Ending the violence at home

Intimate partner violence – particularly sexual violence – is an underreported and hidden problem in South Africa. High levels of gender based violence are highlighted during 16 Days of Activism and Women’s Month but the public perception is that sexual violence and abuse is perpetrated largely by strangers. This couldn’t be further from the truth.

Intimate partner violence (IPV), defined as the experience of “physical, sexual or psychological harm by a current or former partner or spouse” is a significant public health and human rights problem across the globe and in South Africa. In a nationally representative study on IPV, one in three South African women had experienced physical IPV at some point in their current relationship. According to a policy brief on intimate partner violence by Stellenbosch University, South Africa has the highest rate of women killed by their intimate partner in the world – half of all women who are killed in South Africa are killed by their intimate partners.

EVIDENCE

There is strong evidence that intimate partner violence is part of a vicious cycle. Victims of IPV are made vulnerable to HIV, mental illness, poor reproductive health and chronic disease, and the cycle can lead to injury, disability and in some cases death. Abused women are twice as likely as non-abused women to report physical and mental health problems and longitudinal studies show that violence in the home has negative impacts on the lives of the children in these homes.

Significantly for South Africa, which has the largest HIV burden in the world, women with violent or controlling male partners are at increased risk of HIV infection. Women who experience IPV are more likely to become HIV positive and to get other sexually transmitted infections and the rate of IPV among HIV-positive women is double the national rate. Women in relationships with violence have four times the risk for contracting STIs, including HIV, than women in relationships without violence.

REACHING THE VICTIMS

NACOSA’s Intimate Partner Violence programme, funded by the Global Fund, provides counselling services through supervised social auxiliary workers to victims of IPV between the ages of 14 and 64. Victims access the service by visiting the offices of the organisations running the service and through outreach using the “go and fetch” principle at clinics, police stations, courts and in schools. They are screened for IPV using nine simple questions in a standardized tool. The counsellors talk to victims about the risk of HIV, STIs and TB, offer HIV testing, provide condoms and talk about contraception. They then link people to longer-term counselling and other forms of support. The programme will reach almost 90,000 people over three years with 54 social auxiliary workers, seven supervisory social workers working in seven community organisations in the Western Cape, Eastern Cape and Gauteng. At least 80% of the clients will receive HIV testing services.

Recognising that support for victims is only part of the solution, NACOSA also manages an economic empowerment intervention in domestic violence shelters. Four organisations provide between eight and 12 sessions per quarter to shelter residents, former shelter residents and women referred through the IPV programme (where economic abuse has been identified). The women are provided with practical craft skills along with business skills, job readiness support and basic financial literacy to support them to become economically independent. This intensive intervention will reach 1,560 women over three years. At least 60% of these women will receive an HIV test.

AGE AND STIGMA

Throughout the first year of this programme, we have been struck by the age group being positively screened for IPV. Over 30% are young women and girls between 14 and 24 and 29% are women between 25 and 40 years. This correlates strongly with HIV prevalence – women in these age groups are at considerably more risk of becoming HIV positive.

Organisations running the programme have noticed that there is still significant stigma involved in getting an HIV test at clinics, particularly for people experiencing intimate partner violence, and women report that their partners are reluctant to come in for testing. For this reason, it is essential that more social auxiliary workers are trained and certified to provide HIV testing services themselves so that they can test people immediately in the first counselling session. Health officials at clinics also need to make sure they are youth-friendly, non-judgemental spaces where young women at risk can get access to the full range of sexual and reproductive health services.

HEAVY BURDEN

Social auxiliary workers must reach three new clients each day and do follow-up counselling as well – a heavy burden on these workers, who need extensive supportive supervision. They also need regular debriefing because the level of violence that they are seeing is traumatising. High numbers of positive HIV tests are also negatively affecting them. In general, we must find ways of dealing better with mental health issues within the IPV response – greater therapeutic interventions are needed to address the significant mental health issues we are seeing in victims of IPV and their children.

From the available evidence, it is clear that multi-level interventions work better than single level interventions and current IPV programming operates largely at the response level. Doing more to generate awareness of the available services, so that people can seek help earlier, will help to boost the prevention side of the equation. There is also a piece of the puzzle missing. The role of the private sector in responding to and addressing IPV should be boosted: companies that include IPV screening and referral to services in their workplace wellness programmes, for example, could have a significant impact on the IPV issue.

Although we are slowly making progress in understanding the causes and impact of IPV in South Africa, there is a great deal that still needs to be done to begin to turn the tide. Greater public awareness, particularly amongst young people, is essential. Violence in the home is the breeding ground for the country’s high levels of sexual and gender based violence, as well as its heavy HIV burden. We can’t afford to stand still on this.

NACOSA is helping to organise End it Now! Together in response to GBV and HIV – a national conference to promote linking, learning and action on the state response to gender based violence (GBV), the interaction between HIV and GBV and the impact of GBV on young people from 24-26 October in Johannesburg. www.enditnow.co.za

References

1. Joyner K, Rees K and Honikman S. Intimate Partner Violence (IPV) in South Africa: How to break the vicious cycle. Policy Brief, 2015.
2. Abrahams N, Jewkes R, Martin LJ, et al. Mortality of women from intimate partner violence in South Africa: a national epidemiological study. Violence and victims. 2009;24(4):546–556
3. Intimate Partner Violence: Definitions, WHO 2014.
4. Norman R, Schneider M, Bradshaw D, et al. Interpersonal violence: an important risk factor for disease and injury in South Africa. Population Health Metrics. 2010;8(1):32