intimate partner, which received extensive media attention and has also been used extensively in all advocacy campaigns to raise awareness among policy makers and communities. The study finding on the use of guns in these murders has also been used in the process of developing the new Firearms Control Act in South Africa. Partners in this research were Prof Lorna Martin of the UCT Forensic Pathology Unit and Lisa Vetten from The Centre for the Study of Violence and Reconciliation (CSVR). Publications from the study findings have been presented for publication. E-mail: naeemah.abrahams@mrc.ac.za

Project Publications

  • Abrahams N, Martin LJ, Jewkes R, Mathews S, Vetten L,  Lombard C (2008) The epidemiology and the pathology of rape homicide in South Africa. Forensic Science International 178,132-138
  • Mathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C, Vetten L,  (2008) Intimate femicide-suicide in South Africa. Bulletin of the World Health Organisation 86:542-58.
  • Mathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C Alcohol use and its role in female homicides in the Western Cape, South Africa. Journal of Studies on Alcohol and Drugs. 2009. 70(3). pp321-327
  • Mathews S, Abrahams N, Jewkes R, Martin L, Vetten L, Lombard C. Injury patterns of female homicide victims in South Africa. J Trauma .2009. 67(1).pp168-172
  • Abrahams N, Jewkes R, Martin LJ, Mathews S, Lombard C, Vetten L Mortality of women from intimate partner violence in South Africa: a national epidemiological study. Journal of Violence and  Victims  2009. 24(4): 546-556 
  • Abrahams N, Jewkes R, Martin LJ, Mathews S: Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders. PLoS One 2011, 6:e28620.

Policy Brief

  • Mathews S, Abrahams N, Martin LJ, Vetten L van der Merwe L & Jewkes R.  "Every six hours a woman is killed by her intimate partner": A National Study of Female homicide in South Africa (June 2004)
Intervention study to improve PEP adherence following a sexual assault

The aim of this study was to test and evaluate an intervention to improve post exposure prophylaxis (PEP) adherence after a sexual assault to prevent HIV transmission. Previous studies done by the Unit and other researchers have shown the poor level of adherence to the PEP treatment. An intervention was developed to improve compliance to PEP after a sexual assault. This was based on research conducted with women that attended sexual assault services. The intervention developed used a combination of information and support through follow-up telephonic contact during the 28 day period. The support was  provided by trained nurses/counselors to motivate and facilitate the taking of PEP medication. The study was conducted at two sites: Cape Town and Mthatha. E-mail: naeemah.abrahams@mrc.ac.za

Project Publications

  • Abrahams N & Jewkes R. Barriers to Post exposure prophylaxis (PEP) completion after rape: a South African qualitative study. Culture Health and Society 2010. Jun;12(5):471-84
  • Abrahams N, Jewkes R, Mathews S, Lombard C, Campbell J C & Meel B. Impact of telephonic psycho-social support on adherence to Post Exposure Prophylaxis (PEP) after rape. AIDs Care. 2010 Jul 16:1-9. [Epub ahead of print].
Intimate partner violence during pregnancy and linkages with HIV in Zimbabwe

The study assessed the linkages between intimate partner violence (IPV) and HIV infection during pregnancy and after HIV status disclosure. The study also explored women’s experiences of IPV as well as health workers’ perceptions of and experiences in responding to IPV during pregnancy. A mixed-methods approach was applied to understand IPV and HIV during pregnancy. The methods include a systematic review and meta-analysis of African studies on IPV during pregnancy, a survey of 2042 postnatal women’s experiences of IPV during pregnancy and HIV testing and disclosure, and a qualitative study of pregnant and postnatal women, midwives and HIV care nurses in Harare, Zimbabwe. The principal investigator is Simukai Shamu with Christina Zarowsky (School of Public Health, UWC), Maleern Temmerman (Ghent University, Belgium), Naeemah Abrahams (MRC, Gender and Health) and Tamara Shefer (Woman’s and Gender Studies, UWC) as co-investigators. The project received funding from the following institutions: Flemish Inter-University Network (VLIR-UOS) and the Cooperation Agreement between Ghent University and the University of the Western Cape (UWC) through the Dynamics of Building a Better Society (DBBS) project at the UWC, African Population and Health Research Centre’s (AHRC) African Doctoral Dissertation Research Fellowship (ADDRF) in collaboration with the Ford Foundation and Canada’s International Development Research Centre (IDRC), UWC’s HIV Research  Centre and Faculty Research Grant, The South African Medical Research Council, University of Zimbabwe.

