Search

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.07.027 Byline: Rachel Jewkes (a), Kristin Dunkle (b), Mary P. Koss (c), Jonathan B. Levin (d), Mzikazi Nduna (e), Nwabisa Jama (a), Yandisa Sikweyiya (a) Keywords: Rape; Sexual violence; Male perpetrators; South Africa Abstract: Sexual violence is a well-recognised global health problem, but there has been remarkably little research on men as perpetrators. The objectives of this paper are to describe the prevalence, patterns and factors associated with rape of an intimate partner and a woman who was not a partner with men aged 15-26 years in rural South Africa. The analysis presented here is of data collected during a baseline survey of participants in a cluster randomised controlled trial of an HIV behavioural intervention. A total of 1370 male volunteers were recruited from 70 rural South African villages. They completed a questionnaire asking about background, sexual practices and perpetration of rape and intimate partner violence. Among these men 16.3% had raped a non-partner, or participated in a form of gang rape; 8.4% had been sexually violent towards an intimate partner; and 79.1% had done neither. The mean age of first rape was 17 years. There was overlap between rape of a non-partner and partner, in that 44.3% of men who raped an intimate partner had also raped a non-partner, but overall the great majority of men who raped did not disclose both types of rape. The factors associated with rape of an intimate partner and non-partner had similarities and differences. After adjusting for the other variables, both forms of rape were strongly associated with ever having been physically violent to a partner, having had transactional sex with a casual partner and more sexual partners. Non-partner rape was also associated with peer-related variables, including gang membership and peer pressure to have sex, and also drug use. Non-partner rape was more common among wealthier and relatively more socially advantaged men. Both types of rape were associated with having more adverse childhood experiences. There was considerable overlap between rape-associated factors and known HIV risk factors, suggesting a need for further research on the interface of rape and HIV, and integrated prevention programming. Author Affiliation: (a) Gender & Health Research Unit, Medical Research Council, Medical Research Council Private Bag X385, Pretoria 0001, South Africa (b) Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA (c) College of Public Health, University of Arizona, Tucson, AZ, USA (d) Biostatistics Unit, Medical Research Council, South Africa (e) Department of Psychology, University of the Witwatersrand, South Africa

The aim of the paper is to investigate associations between a range of markers of gender inequity, including financial, psychological and physical violence, and two proximal practices in HIV prevention, namely discussion of HIV between partners and the woman suggesting condom use. The paper presents an analysis of data from a cross-sectional study of a representative sample of women from three South African Provinces which was primarily undertaken as an epidemiological study of gender-based violence. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households. Households were randomly selected from within clusters. One randomly selected woman aged 18-49 years was interviewed in each selected home. One thousand three hundred and six women were interviewed (90.3% of eligible women). One thousand one hundred sixty four women had a partner in the previous year and were asked questions related to HIV prevention and gender inequalities in the relationship. The results indicate that discussion of HIV was significantly positively associated with education, living in Mpumalanga Province, the man being a migrant, the woman having multiple partners in the past year and having no confidante. It was significantly negatively associated with living in the Northern Province, the relationship being poor and there being a substantial age difference between partners. The woman suggesting condom use was significantly positively associated with her education, her having multiple partners, domestic violence prior to the past year and financial abuse. It was negatively associated with the relationship being poor. We conclude that this suggests that some indicators of gender inequalities are significantly associated with discussion of HIV and condom use but the direction of association found was both positive and negative. This highlights the need for a more nuanced understanding of gender inequalities and their relationship to HIV risk. Suggestions for key research questions are made. reserved. Keywords: HIV; Gender; Intimate partner violence; South Africa

Objective: There are limited data on symptomatic hyperlactataemia caused by antiretroviral therapy (ART) in resource-limited settings. We assessed individuals who developed symptomatic hyperlactataemia on ART in an outpatient clinic in South Africa., Design: A retrospective record review was performed on patients attending the clinic from January 2004 to December 2005., Results: Thirty-five patients, all on stavudine-containing regimens, developed symptomatic hyperlactataemia. The incidence in this population was 20.5 cases per 1 000 person-years of ART with an associated mortality of 21%. The major risk factor was being female (risk ratio (RR) 3.27). Significant clinical symptoms preceding symptomatic hyperlactataemia include nonspecific gastrointestinal symptoms, weight loss, and development of symptomatic neuropathy., Conclusions: The incidence of symptomatic hyperlactataemia in our population was high. Simple clinical measures, such as neuropathy symptoms and monitoring of weight, may alert the clinician to impending symptomatic hyperlactataemia. Early diagnosis expedites safe outpatient care and switching of ART regimens without interruption, in many cases.