Experiences of Forced Sex Among Female Patrons of Alcohol-Serving Venues in a South African Township

Abstract

South Africa has among the highest rates of forced sex worldwide, and alcohol use has consistently been associated with risk of forced sex in South Africa. However, methodological challenges affect the accuracy of forced sex measurements. This study explored the assessment of forced sex among South African women attending alcohol-serving venues and identified factors associated with reporting recent forced sex. Women (n = 785) were recruited from 12 alcohol-serving venues in a peri-urban township in Cape Town. Brief self-administered surveys included questions about lifetime and recent experiences of forced sex. Surveys included a single question about forced sex and detailed questions about sex by physical force, threats, verbal persuasion, trickery, and spiked drinks. We first compared the single question about forced sex to a composite variable of forced sex as unwanted sex by physical force, threats, or spiked drinks. We then examined potential predictors of recent forced sex (demographics, drinking behavior, relationship to the venue, abuse experiences). The single question about forced sex had low sensitivity (0.38); more than half of the respondents who reported on the detailed questions that they had experienced forced sex by physical force, threats, or spiked drinks reported on the single question item that they had not experienced forced sex. Using our composite variable, 18.6% of women reported lifetime and 10.8% reported recent experiences of forced sex. In our adjusted logistic regression model, recent forced sex using the composite variable was significantly associated with hazardous drinking (OR = 1.92), living farther from the venue (OR = 1.81), recent intimate partner violence (OR = 2.53), and a history of childhood sexual abuse (OR = 4.35). The findings support the need for additional work to refine the assessment of forced sex. Efforts to prevent forced sex should target alcohol-serving venues, where norms and behaviors may present particular risks for women who frequent these settings.

Keywords

sexual assault alcohol and drugs cultural contexts predicting domestic violence domestic violence adult victims

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References

Abbey

Ross

L. T.

McDuffie

(1994). Alcohol’s role in sexual assault. In Watson

R. R.

, ed. Drug and Alcohol Abuse Reviews: Volume 5, Addictive Behaviors in Women (pp. 97-123). Totowa, NJ: Humana Press.

Ackermann

(2002). Social factors that make South African women vulnerable to HIV infection. Health Care for Women International, 23, 163-172.

Boles

S. M.

Miotto

(2003). Substance abuse and violence: A review of the literature. Aggression and Violent Behavior, 8, 155-174.

Bushman

B. J.

Cooper

H. M.

(1990). Effects of alcohol on human aggression: An integrative research review. Psychological Bulletin, 107, 341-354.

Chersich

Rees

(2010). Causal links between binge drinking patterns, unsafe sex and HIV in South Africa: Its time to intervene. International Journal of STD & AIDS, 21, 2-7.

Classen

C. C.

Palesh

O. G.

Aggarwal

(2005). Sexual revictimization: A review of the empirical literature. Trauma Violence Abuse, 6, 103-129.

Cook

S. L.

Gidycz

C. A.

Koss

M. P.

Murphy

(2011). Emerging issues in the measurement of rape victimization. Violence Against Women, 17, 201-218.

Cunradi

C. B.

(2010). Neighborhoods, alcohol outlets and intimate partner violence: Addressing research gaps in explanatory mechanisms. International Journal of Environmental Research and Public Health, 7, 799-813.

Demers

Kairouz

Adlaf

Gliksman

Newton-Taylor

Marchand

(2002). Multilevel analysis of situational drinking among Canadian undergraduates. Social Science & Medicine, 55, 415-424.

10.

Eaton

L. A.

Kalichman

S. C.

Pitpitan

E. V.

Cain

D. N.

Watt

M. H.

Sikkema

K. J.

. . .Pieterse

(2014). The relationship between attending alcohol serving venues nearby versus distant to one’s residence and sexual risk taking in a South African township. Journal of Behavioral Medicine, 37, 381-390.

11.

Felson

R. B.

Pare

(2005). The reporting of domestic violence and sexual assault by nonstrangers to the police. Journal of Marriage and Family, 67, 597-610.

12.

Foran

H. M.

O’Leary

K. D.

(2008). Alcohol and intimate partner violence: A meta-analytic review. Clinical Psychology Review, 28, 1222-1234.

13.

Freisthler

(2011). Alcohol use, drinking venue utilization, and child physical abuse: Results from a pilot study. Journal of Family Violence, 26, 185-193.

14.

