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South Africa: Women, AIDS, and Violence, 2

AfricaFocus Bulletin
Apr 28, 2008 (080428)
(Reposted from sources cited below)

Editor's Note

"In the Southern African region the results of a large scale household survey conducted in eight countries showed that nearly a fifth of the women interviewed reported being a victim of partner physical violence in the preceding year. ... South African based-studies have found that women who experience intimate partner violence are at long-term increased risk of HIV infection, particularly where their partners were involved in multiple concurrent, unprotected sexual relationships." - Amnesty International

In a report released in March, based on interviews in two South African provinces and extensive consultation with South African agencies involved with the issue, Amnesty International provides a detailed portrait of the situation of rural women, and the interaction among violence, poverty, and the risk of HIV/AIDS. The report's title, quoting one of the women interviewed, is "I am at the lowest end of all."

The full 124-page report is available at In this and another issue sent out today, AfricaFocus Bulletin provides brief excerpts from the report's overview and the section on violence against women. The overview also provides a useful concise survey of the development of the AIDS epidemic in South Africa, including the debates about government policy and the active role of civil society.

For previous AfricaFocus Bulletins on related issues, see

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

"I am at the lowest end of all"

Rural women living with HIV face human rights abuses in South Africa

March 2008 AI Index: AFR 53/001/2008

Amnesty International

2. Violence against women and HIV

[Excerpts For full 124-page report, including footnotes and references, see For additional excerpts, including table of contents, see]

"He threatened to kill me and burn down the house if I did not take him back ... So I returned back to stay with him." [Testimony of SS who had been raped and repeatedly beaten by her husband and was fearing receiving the results of her HIV test.]50

"In spite of ample empirical evidence to this effect, states have yet to fully acknowledge and act upon the interconnection between the mutually reinforcing pandemics of VAW and HIV-AIDS". (UN Special Rapporteur on Violence against Women, July 2007)51

South Africa is continuing to experience a major HIV epidemic within a context of persistent and high levels of violence against women (VAW). As noted in the UN Secretary-General"s Study in 2006 on patterns and consequences of VAW, this is a global phenomenon which is both a violation of women"s human rights and prevents women from enjoying other human rights and fundamental freedoms. ...

The South African Constitution of 1996 guarantees that everyone has the right to freedom and security of the person, which includes "the right ... to be free from all forms of violence from either public or private sources".54 Despite this constitutional guarantee thousands of women and girls experience sexual and other forms of violence every year in South Africa. In July 2007 the national Minister of Safety and Security, Mr Charles Nqakula, observed from analysis of the past six years of crime statistics that "the fact that instances of serious and violent crime are very high is disconcerting and unacceptable." They included rape, "indecent assault"55 and attempts to commit these crimes. The Minister also observed that "poorer communities" were experiencing "more violent crime than wealthier ones," and "at least two thirds of all serious and violent crimes happen between people who know one another and who will be found mostly within the confines of the same social environment.56

As is evident from the Minister"s comments, violence or the threat of violence is a pervasive problem for many people in South Africa. Women and girls can experience gender-based violence or witness it from a very early age. Indicative of the scale of the problem were the results of a national survey conducted in the early 2000s, in which a third of the 1,000 women interviewed had experienced physical, sexual, emotional and economic abuse, most typically in their home environment, and two-thirds had experienced at least one form of abuse. The South African Human Rights Commission (SAHRC) concluded after hearings on school-based violence in 2006 that schools were the "most likely place where children would become victims of crime including crimes of sexual violence". A national cross-sectional study of nearly 270,000 high school students in 2002 identified an "expectation of sexual coercion among the youth".57 A majority of the women whom AI interviewed in May 2007 had experienced, witnessed or were aware of incidents of violence in the home or rapes occurring in the wider community, including in schools or while en route to school, or on farms where some of the women had worked as seasonal contract workers.

