Gender and Health Research Unit

Pretoria, South Africa

Gender and Health Research Unit

Pretoria, South Africa
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Jewkes R.K.,Gender and Health Research Unit | Dunkle K.,Emory University | Nduna M.,University of Witwatersrand | Shai N.,Gender and Health Research Unit
The Lancet | Year: 2010

Background Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women. Methods We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions.Findings 128 women acquired HIV during 2076 person-years of follow-up (incidence 6·2 per 100 person-years). 51 of325 women with low relationship power equity at baseline acquired HIV (8·5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5·5 per 100 person-years); adjusted multivariable Poisson model IRR 1·51, 95% CI 1·05-2·17, p=0·027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9·6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5·2 per 100 person-years); adjusted multivariable Poisson model IRR 1·51, 1·04-2·21, p=0·032. The population attributable fractions were 13·9% (95% CI 2·0-22·2) for relationship power equity and 11·9% (1·4-19·3) for intimate partner violence. Interpretation Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources. Funding National Institute of Mental Health and South African Medical Research Council.


Abrahams N.,Gender and Health Research Unit | Devries K.,London School of Hygiene and Tropical Medicine | Watts C.,London School of Hygiene and Tropical Medicine | Petzold M.,Gothenburg University | And 2 more authors.
The Lancet | Year: 2014

Background: Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence. Methods: We searched for articles published from Jan 1, 1998, to Dec 31, 2011, and manually search reference lists and contacted experts to identify population-based data on the prevalence of women's reported experiences of sexual violence from age 15 years onwards, by anyone except intimate partners. We used random effects meta-regression to calculate adjusted and unadjusted prevalence for regions, which we weighted by population size to calculate the worldwide estimate. Findings: We identified 7231 studies from which we obtained 412 estimates covering 56 countries. In 2010 7·2% (95% CI 5·2-9·1) of women worldwide had ever experienced non-partner sexual violence. The highest estimates were in sub-Saharan Africa, central (21%, 95%CI 4·5-37·5) and sub-Saharan Africa, southern (17·4%, 11·4-23·3). The lowest prevalence was for Asia, south (3·3%, 0-8·3). Limited data were available from sub-Saharan Africa, central, North Africa/Middle East, Europe, eastern, and Asia Pacific, high income. Interpretation: Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern. © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.


Jewkes R.,Gender and Health Research Unit | Flood M.,University of Wollongong | Lang J.,Regional Development Centre
The Lancet | Year: 2015

Violence perpetrated by and against men and boys is a major public health problem. Although individual men's use of violence differs, engagement of all men and boys in action to prevent violence against women and girls is essential. We discuss why this engagement approach is theoretically important and how prevention interventions have developed from treating men simply as perpetrators of violence against women and girls or as allies of women in its prevention, to approaches that seek to transform the relations, social norms, and systems that sustain gender inequality and violence. We review evidence of intervention effectiveness in the reduction of violence or its risk factors, features commonly seen in more effective interventions, and how strong evidence-based interventions can be developed with more robust use of theory. Future interventions should emphasise work with both men and boys and women and girls to change social norms on gender relations, and need to appropriately accommodate the differences between men and women in the design of programmes. © 2015 Elsevier Ltd.


Fulu E.,UNDP Inc | Jewkes R.,Gender and Health Research Unit | Jewkes R.,University of Witwatersrand | Roselli T.,UNDP Inc | Garcia-Moreno C.,World Health Organization
The Lancet Global Health | Year: 2013