Email: sshamu@mrc.ac.za

Project Publications

  • Shamu S, Abrahams N, Temmerman M, Musekiwa A, Zarowsky C (2011) A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors. PLoS ONE 6(3): e17591. doi:10.1371/journal.pone.0017591
  • Shamu S, Zarowsky C, Shefer T, Abrahams N, Temmerman M. (2013). Intimate partner violence during pregnancy in Zimbabwe: A Cross-sectional study of prevalence, predictors, and associations with HIV. Tropical Medicine and International Health doi:10.1111/tmi.12078  (epub ahead of print)
  • Shamu S, Abrahams N, Temmerman M, Shefer T, Zarowsky C (2012) ‘‘That pregnancy can bring noise into the Family’’: Exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe. PLoS ONE 7(8): e43148. doi:10.1371/journal.pone.0043148
  • Shamu S, Abrahams N, Temmerman M, Zarowsky C. (2013). Opportunities and obstacles to screening pregnant women for intimate partner violence during antenatal care in Zimbabwe. Culture Health and Sexuality.  http://dx.doi.org/10.1080/13691058.2012.759393 (epub ahead of print)
Associations between gender-based violence and HIV

Rachel Jewkes and Kristin Dunkle worked together on this research on associations between gender-based violence and HIV infection. The study was undertaken in four Soweto antenatal clinics amongst first time attendees aged 16 or over who had agreed to VCT but had not yet received their HIV results and who had not been previously tested. Women who were eligible were systematically approached by interviewers. A standard questionnaire was used and 1395 women were interviewed with a response rate of 95%. The questionnaire asked questions about intimate partner violence (IPV), child sexual abuse, sexual assault by non-partners as well as a range of factors which could have mediated or confounded the relationship. The HIV results were collected. The data has been analysed by Kristin Dunkle for her PhD. e-mail: rjewkes@mrc.ac.za

Project Publications

  • Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. (2004) Gender-Based Violence, Relationship Power and Risk of Prevalent HIV Infection among Women Attending Antenatal Clinics in Soweto, South Africa. The Lancet 363: 1415-1421.
  • Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD. (2004) Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection.  Social Science & Medicine 59, 1581-1592.
  • Dunkle KL, Jewkes RK, Brown HC, et al. 2004 Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. American Journal of Epidemiology  160, 230-9.
  • K Dunkle, R Jewkes, H Brown, J McIntyre, G Gray, S Harlow. Gender-Based Violence and HIV Infection among Pregnant Women in Soweto. A Technical Report to the Australian Agency for International Development. Medical Research Council, Pretoria, 2003.
National situation analysis of sexual assault services

This project aimed to describe the facilities in a randomly-selected national sample of South African hospitals and facilities which provided sexual assault care to determine the factors associated with providing higher quality care. The study was a project of the South African Gender-based Violence and Health Initiative (SAGBVHI). E-mail: nicola.chris@mrc.ac.za

Project Publications

  • Christofides N, Jewkes R, Webster N, Penn-Kekana L, Abrahams N, Martin L “Other patients are really in need of medical attention”- the quality of sexual assault services in South Africa. World Health Bulletin 2005;83 :495-502.
  • How to Conduct a Situation Analysis of Health Services for Sexual Violence Survivors: The guide can be downloaded from: http://www.svri.org/analysis.htm
    Christofides N, Webster N, Jewkes R, Penn-Kekana L, Martin L, Abrahams N, Kim J. The state of sexual assault services: findings from a situation analysis of services in South Africa. Technical report published by the South African Gender-based Violence & Health Initiative. Medical Research Council, Pretoria.2004
Safety in school toilets

This study was undertaken in collaboration with the CSIR to develop a methodology for exploring sexual abuse of school-going girls, the risks associated with use of school toilets, and school-based strategies for reducing risks. Rapid participatory research methods were used in three schools. Focus group discussions and visualisation techniques (mapping and photography) were used. The key findings are as follows: toilets varied greatly between schools, with some being sites with a risk of sexual violence; stopping smoking in toilets was at times prioritised over basic access and safety; many cases of sexual harassment by teachers were reported in the schools. Strategies for supporting and protecting girls who reported male educators, as well as strategies for raising such cases with the Department of Education, were developed. The research team is involved in redesigning one of the school toilets and a follow-up project is planned in the Johannesburg area to ensure that future architectural designs of schools and public toilets are done from a gendered perspective. E-mail: naeemah.abrahams@mrc.ac.za