The consequences for the health and psychological well-being of the women and girls subjected to these forms of violence can be devastating. At the same time violence against women and girls can have damaging psychological effects on boys who witness their mothers being beaten or their sisters" abuse at the hands of fathers and partners. Research evidence indicates that men who had witnessed domestic violence during their childhood were responsible for significantly higher levels of abuse against women in their adult lives, as opposed to men who had not witnessed violence against women in their childhood.58 For women and girls experiencing violence and abuse, the consequences are immediate, but can also be longer-term, including through provoking a change of behaviour in the victim. ...

Sexual violence and its consequences

"We live in fear. There is nothing we can do to protect ourselves." (Testimony of LE, a rape survivor living with HIV in rural KwaZulu Natal)61


The World Health Organization has commented on the "profound impact" of sexual violence on the physical and mental health of survivors. Its impact can include physical injury and is associated with "an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences." There is also a serious and possibly long-term impact on the victim"s mental health.63 The link between gender-based violence and HIV is most apparent in respect to the crime of rape, which can lead to direct HIV transmission. Due to the high HIV prevalence and high levels of sexual violence in South Africa, women are at risk of contracting HIV as a consequence of rape.64 ...

Reported cases of rape amounted nationally to 117 per 100,000 of the population in the financial year April 2006 to March 2007, with a range from 80.6 (Limpopo) to 142.8 (Northern Cape) in the nine provinces.69 Research and support organizations believe, however, that the actual figures annually are much higher than those cases reported to the police, because of the social and economic pressures which discourage women from reporting rape.70 ...

Police analysis in 2007 of reported cases indicated that "76 per cent of rapes covered by the sample studied involved people known to one another." In just under a fifth of the total cases the perpetrators were relatives.72 Women in certain areas also seem to be at greater risk of violence. From an analysis of crime patterns at the police station area-level, it appears that 40 per cent of the cases of rape and other "socially motivated contact crimes" such as murder and assault with intent to cause grievous bodily harm (assault GBH), which were reported in 2006/2007, had occurred in only ten per cent of the 1,105 police station jurisdictions.73 Of the areas where AI conducted its interviews in May 2007, all but one fell within the areas of the police stations with the highest reporting rates.

These official statistics and accompanying analysis indicate that many South African women live in a general environment of high levels of violent crime, including rape, which affects their lives at home, in the community and wider society, placing them at risk of HIV infection in an accompanying context of high HIV prevalence levels.

Among the women whom AI interviewed, a number of them reported being raped and living in a generally threatening environment.

The sense of vulnerability experienced by women living in unsafe, poorly policed areas is also evident in the comments of 39-year-old EZ, who was living with her three children and two grandchildren in Mpumalanga. She told AI that she was worried about the safety of her girls and tried to prevent them from taking risks, such as going out at night or going to shebeens.76 In addition she worried about their vulnerability as a female-only household."I am trying to keep it quiet that I am staying alone without a man in the home," she told AI.77
Some initiatives have been taken by the state to improve the criminal justice response to crimes of rape and to a lesser extent to address the lack of safety in local communities. The former initiatives include:

strengthening the coordination of the work of police investigating officers and medical practitioners involved in examining rape survivors and gathering forensic evidence and, in some cases, the development of "one-stop" centres for the provision of medical, investigative, prosecutorial and psychological services for rape survivors;

  • the development of national policy guidelines for the handling of victims of sexual offences and national management guidelines for care of victims of sexual assault;
  • the development of specialised sexual offences courts which have achieved a higher conviction rate in the prosecution of rape and other sexual offences;
  • the training of criminal justice personnel including police in the principles of "victim empowerment" and the establishment in some police stations of "victim friendly" facilities, often in collaboration with NGO support organizations;
  • the reform of the legal framework for prosecuting sexual offences, in particular by widening the definition of what constitutes rape to include oral and anal, as well as vaginal, penetration by a body part or object without the consent of the victim, which may be confirmed by the presence of "coercive circumstances"; and, more controversially,
  • minimum sentencing legislation in cases of rape.81

However a number of concerns remain. The Department of Justice and Constitutional Development appears to have decided not to expand the development of the specialised sexual offences courts. Rape remains a difficult crime to prosecute and requires a high level of training for prosecutors and presiding officers. In the ordinary courts the conviction rates are low. In a recent study of the outcomes of over 2,000 police investigation cases in Gauteng province, 359 of the cases went to trial resulting in convictions for rape in about 87 cases, equivalent to less than five per cent of the original group.82 Advocacy organizations who were involved in the decade-long process of reforming the sexual offences legislation have expressed concern that the final version of the reformed law has eroded the protections afforded to rape complainants and other vulnerable witnesses contained in the initial draft law.83


