Understanding Men's Health and Use of Violence: Interface of Rape and HIV in South Africa

This report, published by the Gender and Health Research Unit of the Medical Research Council (MRC), is based on research that sought to: clarify the prevalence of rape perpetration in a random sample of community-based adult men, understand factors associated with rape perpetration, and describe intersections between rape, physical intimate partner violence, and HIV. The authors argue that high levels of rape are rooted in negative conceptions of masculinity and that the problem cannot solely be addressed through criminal prosecution, but requires a broader approach that addresses these conceptions of manhood.

The research found that almost 27% of all men surveyed had reported raping at least one woman or girl in their lifetime. Several factors among men were found to be positively associated with perpetrating rape, including age, childhood trauma, criminality, sexual risk-taking, and intimate partner violence. The researchers note that men who raped reported parental absence through much of their childhoods. They also were more likely to view both their mothers and fathers as significantly less kind and had experienced significantly more trauma during childhood in the form of physical or sexual abuse, physical hardship, or emotional neglect or abuse. This association between childhood trauma and rape confirmed earlier findings from the Stepping Stones study that early trauma can influence the trajectory of child development and increase the likelihood of anti-social behaviour later in life. Researchers noted that the overall pattern of childhood described by the men interviewed reflected Apartheid's systematic destruction of the family unit through policies such as its migrant labour system.

Perpetrating rape was also found to be associated with sexual risk taking. Men who reported having raped a woman or girl were more likely to report risky behaviours such as having had more than 20 sexual partners, transactional sex, or sex with a sex worker. They were also more likely to report heavy alcohol consumption and inconsistent condom use.

Finally, men who raped were also more likely to report being physically violent towards an intimate partner. Researchers posit that involvement in intimate partner violence is a risk factor positively linked with the risk factor for perpetrating rape. Significantly, according to the authors, men who were physically violent with partners - whether they had or had not raped - were more likely to be HIV-positive. While the study noted there were no differences in the HIV prevalence rates of those who had or had not raped, the association between intimate partner violence and an increased likelihood of HIV infection is considered extremely important and confirms long-standing suspicions among those within the HIV/AIDS field that men who commit this type of violence are at a heightened risk of HIV infection. The researchers argue that while there is no biological explanation for the association, it is probably related to the construction of manhood that emphasises male dominance and links it to sexual risk taking and violence.

The study concludes by stating that data from South Africa suggest that pervasive negative constructions of masculinity continue to fuel rape, intimate partner violence, and the spread of HIV in the country. Researchers point out that in this context, the provision of post-exposure prophylactics (PEP) to rape survivors remains pivotal. The report also outlined three recommendations aimed at addressing high levels of rape in the country:

• Rape prevention should focus on changing the social norms around masculinity and sexual entitlement.
• A comprehensive care package that includes not just PEP but also access to psychological aftercare should be delivered to all rape survivors.
• HIV prevention must promote more gender equitable models of masculinity.