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Background: The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries., Methods: In a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins., Results: In the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age., Conclusions: This study found that being a virgin, multiple perpetration rape and the examiner's qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.

Background: Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system., Methods and Findings: We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87-18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14-34.3, p = 0.036), ano-genital injuries alone (AOR 7.00, 95% CI 1.44-33.9, p = 0.017), or both nongenital and ano-genital injuries (AOR 12.34, 95% CI 2.87-53.0, p = 0.001). DNA was not associated with case outcome., Conclusions: This is the first study, to our knowledge, to show an association between documentation of ano-genital injuries, trials commencing, and convictions in rape cases in a developing country. Its findings are of particular importance because they show the value of good basic medical practices in documentation of injuries, rather than more expensive DNA evidence, in assisting courts in rape cases. Health care providers need training to provide high quality health care responses after rape, but we have shown that the core elements of the medico-legal response require very little technology. As such they should be replicable in low- and middle-income country settings. Our findings raise important questions about the value of evidence that requires the use of forensic laboratories at a population level in countries like South Africa that have substantial inefficiencies in their police services. Please see later in the article for the Editors' Summary.

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.

Background: Research into the circumstances of rape, and criminal justice system responses, is pivotal to informing prevention and improving the likelihood of justice for victims. In this paper, we explore the differences in the circumstances of multiple-perpetrator rapes (MPRs) and single-perpetrator rapes (SPRs), their case management, and attrition, and describe areas for improvemensuplt around rape response within the South African criminal justice system. Methods: The sample comprised 3952 rape cases reported to the South African Police Services (SAPS) in 2012, selected through a multi-stage random sampling of 172 police stations from a total of 1164 police stations in the nine provinces, followed by the random selection of cases from each station's case list. Data were abstracted from police dockets, medico-legal examination forms, charge sheets, and trial transcripts. MPRs were defined as cases in which more than one perpetrator had sexual contact with the victim during a single incident, i.e., sexually assaulted or raped. Descriptive statistics and Chi-square tests for associations were used to compare MPRs and SPRs in circumstances of the rape, case management, and attrition. Results: Seventeen percent of cases were MPRs. MPRs were comparably more violent crimes with a higher frequency of aggressive tactics employed by perpetrators, for example, abductions, firearms use, and threats to kill. Overall, cases were often poorly handled by police, and there were deviations from standard policing and investigation procedures; we found more evidence of this with MPRs compared to SPRs. MPR cases were most likely to have been closed by police due to undetected perpetrators in combination with other victim reasons. The weaker investigations of MPRs were associated with higher attrition rates compared to SPRs, firstly at the police investigation and subsequent stages. Conclusions: The findings confirm differences in case management, patterns of attrition and trajectories of MPRs compared to SPRs. In an overall context of high rape case attrition and impunity for perpetrators, MPR victims are even less likely to see justice served than SPR victims. There needs to be much more effective supervision of rape case investigations by SAPS, particularly in MPR cases. Continual investigator training strengthened supervision and better resourcing are necessary to improve MPRs detection and convictions in adherence to the Directives for rape policing. [ABSTRACT FROM AUTHOR]

The attrition of rape cases within the criminal justice system is driven by different factors. We aimed to describe the patterns of rape case attrition and associated factors in South Africa. We analysed a national sample of 3,952 cases reported in 2012. We found that 35 per cent of cases were closed by police, 31 per cent were declined by the prosecutors, 16 per cent were enrolled but later struck off the roll, 19 per cent went on trial and 9 per cent were finalised with conviction. Aggravating circumstances, availability of forensic evidence and success at perpetrator arrests were key for case progression and increased likelihood of convictions. Thorough police investigations and continual training which addresses negative gender or other rape stereotyping are critical to ensure rape convictions. [ABSTRACT FROM AUTHOR]

If the criminal justice system were to advertise itself to victims of sexual violence, would its tag line be L'Oreal's 'Because you're worth it'? Or would the Foundry Premium Cider comment on the building of a pyramid: 'Twelve years in the making and it still doesn't taste very good' be more apposite? Certainly, a lack of faith in, or fear of, legal processes, is one of the reasons why eight out of nine women who are raped do not report the matter to the police. This article explores the extent to which victims' lack of faith in legal processes is warranted and asks if laying a complaint is worth the effort. [ABSTRACT FROM AUTHOR]

A study of gang rape cases reported to police in inner-city Johannesburg in 1999 - although fairly dated - provides new insights into a disturbing phenomenon. The most striking thing about these rapes is their predatory nature. Typically, groups of men either lie in wait for their victims, or actively drive around looking for someone to abduct. The attacks are also brazen and violent: women are confronted in public spaces, and the use of force increases with the number of perpetrators involved in the rape. [ABSTRACT FROM AUTHOR]