Finally, in regard to prevention, much more needs to be done by municipal authorities in cooperation with the police, businesses and local rural communities to improve women"s physical security by identifying and addressing threats to their safety in the physical environment. AI visited a number of areas where poor or no lighting, high bushes along pathways and inadequate transport links increased the risks of violence for women and girls on a daily basis. Police management could also give greater priority to increasing the level of personnel, vehicles and equipment for rural-based police stations.86

Domestic Violence as a long-term threat to women"s health

"To the extent that [domestic violence] is systemic, pervasive and overwhelmingly gender- specific, domestic violence both reflects and reinforces patriarchal domination and does so in a particularly brutal form.The non-sexist society promised in the foundational clause of the Constitution [section 1], and the right to equality and non-discrimination guaranteed by section 9, are undermined when spouse-batterers enjoy impunity."87 (South African Constitutional Court in S v Baloyi)

Domestic violence, particularly intimate partner violence, may involve physical and sexual violence, as well as threats of violence and psychological and emotional abuse, and has been identified by the WHO as a serious health problem internationally affecting up to 60 per cent of women across different countries. 88 The phenomenon is defined by unequal gender relations and has an impact on women"s ability to protect themselves from HIV infection. The UN Committee on the Elimination of Discrimination against Women (CEDAW), in General Recommendation 19,89 described "family violence as one of the most insidious forms of violence against women" which is evident in "violence of all kinds" and underpinned by "traditional attitudes" and a lack of economic independence which forces many women to stay in violent relationships. CEDAW concluded that "[t]hese forms of violence put women"s health at risk and impair their ability to participate in family life and public life on a basis of equality."

In the Southern African region the results of a large scale household survey conducted in eight countries showed that nearly a fifth of the women interviewed reported being a victim of partner physical violence in the preceding year. The study found that men having multiple concurrent partners was significantly associated with the occurrence of partner physical violence. Another significant factor associated with violence was the holding by men of certain attitudes about sexuality and sexual violence. These beliefs included that women do not have the right to refuse sex to husbands and boyfriends; that forcing one"s partner to have sex is not rape; and women sometimes deserve to be beaten. The women who reported experiencing partner physical violence were significantly more likely to believe that they were at risk of getting HIV.90 South African based-studies have found that women who experience intimate partner violence are at long-term increased risk of HIV infection, particularly where their partners were involved in multiple concurrent, unprotected sexual relationships.91

The scale of the problem in South Africa has been difficult to assess accurately as the police do not appear to keep separate figures for "domestic violence" or at least include them in their public crime statistics. However, in late 2007 the SAPS submitted reports to the Parliamentary Portfolio Committee on Safety and Security in which they noted a total of 88,784 "domestic violence incidents" had been recorded between 1 July 2006 and June 2007.92 These cases would have included a range of forms of abuse as, under the 1998 DVA, "domestic violence" is defined to include physical, sexual, emotional, verbal, psychological and economic abuse; intimidation, harassment, stalking, damage to property; entry into complainant"s residence without consent where the parties do not share the same residence; or any other controlling or abusive behaviour towards a complainant, where such conduct harms, or may cause imminent harm to the safety, health or well-being of the complainant.93 Between April 2006 and March 2007, 63,000 applications for protection orders, under the terms of the DVA, were confirmed by the courts.94

Further insight into the levels of violence which may be affecting women in their homes can be gleaned from the SAPS crime statistics for incidents of assault GBH. The SAPS noted that a quarter of the perpetrators were relatives and in nearly 90 per cent of the cases the victim knew the perpetrator.95 The actual number of reported incidents of assault GBH for the year 2006/2007 218,030 is indicative of serious levels of interpersonal violence, with one quarter or some 55,000 incidents involving family members.96 To these figures could also be added the number of cases of murder or attempted murder, both of which could be relevant for an analysis of domestic violence trends. South African legal researchers reviewing the results of community-based, local and regional studies noted that the estimates range from one in two to one in six women experiencing domestic violence.97 A hospital-based survey reported that more than one third of women from a low-income community had experienced domestic violence at some stage.98 Half of all South African women killed in 1999 were "killed by their intimate partners, with violence a factor in many of these relationships."99