Background: Male perpetration of intimate partner violence (IPV) is under-researched. In this Article, we present data for the prevalence of, and factors associated with, male perpetration of IPV from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. We aimed to estimate the prevalence of perpetration of partner violence, identify factors associated with perpetration of different forms of violence, and inform prevention strategies. Methods: We undertook standardised population-based household surveys with a multistage representative sample of men aged 18-49 years in nine sites in Bangladesh, China, Cambodia, Indonesia, Sri Lanka, and Papua New Guinea between January, 2011, and December, 2012. We built multinomial regression models of factors associated with lifetime violence perpetration: physical IPV, sexual IPV, both physical and sexual IPV, multiple emotional or economic IPV versus none, and calculated population-attributable fractions. In the analysis, we considered factors related to social characteristics, gender attitudes and relationship practices, victimisation history, psychological factors, substance misuse, and participation in violence outside the home. Findings: 10 178 men completed interviews in our study (between 815 and 1812 per site). The response rate was higher than 82·5% in all sites except for urban Bangladesh (73·2%) and Sri Lanka (58·7%). The prevalence of physical or sexual IPV perpetration, or both, varied by site, between 25·4% (190/746; rural Indonesia) and 80·0% (572/714; Bougainville, Papua New Guinea). When multiple emotional or economic abuse was included, the prevalence of IPV perpetration ranged from 39·3% (409/1040; Sri Lanka) to 87·3% (623/714; Bougainville, Papua New Guinea). Factors associated with IPV perpetration varied by country and type of violence. On the basis of population-attributable fractions, we show factors related to gender and relationship practices to be most important, followed by experiences of childhood trauma, alcohol misuse and depression, low education, poverty, and involvement in gangs and fights with weapons. Interpretation: Perpetration of IPV by men is highly prevalent in the general population in the sites studied. Prevention of IPV is crucial, and interventions should address gender socialisation and power relations, abuse in childhood, mental health issues, and poverty. Interventions should be tailored to respond to the specific patterns of violence in various contexts. Physical and sexual partner violence might need to be addressed in different ways. Funding: Partners for Prevention-a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacific; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; UN Development Programme in Papua New Guinea and Pacific Centre; and the Governments of Australia, the UK, Norway, and Sweden. © 2013 Fulu et al. Open Access article distributed under the terms of CC BY-NC-ND.


Jewkes R.,Gender and Health Research Unit | Jewkes R.,University of Witwatersrand | Fulu E.,UNDP Inc | Roselli T.,UNDP Inc | Garcia-Moreno C.,World Health Organization
The Lancet Global Health | Year: 2013

Background: Rape perpetration is under-researched. In this study, we aimed to describe the prevalence of, and factors associated with, male perpetration of rape of non-partner women and of men, and the reasons for rape, from nine sites in Asia and the Pacific across six countries: Bangladesh, China, Cambodia, Indonesia, Papua New Guinea, and Sri Lanka. Methods: In this cross-sectional study, undertaken in January 2011-December 2012, for each site we chose a multistage representative sample of households and interviewed one man aged 18-49 years from each. Men self-completed questions about rape perpetration. We present multinomial regression models of factors associated with single and multiple perpetrator rape and multivariable logistic regression models of factors associated with perpetration of male rape with population-attributable fractions. Findings: We interviewed 10 178 men in our study (815-1812 per site). The prevalence of non-partner single perpetrator rape varied between 2·5% (28/1131; rural Bangladesh) and 26·6% (225/846; Bougainville, Papua New Guinea), multiple perpetrator rape between 1·4% (18/1246; urban Bangladesh) and 14·1% (119/846; Bougainville, Papua New Guinea), and male rape between 1·5% (13/880; Jayapura, Indonesia) and 7·7% (65/850; Bougainville, Papua New Guinea). 57·5% (587/1022) of men who raped a non-partner committed their first rape as teenagers. Frequent reasons for rape were sexual entitlement (666/909; 73·3%, 95% CI 70·3-76·0), seeking of entertainment (541/921; 58·7%, 55·0-62·4), and as a punishment (343/905; 37·9%, 34·5-41·4). Alcohol was a factor in 249 of 921 cases (27·0%, 95% CI 24·2-30·1). Associated factors included poverty, personal history of victimisation (especially in childhood), low empathy, alcohol misuse, masculinities emphasising heterosexual performance, dominance over women, and participation in gangs and related activities. Only 443 of 1933 men (22·9%, 95% CI 20·7-25·3) who had committed rape had ever been sent to prison for any period. Interpretation: Rape perpetration committed by men is quite frequent in the general population in the countries studied, as it is in other countries where similar research has been undertaken, such as South Africa. Prevention of rape is essential, and interventions must focus on childhood and adolescence, and address culturally rooted male gender socialisation and power relations, abuse in childhood, and poverty. Funding: Partners for Prevention-a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacific; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; United Nations Development Programme in Papua New Guinea and Pacific Centre; and the Governments of Australia, the UK, Norway, and Sweden. © 2013 Jewkes et al. Open Access article distributed under the terms of CC BY-NC-ND.


