Sexual Violence and VictimizationSpecific Offenses Rape Statutory Rape Incest Sexual Assault Domestic violence Sexual Abuse Child sexual abuse Sexual Harassment Pimping Attempted rape Genital mutilation Deviant sexual intercourseForms of Violence and Victimization Types of rape War rape Sexual slavery Spousal Rape Prison rape Date rape Date rape drug Human trafficking Prostitution Victimization of Children Child pornography Child trafficking Prostitution of children Commercial exploitation Sociological Theories Sociobiological theories of rape Motivation for rape Victim blaming Misogyny Misandry Aggression Pedophilia Effects and aftermath Rape Trauma Syndrome Social and Cultural Aspects Rape culture History of rape raptio Comfort women Policy Laws about rape Rape shield law Laws regarding child sexual abuse Rape crisis center Honor killing Anti-rape female condom Rape statistics Portals: Law As sexual violence affects all parts of society, the responses that arise to combat it are comprehensive, taking place on the individual, administrative, legal, and social levels.
Individual approaches
Programmes for perpetrators There are few programmes outside of the criminal justice system which are targeting perpetrators of sexual violence, generally aimed at men convicted of male-on-female sexual assault, who form a significant portion of criminal cases of sexual violence. A common response of men who commit sexual violence is to deny both that they are responsible and that what they are doing is violent.Kelly L, Radford J. Sexual violence against women and girls: an approach to an international overview. In: Dobash E, Dobash R, eds. Rethinking violence against women. London, Sage, 1998.Sen P. Ending the presumption of consent: nonconsensual sex in marriage. London, Centre for Health and Gender Equity, 1999. These programs, found mainly in Industrialized nations, work with male perpetrators to make them admit responsibility and be publicly seen as responsible for their actions. One way of achieving this is for programmes that target male perpetrators of sexual violence to collaborate with support services for victims, which would potentially be a revictimization of rape victims and be a poor choice of action unless the rape perpetrator is highly contrite and apologetic, as well as with campaigns against sexual violence.
Life-skills and other educational programmes In recent years, several programmes for sexual and reproductive health promotion, particularly those promoting HIV prevention, have begun to introduce gender issues and to address the problem of sexual and physical violence. Two notable examples developed for Africa but used in many parts of the developing world include "Stepping Stones" and "Men As Partners".Welbourn A. Stepping Stones. Oxford, Strategies for Hope, 1995.Men as partners. New York, NY, AVSC International, 1998. These programmes have been designed for use in peer groups of men and women and are delivered over several workshop sessions using participatory learning approaches. Their comprehensive approach helps men, who might otherwise be reluctant to attend programmes solely concerned with violence against women, participate and discuss a range of issues concerning violence. Furthermore, even if men are sometimes the perpetrators of sexual violence, the programmes are careful to avoid labelling them as such.
A review of the effect of the Stepping Stones programme in Africa and Asia found that the workshops helped the men participating take greater responsibility for their actions, relate better to others, have greater respect for women and communicate more effectively. As a result of the programme, reductions in violence against women have been reported in communities in Cambodia, the Gambia, South Africa, Uganda, Fiji, the United Republic of Tanzania and elsewhere. The evaluations to date, though, have generally used qualitative methods and further research is needed to adequately test the effectiveness of this programme.Gordon G, Welbourn A. Stepping Stones and men. Washington, DC, Inter-Agency Gender Working Group, 2001.
Developmental approaches Research has stressed the importance of encouraging nurturing, with better and more gender balanced parenting, to prevent sexual violence. At the same time, Schwartz Online. has developed a prevention model that adopts a developmental approach, with interventions before birth, during childhood and in adolescence and young adulthood. In this model, the prenatal element would include discussions of parenting skills, the stereotyping of gender roles, stress, conflict and violence. In the early years of childhood, health providers would pursue these issues and introduce child sexual abuse and exposure to violence in the media to the list of discussion topics, as well as promoting the use of non-sexist educational materials. In later childhood, health promotion would include modelling behaviours and attitudes that avoid stereotyping, encouraging children to distinguish between good and bad touching, and enhancing their ability and confidence to take control over their own bodies. This intervention would allow room for talking about sexual aggression. During adolescence and young adulthood, discussions would cover myths about rape, how to set boundaries for sexual activity, and breaking the links between sex, violence and coercion. While Schwartz's model was designed for use in industrialized countries, some of the principles involved could be applicable to developing countries.