Nearly ten years after the DVA came into force and after the provision of training on their obligations by official and civil society organizations, there is still evidence that some members of the SAPS do not understand their legal responsibilities or do not feel under sufficient pressure to fulfil them. A view that these are "family matters" still persists among some police officers, an attitude which may be reinforced by policing priorities which emphasise combating crimes which have an impact on the economy and more influential sectors of society. The professionalism of the police response to reports of domestic violence may also have been weakened by the decision taken in 2006 by police management to decentralise specialist police units, including the FCS. Members of the Unit have been redistributed to local police stations, but in a manner which appears to have left them without adequate support and at risk of being deskilled.109


Finally, urgent attention is needed to increase information about and the availability of places of safety. All of the women interviewed by AI, when asked if there were shelters for women experiencing violence in their homes, replied that they were not aware of any. Their only resort was to go back to their parents or other relatives" homes, but with the risk of being found. A support organization in Mpumalanga informed AI that they were aware of one shelter which allowed a woman to stay for three months, including with her children, but transport was difficult to arrange. According to the national Department of Social Development, which is responsible for approving provincial plans within agreed national policy guidelines, in addition to the Louieville Women"s Support Centre in Mpumalanga which was opened in 2002, a further shelter was opened in 2006, in Badplaas, and planning for a third one was underway.110



The period of democracy in South Africa since 1994 has coincided with the most intense increase in the prevalence of HIV and the feminisation of the epidemic. The legacies of the apartheid period - the deliberate underdevelopment of black residential communities and rural "homeland" areas, the lack of effective policing apart from reasons of political repression, and the racially skewed delivery of health and other social services and access to education - still pose major challenges to a government under pressure to respond more immediately, effectively and compassionately to the problems of persistent poverty, high unemployment, preventable diseases and the consequences of violent crime. Although the formal, legal status of women and the level of their participation in political life have improved enormously since 1994, women, particularly rural women living with HIV who are the focus of this report, are disproportionately affected by poverty and unemployment. They continue to experience discriminatory attitudes and practices, particularly from male partners, and to live in a general environment of high levels of sexual and other forms of gender-based violence.

AI concluded from the research conducted for this report that there is evidence indicating that the realization of the women"s right to the highest attainable standard of health is impeded by:

  • the lack of secure income which affected their ability to access health services and adequate food, although the state provision of various kinds of social grants mitigated the worst effects for some women;

  • the lack of affordable and reliable transport enabling them to reach HIV-related health services urgently or for necessary monitoring, treatment and care;

  • the still limited availability of comprehensive HIV services including ART in rural areas due to severe staff shortages, some which appeared to be caused by the lack of due diligence on the part of department of health officials responsible for recruitments and planning, particularly in Mpumalanga province, but also by the competitive pressures from the private sector and foreign governments;

  • the still limited accessibility and availability of comprehensive HIV services including ART in rural areas due to blockages in the accreditation process, particularly in Mpumalanga province, for certifying sufficient, decentralised facilities to offer these services, although positive trends are emerging in some provinces in this regard;

  • the impact of sexual and other forms of gender-based violence on the women, who had been exposed to the risk of HIV infection through coercive unprotected sex and/or from the longer-term consequences of living in abusive relationships;

  • the impact of other forms of discrimination against women and social stigma attached to HIV and AIDS which impeded their ability to make the best decisions for their health, including being able to refuse unprotected sex and undergo HIV testing without risks of verbal abuse, violence or threats of violence and abandonment;

  • the impact of the obstacles to their access to legal remedies due to still inconsistent practices, poor training and under-resourcing in the police response to crimes of violence against women in rural areas; and

  • the impact of the lack of information on or actual shortages of shelters for women experiencing domestic violence.

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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