Stockl H.,London School of Hygiene and Tropical Medicine | Devries K.,London School of Hygiene and Tropical Medicine | Rotstein A.,McMaster University | Abrahams N.,Gender and Health Research Unit | And 3 more authors.
The Lancet | Year: 2013

Background: Homicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of missing information about the victim-offender relationship. The objective of the study was to estimate global and regional prevalence of intimate partner homicide. Methods: A systematic search of fi ve databases (Medline, Global Health, Embase, Social Policy, and Web of Science) yielded 2167 abstracts, and resulted in the inclusion of 118 full-text articles with 1122 estimates of the prevalence of intimate partner homicide after double-blind screening. All studies were included that reported the number or proportion of women or men who were murdered by an intimate partner in a country, province, or town, using an inclusive defi nition of an intimate partner. Additionally, a survey of offi cial sources of 169 countries provided a further 53 estimates. We selected one estimate per country-year using a quality assessment decision algorithm. The median prevalence of intimate partner homicide was calculated by country and region overall, and for women and men separately. Findings: Data were obtained for 66 countries. Overall 13.5% (IQR 9.2-18.2) of homicides were committed by an intimate partner, and this proportion was six times higher for female homicides than for male homicides (38.6%, 30.8-45.3, vs 6.3%, 3.1-6.3). Median percentages for all (male and female) and female intimate partner homicide were highest in high-income countries (all, 14.9%, 9.2-18.2; female homicide, 41.2%, 30.8-44.5) and in southeast Asia (18.8%, 11.3-18.8; 58.8%, 58.8-58.8). Adjustments to account for unknown victim-off ender relationships generally increased the prevalence, suggesting that results presented are conservative. Interpretation: At least one in seven homicides globally and more than a third of female homicides are perpetrated by an intimate partner. Such violence commonly represents the culmination of a long history of abuse. Strategies to reduce homicide risk include increased investment in intimate partner violence prevention, risk assessments at diff erent points of care, support for women experiencing intimate partner violence, and control of gun ownership for people with a history of violence. Improvements in country-level data collection and monitoring systems are also essential, because data availability and quality varied strongly across regions. Funding: WHO, Sigrid Rausing Trust, and the UK Economic and Social Research Council.


Morrell R.,University of Cape Town | Jewkes R.,Gender and Health Research Unit
International Journal for Equity in Health | Year: 2011

Background: The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. Interventions are being developed to work with masculinity and to 'change men'. Researchers now face a challenge of identifying change in men, especially in domains of their lives beyond relations with women. Engagement in carework is one suggested indicator of more gender equitable practice. Methods. A qualitative approach was used. 20 men in three South African locations (Durban, Pretoria/Johannesburg, Mthatha) who were identified as engaging in carework were interviewed. The men came from different backgrounds and varied in terms of age, race and socio-economic status. A semi-structured approach was used in the interviews. Results: Men were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Conclusions: Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes. Interventions that promote caring also advance gender equity. © 2011 Morrell and Jewkes; licensee BioMed Central Ltd.


Abrahams N.,Gender and Health Research Unit | Jewkes R.,Gender and Health Research Unit
Journal of the International AIDS Society | Year: 2012

Background: Living with HIV is of daily concern for many South Africans and poses challenges including adapting to a chronic illness and continuing to achieve and meet social expectations. This study explored experiences of being HIV-positive and how people manage stigma in their daily social interactions. Methods: Using qualitative methods we did repeat interviewed with 42 HIV-positive men and women in Cape Town and Mthatha resulting in 71 interviews. Results: HIV was ubiquitous in our informants' lives, and almost all participants reported fear of stigma (perceived stigma), but this fear did not disrupt them completely. The most common stigma experiences were gossips and insults where HIV status was used as a tool, but these were often resisted. Many feared the possibility of stigma, but very few had experiences that resulted in discrimination or loss of social status. Stigma experiences were intertwined with other daily conflicts and together created tensions, particularly in gender relations, which interfered with attempts to regain normality. Evidence of support and resistance to stigma was common, and most encouraging was the evidence of how structural interventions such as de-stigmatizing policies impacted on experiences and transference into active resistance. Conclusions: The study showed the complex and shifting nature of stigma experiences. These differences must be considered when we intensify stigma reduction with context- and gender-specific strategies focussing on those not yet on ARV programmes. Copyright: © 2012 Piloya T et al; licensee International AIDS Society.


Jewkes R.,Gender and Health Research Unit
Science | Year: 2010

Building gender equity and reducing gender-based violence are vital in the fight against AIDS.


South Africa has a female homicide rate six times the global average, with half of murdered women killed by an intimate partner. The gendered nature of such murders indicates the need to explore the masculinities of men who kill an intimate partner. This paper explores the childhoods of 20 men who were incarcerated for such murders and draws on 74 in-depth interviews with these men, family and friends. This study found that traumatic childhood experiences increases emotional vulnerability, resulting in their feeling unloved, insecure and powerless. We argue that they adopt violent forms of masculinities to achieve respect and power. Yet, there is no linear relationship between traumatic childhood experiences and adopting violent masculinities. © The Author 2011. Published by Oxford University Press. All rights reserved.

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