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Group calls for more research on sexual violence

[South Africa] Mampho - an HIV-positive mother from Soweto and her baby.
The maternal mortality rate for HIV-positive women is almost 10 times higher (Andrew Bannister)

Though sexual violence affects millions around the world every year, deeply entrenched cultural taboos and a lack of political leadership have historically left the issue largely unrecognised in government boardrooms, health ministries, and scientific research. But that may change, as an emerging global initiative argues sexual violence is a legitimate public health and human rights issue that warrants its own research, prevention, and interventions.

The Pretoria-based Sexual Violence Research Initiative, or SVRI, was developed in 2000 by a cadre of researchers who saw sexual violence as an issue in urgent need of research and resources. Today, SVRI is an initiative of the Global Forum for Health Research, and since late 2006 has been hosted at the Gender and Health Research Unit of the Medical Research Council of South Africa.

According to SVRI project manager Liz Dartnall, little is understood about sexual violence because it is so often overlooked as an area of research. But she says this form of violence has major ramifications for various sectors of society – including education, justice, and health systems – and therefore should be explicitly addressed by policy makers and service providers, such as hospitals and clinics.

"Sexual violence flows under the radar," Dartnall said. "It hasn't really been recognised as a public health issue, but rather as a violence issue and a legal issue. But it has health implications, both psychological and physical. Survivors of sexual violence will use [health] services, and those services have a key role to play."

There is no question that awareness of gender-based violence is growing internationally. In recent years, national governments have taken steps to stem gender-based violence, particularly domestic violence. For example, in 2006, a total of 89 countries worldwide had adopted legislative provisions that address domestic violence, up from only 45 countries in 2003, according to UNIFEM, the United Nations Development Fund for Women.

Yet sexual violence – as a distinct type of violence which can include rape, forced prostitution, and other coerced sexual activity – is commonly overlooked in such legislation. Meanwhile, existing programmes that directly address sexual violence tend to be small-scale, donor-supported groups that usually operate in isolation, without substantive government endorsement or financial backing. At the same time, research about sexual violence remains limited, especially in a developing world context, and advocates describe "huge gaps" in the research literature on sexual violence compared to other forms of violence.

Some argue that this is because women's issues largely tend to fall off the agenda of national governments and multilateral agencies, including the United Nations. Last July, the UN special envoy for AIDS in Africa, Stephen Lewis, said sexual violence was one of many issues regularly sidelined at the expense of greater gender equality.

"It matters not the issue: whether its levels of sexual violence, or HIV/AIDS, or maternal mortality, or armed conflict, or economic empowerment, or parliamentary representation, women are in terrible trouble. And things are getting no better," he remarked to a high-level panel on UN reform in Geneva.

Existing Research is Limited

Available data suggests sexual violence is pervasive throughout the world. In some countries, one in four women has been sexually assaulted by an intimate partner, according to the World Health Organisation. Its 2002 research, World Report on Violence and Health, also finds that in some countries as many as one in three young women report being forced into their first sexual experience.

Much existing research on sexual violence was conducted in the developed world. In the January 2007 issue of the journal 'Trauma, Violence & Abuse', a literature review on interventions for sexual violence survivors in a health care setting revealed that the vast majority of such research was conducted within the United States. That research gap means little is understood about sexual violence in low- and middle-income countries, according to Dartnall.

"If you are raped in the United States, for example, you have access to a number of services, there will be different levels of stigma and you will be responded to differently than if you were raped in Rwanda," Dartnall said.

Dartnall added that asking sexual violence survivors what they want can improve the efficacy of services.

For example, a recent debate in South Africa included many who argued that requiring rape survivors to have an HIV test before receiving post-exposure prophylaxis (PEP) might prevent women from seeking out services. But this was contradicted by a 2005 study published by the UK-based BMJ, 'Women’s experiences of and preferences for services after rape in South Africa', which found rape survivors were anxious to get PEP, and the need to test for HIV did not seem to deter women from attending services.

One of the challenges to making sexual violence part of mainstream health research is its long-time association with nongovernmental organisations. Many sexual violence programmes, such as domestic violence shelters and rape crisis centres, are community-driven and heavily dependent on donor funding.

"They don't have the time or funding to say, 'How effective is what we're doing in the short term and the long term?'" said Debbie Billings, a member of SVRI's coordinating committee. "And that's what we as researchers want to help them find out."

Activists say that for these programmes to be sustainable, they have to be supported by national governments and multilateral institutions. That means making sexual violence a priority, along with gender equity more generally.

Creating an International Network around Sexual Violence

From its offices in Pretoria, SVRI supports existing researchers by centralising practical information about research, programmes and grants. It also provides technical support for researchers, as well as fundraises and identifies priorities for research around sexual violence.

"We can get a pretty good sense of where the gaps are, what needs to be translated, what proposals people are working on," said Billings, who is also a researcher at Ipas, an international reproductive health organisation.

There's a growing expression of political will to step up efforts to end violence against women, one that activists say has been emerging since 1994, when 179 countries made commitments to public health and individual well-being at the watershed International Conference on Population and Development in Cairo, and then the Forth World Conference on Women in Beijing in 1995.

"We're a lot further along then we would have been without those conferences. Some governments are finally coming around to implement programmes and dedicating resources to gender-based violence," Billings said. "Still, this is brand new in a lot of countries."

The Role of Sexual Violence in the Spread of HIV

In sub-Saharan Africa, HIV experts now tend to agree that sexual violence and domestic violence are among the key drivers to what’s been a determinedly unmitigated spread of the disease. Dr Julia Kim, senior researcher at Rapid Action Deployment of AIDS Research (RADAR) at the School of Public Health at the University of Witwatersrand, says there's a growing interest in the issue of sexual violence as its links with HIV become clearer.

"But that doesn't necessarily mean that that interest has been matched by resources to do sexual violence research or to support organisations that are addressing sexual violence," Kim told IRIN/PlusNews. "If you compare the money on basic science research around HIV, or on the development of HIV-related pharmaceuticals, it really overshadows by orders of magnitude the kind of funding that goes in to research around sexual violence."

She argues that sexual violence research is crucial in highlighting some of the underlying socio-economic factors of the disease's transmission, which she says will never be understood if researchers focus only on health interventions.

"It's easy for us to think that HIV is a health problem, so we've tended to focus on interventions that are driven by the hospital, by doctors, antiretroviral treatment," she said. "This isn't to say that those aren't important, but it's missing the broader issues that make women vulnerable to HIV."

Kim said broadening research to include sexual violence is all the more urgent because it's within our control.

"Sexual violence is preventable," Kim said. "So it's not hopeless; it's within our grasp. We can change this in our generation so the next generation grows up in a different landscape."

gw/oa


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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