Gass

J. D.

Stein

D. J.

Williams

D. R.

Seedat

(2011). Gender differences in risk for intimate partner violence among South African adults. Journal of Interpersonal Violence, 26, 2764-2789.

15.

Graham

Bernards

Wilsnack

S. C.

Gmel

(2011). Alcohol may not cause partner violence but it seems to make it worse: A cross national comparison of the relationship between alcohol and severity of partner violence. Journal of Interpersonal Violence, 26, 1503-1523.

16.

Harford

T. C.

Wechsler

Seibring

(2002). Attendance and alcohol use at parties and bars in colleges: A national survey of current drinkers. Journal of Studies on Alcohol and Drugs, 63, 726-733.

17.

Jewkes

(2002). Intimate partner violence: Causes and prevention. The Lancet, 359, 1423-1429.

18.

Jewkes

Abrahams

(2002). The epidemiology of rape and sexual coercion in South Africa: An overview. Social Science & Medicine, 55, 1231-1244.

19.

Jewkes

Dunkle

Koss

M. P.

Levin

J. B.

Nduna

Jama

Sikweyiya

(2006). Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Social Science & Medicine, 63, 2949-2961.

20.

Jewkes

Fulu

Roselli

Garcia-Moreno

(2013). Prevalence of and factors associated with non-partner rape perpetration: Findings from the UN Multi-country cross-sectional study on men and violence in Asia and the Pacific. The Lancet Global Health, 1, e208-e218.

21.

Jewkes

Levin

Penn-Kekana

(2002). Risk factors for domestic violence: Findings from a South African cross-sectional study. Social Science & Medicine, 55, 1603-1617.

22.

Jewkes

Nduna

Levin

Jama

Dunkle

Puren

Duvvury

(2008). Impact of stepping stones on incidence of HIV and HSV-2 and sexual behavior in rural South Africa: Cluster randomised controlled trial. British Medical Journal, 337, Article 506.

23.

Jewkes

Sikweyiya

Morrell

Dunkle

(2011). Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: Findings of a cross-sectional study. PLoS ONE, 6, e29590.

24.

Jewkes

Vundule

Maforah

Jordaan

(2001). Relationship dynamics and teenage pregnancy in South Africa. Social Science & Medicine, 52, 733-744.

25.

Kahn

A. S.

Jackson

Kully

Badger

Halvorsen

(2003). Calling it rape: Differences in experiences of women who do or do not label their sexual assault as rape. Psychology of Women Quarterly, 27, 233-242.

26.

Kalichman

S. C.

Simbayi

L. C.

(2004). Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa. AIDS Care, 16, 681-689.

27.

Kalichman

S. C.

Simbayi

L. C.

Cloete

Clayford

Arnolds

Mxoli

. . .Kalichman

M. O.

(2009). Integrated gender-based violence and HIV risk reduction intervention for South African men: Results of a quasi-experimental field trial. Prevention Science, 10, 260-269.

28.

Kalichman

S. C.

Simbayi

L. C.

Kaufman

Cain

Cherry

Jooste

Mathiti

(2005). Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa. The Journal of Sex Research, 42, 299-305.

29.

Koss

M. P.

(1992). The under detection of rape: Methodological choices influence incidence estimates. Journal of Social Issues, 48, 61-75.

30.

Krug

E. G.

Mercy

J. A.

Dahlberg

L. L.

Zwi

A. B.

(2002). The world report on violence and health. The Lancet, 360, 1083-1088.

31.

Kyriacou

D. N.

Anglin

Taliaferro

Stone

Tubb

Linden

J. A.

. . .Kraus

J. F.

(1999). Risk factors for injury to women from domestic violence against women. New England Journal of Medicine, 341, 1892-1898.

32.

Leonard

(2001). Domestic violence and alcohol: What is known and what do we need to know to encourage environmental interventions? Journal of Substance Use, 6, 235-247.

33.

Mugweni

Pearson

Omar

(2012). Traditional gender roles, forced sex and HIV in Zimbabwean marriages. Culture, Health & Sexuality, 14, 577-590.

34.

Noll

J. G.

Horowitz

L. A.

Bonanno

G. A.

Trickett

P. K.

Putnam

F. W.

(2003). Revictimization and self-harm in females who experienced childhood sexual abuse: Results from a prospective study. Journal of Interpersonal Violence, 18, 1452-1471.

35.

Peterson

Z. D.

Muehlenhard

C. L.

(2004). Was it rape? The function of women’s rape myth acceptance and definitions of sex in labeling their own experiences. Sex Roles, 51, 129-144.