Health care responses
Medico-legal services In many countries, when sexual violence is reported, the health sector has the duty to collect medical and legal evidence to corroborate the accounts of the victims or to help in identifying the perpetrator. Research in Canada suggests that medico-legal documentation can increase the chance of a perpetrator being arrested, charged, or convicted. For instance, one study found that documented physical injury, particularly of the moderate to severe type, was associated with charges being filed, irrespective of the patient's income level or whether the patient knew the assailant, either as an acquaintance or an intimate partner. However, a study of women attending a hospital in Nairobi, Kenya, following rape, has highlighted the fact that in many countries rape victims are not examined by a gynaecologist or an experienced police examiner and that no standard protocols or guidelines exist on this matter.
The use of standard protocols and guidelines can significantly improve the quality of treatment and psychological support of victims, as well as the evidence that is collected. Comprehensive protocols and guidelines for female victims of assault should include:
recording a full description of the incident, listing all the assembled evidence; listing the gynecological and contraceptive history of the victim; documenting in a standard way the results of a full physical examination; assessment of the risk of pregnancy; testing for and treating sexually transmitted diseases, including, where appropriate, testing for HIV; providing emergency contraception and, where legal, counseling on abortion; providing psychological support and referral.
In some countries, the protocol forms part of the procedure of a sexual assault evidence kit that includes instructions and containers for collecting evidence, appropriate legal forms and documents for recording histories. Examinations of rape victims are by their nature extremely stressful. The use of a video to explain the procedure before an examination has been shown significantly to reduce the stress involved.
Training for health care professionals Issues concerning sexual violence need to be addressed in the training of all health service staff, including psychiatrists and counsellors, in basic training as well as in specialized postgraduate courses. Such training should, in the first place, give health care workers greater knowledge and awareness of sexual violence and make them more able to detect and handle cases of abuse in a sensitive but effective way. It should also help reduce instances of sexual abuse within the health sector, something that can be a significant, though generally unacknowledged, problem.
In the Philippines, the Task Force on Social Science and Reproductive Health, a body that includes doctors, nurses and social scientists and is supported by the Department of Health, has produced training modules for nursing and medical students on gender-based violence. The aims of this programme are:Ramos-Jimenez P. Philippine strategies to combat domestic violence against women. Manila, Social Development Research Center and De La Salle University, 1996.
to understand the roots of violence in the context of culture, gender and other social aspects; to identify situations, within families or homes that are at a high risk for violence, where it would be appropriate to undertake; primary interventions, in particular in collaboration with other professionals; secondary interventions, including identifying victims of violence, understanding basic legal procedures and how to present evidence, referring and following up patients, and helping victims reintegrate into society.
These training modules are built into the curricula for both nursing and medical students. For the nursing curriculum, the eleven modules are spread over the four years of formal instruction, and for medical students over their final three years of practical training.
Prophylaxis for HIV infection
The possibility of transmission of HIV during rape is a major cause for concern, especially in countries with a high prevalence of HIV infection.Violence against women and HIV/AIDS: setting the research agenda. Geneva, World Health Organization, 2001 (document WHO/FCH/GWH/01.08). The use of antiretroviral drugs following exposure to HIV is known in certain contexts to be reasonably effective. For instance, the administration of the antiretroviral drug zidovudine (AZT) to health workers following an occupational needle-stick exposure (puncturing the skin with a contaminated needle) has been shown to reduce the subsequent risk of developing HIV infection by 81%.Case–control study of HIV seroconversion in health care workers after percutaneous exposure to HIVinfected blood: France, United Kingdom, and United States, January 1988 to August 1994. Morbidity and Mortality Weekly Report, 1995, 44:929–933. The average risk of HIV infection from a single act of unprotected vaginal sex with an infected partner is relatively low (approximately 1.2 per 1000, from male to female, and around 0.5–1 per 1000 from female to male). This risk, in fact, is of a similar order to that from a needle-stick injury (around 3 per 1000), for which post exposure prophylaxis is now routine treatment.Ippolito G et al. The risk of occupational HIV in health care workers. Archives of Internal Medicine, 1993, 153:1451–1458. The average risk of HIV infection from unprotected anal sex is considerably higher, though, at around 5.30 per 1000. However, during rape, because of the force used, it is very much more likely that there will be macroscopic or microscopic tears to the vaginal mucosa, something that will greatly increase the probability of HIV transmission. There is no information about the feasibility or cost-effectiveness in resource-poor settings of routinely offering rape victims prophylaxis for HIV.
Testing for HIV infection after rape is difficult in any case. In the immediate aftermath of an incident, many victims are not in a position fully to comprehend complicated information about HIV testing and risks. Ensuring proper follow-up is also difficult as many victims will not attend further scheduled visits for reasons that probably relate to their psychological coping following the assault.