Project publications

  • Abrahams N, Mathews S, Ramela P. Intersections of ‘sanitation, sexual coercion and girls’ safety in schools’. Tropical Medicine and International Health 2006; 11(5): 751-756.
An ethnography of sexual health & violence among township youth in South Africa

This work was undertaken as Kate Wood's PhD. It was based on eighteen months of field work in Ngangelizwe Township, Umtata, where Kate worked as an ethnographer. The thesis focuses on HIV/AIDS and physical and sexual violence within youth sexual relationships. The work describes patterns of youth sexual relationships: giving an account of multiple partnering, patterns of early sexual experiences, the mediation of relationships by money (or its lack), and the gendering of sexual reputations. E-mail: k.wood@ioe.ac.uk

Project publication

  • Wood K (2005). Contexualising group rape in post apartheid South Africa. Culture Health and Sexuality. 2005; 7(4): 303-317
  • Wood K, Lambert H, Jewkes R  ‘Showing roughness in a beautiful way’: talk about love,  coercion and rape in South African youth culture. Medical Anthropology Quarterly 2007; 21(3): 277-300
  • Wood K, Lambert H, Jewkes R, ‘Injuries are beyond love’: young South Africans’ understandings of limit and legitimacy in relation to physical violence in their sexual relationships. Medical Anthropology (in press) 2008; 27(1):
The study of the prevalence of emotional, physical and sexual abuse of women in three South African provinces

The Three Province study was the first large-scale violence against women community-based study in South Africa. It had a more specific objective than the SADHS: to describe the epidemiology of violence against women in specific areas and to further validate the findings of the national survey (SADHS). A similar sampling frame as the SADHS was used to allow for comparison and 1 306 women aged 18-49 years in Mpumalanga, Eastern Cape and Northern Province were interviewed. The first South African Demographic and Health Survey (SADHS) were conducted in 1998 and included questions on violence against women. E-mail: rjewkes@mrc.ac.za

Project publications

  • Jewkes R, Penn-Kekana L, Levin J. Risk factors for domestic violence: findings from a South African cross-sectional study. Social Science and Medicine 2002; 55, 1603-1618
  • Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African Provinces. South African Medical Journal 2001; 91(5):421-428
  • Jewkes R, Abrahams N The epidemiology of rape and sexual coercion in South Africa: an overview. Social Science & Medicine 2002; 55:153-166.
  • Jewkes R, Levin J, Penn-Kekana L. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Social Science & Medicine. 2003, 56(1), 125-34
Men's use of violence against intimate partners: a study of working men in Cape Town

Interviews were conducted with a random sample of 1 400 men employed by three municipalities in the Cape Town area. All were administered a standard questionnaire on their use of physical and sexual violence against their intimate partners of the previous ten years. The data has been further analysed to explore adult violent behaviours associated with having witnessed domestic violence against their mother in childhood. Key findings: 15% of the men reported sexual violence and 42.3% reported physical violence against a partner. Men who were sexually violent were more likely to have other partners, making them multiple sources of risk for their partners. Use of violence against intimate partners was associated with having witnessed it at home in childhood, as was involvement in crime and the use of violence at work and in the community. E-mail: naeemah.abrahams@mrc.ac.za

 Publications

  • N Abrahams, R. Jewkes, M. Hoffman, R. Laubscher (2004) Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men. Bulletin of the World Health Organisation 82: 330-337.
  • Abrahams N, Jewkes R. What is the impact of witnessing mother abuse during childhood on South African men’s violence as adults? American Journal of Public Health 2005;95:1811-1816.
  • Abrahams N, Jewkes R, Laubscher R, Hoffman M. (2006) Intimate partner violence: prevalence and risk factors for men in Cape Town, South Africa. Violence and Victims  21(2),247-264.
Integrating gender-based violence into health care in primary care and VCT