36.

Saunders

J. B.

Aasland

O. G.

Babor

T. F.

Fuente

J. R.

Grant

(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88, 791-804.

37.

Shannon

Leiter

Phaladze

Hlanze

Tsai

A. C.

Heisler

. . .Weiser

S. D.

(2012). Gender inequity norms are associated with increased male-perpetrated rape and sexual risks for HIV infection in Botswana and Swaziland. PLoS ONE, 7, e28739.

38.

South African Department of Health, Medical Research Council, & ORC Macro. (2007). South African Demographic and Health Survey. Pretoria: South African Department of Health.

39.

South African Police Service. (2011). Crime Report 2010/2011. Pretoria: South African Police Service.

40.

Stanton

(1993). A qualitative and quantitative analysis of empirical data on violence against women in greater Cape Town from 1989 to 1991. Cape Town, South Africa: Institute of Criminology, University of Cape Town.

41.

Strebel

Crawford

Shefer

Cloete

Henda

Kaufman

. . .Kalichman

(2006). Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa. Journal of Social Aspects of HIV/AIDS Research Alliance, 3, 516-528.

42.

Testa

Livingston

J. A.

(2009). Alcohol consumption and women’s vulnerability to sexual victimization: Can reducing women’s drinking prevent rape? Substance Use & Misuse, 44, 1349-1376.

43.

Testa

Quigley

B. M.

Leonard

K. E.

(2003). Does alcohol make a difference? Within-participants comparison of incidents of partner violence. Journal of Interpersonal Violence, 18, 735-743.

44.

Tsai

A. C.

Leiter

Heisler

Iacopino

Wolfe

Shannon

. . .Weiser

S. D.

(2011). Prevalence and correlates of forced sex perpetration and victimization in Botswana and Swaziland. American Journal of Public Health, 101, 1068-1074.

45.

U.S. Agency for International Development. (2011). Domestic violence module: Questionnaire, interviewer’s manual, and tabulation plan. Demographic and Health Surveys Toolkit. Retrieved from https://www.k4health.org/toolkits/dhs/domestic-violence-module-questionnaire-and-interviewers-manual

46.

Van de Goor

L. A.

Knibbe

R. A.

Drop

M. J.

(1990). Adolescent drinking behavior: An observational study of the influence of situational factors on adolescent drinking rates. Journal of Studies on Alcohol, 51, 548-555.

47.

van den Berg

Hendricks

Hatcher

Peacock

Godana

Dworkin

(2013). “One man can”: Shifts in fatherhood beliefs and parenting practices following a gender-transformative programme in Eastern Cape, South Africa. Gender and Development, 21, 111-125.

48.

Watt

M. H.

Aunon

F. M.

Skinner

Sikkema

K. J.

Kalichman

S. C.

Pieterse

(2012). “Because he has bought for her, he wants to sleep with her”: Alcohol as a currency for sexual exchange in South African drinking venues. Social Science & Medicine, 74, 1005-1012.

49.

Watt

M. H.

Aunon

F. M.

Skinner

Sikkema

K. J.

MacFarlane

J. C.

Pieterse

Kalichman

S. C.

(2012). Alcohol-serving venues in South Africa as sites of risk and potential protection for violence against women. Substance Use & Misuse, 47, 1271-1280.

50.

Weir

S. S.

Pailman

Mahlalela

Coetzee

Meidany

Boerma

J. T.

(2003). From people to places: Focusing AIDS prevention efforts where it matters most. AIDS, 17, 895-903.

51.

White

H. R.

Chen

P. H.

(2002). Problem drinking and intimate partner violence. Journal of Studies on Alcohol and Drugs, 63, 205-214.

52.

Wojcicki

J. M.

(2002). “She drank his money”: Survival sex and the problem of violence in taverns in Gauteng province, South Africa. Medical Anthropology Quarterly, 16, 267-293.

53.

Wood

Lambert

Jewkes

(2007). “Showing roughness in a beautiful way”: Talk about love, coercion, and rape in South African youth sexual culture. Medical Anthropology Quarterly, 21, 277-300.

54.

Wood

Lambert

Jewkes

(2008). “Injuries are beyond love”: Physical violence in young South Africans’ sexual relationships. Medical Anthropology, 27, 43-69.

55.

World Health Organisation. (2005). Addressing violence against women and achieving the millennium development goals. Geneva, Switzerland: Author.