The Unit has been working on addressing gender-based violence in health services since 1998. The initial work led to the development of materials for training in primary health care. The programme was called Vezimfihlo and lasted for three days. It was developed by Tanya Jacobs and Rachel Jewkes with Shereen Usdin of Soul City and tested with nurses in the Western and Eastern Cape in 2000. Subsequently the materials were adapted for use in VCT settings and a two day training programme for VCT counselors is available from the Unit. This has been piloted in the Esselen Street Clinic and was developed by Rachel Jewkes with Nicola Christofides, Claire Mooideen and Rowena Ngubeni. E-mail: rjewkes@mrc.ac.za

Publications

  • Jewkes R, Christofides N, Mooideen C, Ngubeni R (2007) Vezimfihlo. A training manual for addressing gender-based violence in VCT. Medical Research Council, Pretoria.
  • Jacobs T, Jewkes R (2001) Health sector response to gender violence: a model for the development, implementation and evaluation of training for health care workers. Gender & Health Group Report. Medical Research Council, Pretoria.
  • Jacobs T, Jewkes R Vezimfihlo: a model for health sector response to gender violence in South Africa. International Journal of Obstetrics and Gynaecology 2002; Sep;78 Suppl 1:S51-6.
Monitoring the impact of Domestic Violence legislation

Naeema Abrahams collaborated with Shanaaz Mathews when she worked for the Gender Advocacy Project in Cape Town on an evaluation of the impact of the Domestic Violence Act on the lives of women. The Act, no.116 of 1998, was implemented in December 1999. The study collected data from magistrate court records of applications for protection orders and undertook in-depth interviews with 25 women six weeks after they had applied for the protection orders. A total of 1 172 cases were randomly selected from two courts from their case roll for 1999 and 2000. The study found that the 40% increase in protection orders after the new legislation was enacted could be accounted for by those taken against non-intimate partners or by men against women. The study concluded that there was little evidence to support a positive benefit for women from the new legislation because the process was not adequately resourced. E-mail: shanaaz.mathews@mrc.ac.za

Publication

  • Mathews S, Abrahams N. (2001). Combining stories and numbers. An Analysis of the Impact of the Domestic Violence Act (No.116 of 1998) on Women. Gender Advocacy Programme & Medical Research Council.
Research on infertility

Naeema Abrahams has been working for several years with the Department of Obstetrics and Gynaecology of the University of Cape Town on aspects of infertility. Her work has included research into women's perceptions, knowledge and experiences of infertility and infertility care as well as the cultural and social barriers to help-seeking. Since 2001 the study has explored psychological distress related to infertility. Key findings of the research have been the perceived need of couples to know more about the cause of their infertility and treatment options before starting treatment. This has led to the development and pilot testing of a service to provide initial infertility management in primary health care by an infertility-trained nurse. The study has highlighted the problems experienced by both services and clients, which result from a lack of management guidelines for infertility at a primary health care level. E-mail: naeemah.abrahams@mrc.ac.za

Publications

  • Dyer SJ, Abrahams N, Mokoena NE, Lombard C  & van der Spuy ZM. Psychological distress among women suffering from couple infertility in South Africa – a quantitative assessment. Human Reproduction. 2005 20(7) (pp. 1938-43)
  • Dyer SJ, Abrahams N, Mokoena NE & van der Spuy ZM.’You are a man because you have children’: Experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility. Human Reproduction 2004. 19 (4) (pp960 -67).
  • Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. (2002). Men leave me as I cannot have children: Women’s experiences with involuntary childlessness. Human Reproduction. 17(6):1663‑8.
  • Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. (2002). Infertility in South Africa. Women’s Reproductive health knowledge and treatment-seeking
Associations between child sexual abuse and HIV in South Africa and Namibia

This had three parts: a desk review of Southern Africa literature on child sexual abuse, a study of the social context of child sexual abuse in a district in Mpumalanga and a similar study in Windhoek, Namibia. The primary research was ethnographic with interviews conducted at each site with children, people from the community and a range of key informants. The aim was to gain an understanding of the nature of child sexual abuse at each site, how local people explained its causation, rules governing adult-child relationships, perceptions of victims and perpetrators of child sexual abuse, awareness of and ideas about child sexual abuse prevention, barriers to reporting cases and problems experienced by service providers. E-mail: rjewkes@mrc.ac.za

Publications

  • Jewkes R, Penn-Kekana L, Rose-Junius H (2005) “If they rape me, I can’t blame them”: reflections on the social context of child sexual abuse in South Africa and Namibia. Social Science and Medicine 61, 1809-1820.
  • Jewkes R, Penn-Kekana L, Rose-Junius H, Malala J (2004) Child sexual abuse and HIV:Study of links in South Africa & Namibia. Medical Research Council, Pretoria.
  • Jewkes R, Rose-Junius H, Penn-Kekana L (2007) “In my culture children have no status and if you are a girl child you have even less status”: Reflections on gender in the  social context of child rape in Namibia. In: LaFont S, Hubbard D. (eds) Unraveling taboos: Gender & sexuality in Namibia. Legal Assistance Centre, Windhoek.
  • Jewkes R (2004) Child sexual abuse and HIV infection. In: Richter L, Dawes A & Higson-Smith C (eds) The sexual abuse of young children in Southern Africa. HSRC, Cape Town.  p.130-142.
Evaluation of the 1997 Choice in Termination of Pregnancy Act

In 1999 the National Department of Health commissioned the researchers who had undertaken the 1994 National Abortion Study to repeat the study so that the impact of the new legislation could be evaluated. The research was undertaken in 2000 and completed in 2002. It had three arms: a study of the national epidemiology of incomplete abortion in 2000; a situational analysis of services for termination of pregnancy nationally in 1999 and a study of why women are still aborting outside designated services in areas where these services are available. The preliminary findings were presented to the oversight hearings of the Parliamentary Portfolio Committee on Health on the Choice in Termination of Pregnancy Act in June 2000. This research was undertaken with the Reproductive Health Research Unit of the University of the Witwatersrand. E-mail: rjewkes@mrc.ac.za

Publications

  • Jewkes R, Rees H, Dickson K, Brown H, Levin J The impact of age on the epidemiology of incomplete abortions in South Africa after legislative  change. BJOG. 2005 Mar;112(3):355-9.
  • Jewkes R , Rees H Dramatic decline in abortion mortality due to the Choice in termination of Pregnancy Act. South African Medical Journal 2005; 95: 250.
  • Jewkes R, Gumede T, Westaway M, Levin J, Dickson-Tetteh K,  Brown H, Rees H (2005) Why are women still aborting outside designated facilities in metropolitan South Africa? British Journal of Obstetrics & Gynaecology 112, 1236-42.
  • Jewkes R, Brown H, Dickson-Tetteh K,  Levin J, Rees H.Prevalence of morbidity associated with abortion before and after legislation in South Africa. British Medical Journal 2002; 324:1252-3.
  • Brown H, Jewkes R, Dickson Tetteh K, Levin J, Rees H. Management of incomplete abortion in South African public hospitals. British Journal of Obstetrics and Gynaecology 2003; 110: 371-7.
  • Dickson Tetteh K, Jewkes R, Brown H, Levin J, Rees H, Mavuya L (2003) Implementation of South Africa’s 1996 Choice on Termination of Pregnancy Act: service provision after three years. Studies in Family Planning 34(4), 277-284
Study of what women want from health services after rape and the cost effectiveness of PEP

This project was designed to provide information to inform the health service response to rape. The overall study was divided into three complementary components. First, we developed and conducted a discrete choice exercise aimed to quantify women’s preferences regarding key aspects of post- sexual assault health service delivery. This was informed by qualitative research carried out in five provinces. The second component of the project was the costing of two sites, one rural and one urban, that routinely provide post--rape care. This data was then used to estimate the scale-up costs of providing post--rape services in accordance with the Department of Health’s sexual assault policy. The third component of the study was modelling the cost effectiveness of providing post-exposure prophylaxis to prevent the transmission of HIV after rape. Project partners were Arum Health Care and the Centre for Health Policy of the University of Witwatersrand. E-mail: nicola.chris@mrc.ac.za

Publications

  • Christofides N, Muirhead D, Jewkes R, Penn-Kekana L, Conco ND Patient experiences of post-sexual assault services and their preferences for how services should be delivered in South Africa.  British Medical Journal 2006; 332(7535):209-23.
Christofides N, Muirhead D, Jewkes R, Penn-Kekana L, Conco N Including post--exposure prophylaxis to prevent HIV/AIDS into post- sexual assault health services in South Africa: costs and cost effectiveness of user preferred approaches to provision. Medical Research Council, Pretoria 2006.

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