South Africa: Women, Aids, and Violence, 04/28/08

AFRICAN STUDIES CENTER - UNIVERSITY OF PENNSYLVANIA

South Africa: Women, Aids, and Violence, 04/28/08

South Africa: Women, AIDS, and Violence, 1

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

Editor's Note

"Despite gradual improvements in the government's response to the HIV epidemic and the adoption of a widely-welcomed five-year plan, five and a half million South Africans are HIV-infected - one of the highest numbers in any country in the world. Fifty-five percent of them are women. South African women under 25 are three to four times more likely to be HIV-infected than men in the same age group. ... the level of new HIV infections amongst women in South Africa continues to increase, while overall incidence of the disease has levelled off." - 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 http://www.amnesty.org/en/library/info/AFR53/001/2008/en 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 http://www.africafocus.org/healtexp.php

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"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

[Excerpts from preface and introduction only. For full 124-page report, including footnotes and references, see http://www.amnesty.org/en/library/info/AFR53/001/2008/en]

Summary Table of Contents

Introduction

HIV and AIDS in South Africa
The female face of the HIV epidemic: the impact of discrimination, violence and poverty

Violence against women and HIV

Sexual violence and its consequences
Domestic Violence as a long-term threat to women"s health
Caring for the survivors: overcoming barriers to their right to health
Reducing the risk of HIV transmission: The provision of post-exposure prophylaxis (PEP)

Gender-based discrimination as a barrier to prevention, treatment and care for HIV

Legal Framework
Now social status and vulnerability to HIV infection and its consequences
Denial of women"s sexual and reproductive rights
Gender-based discrimination & access to treatment for women living with HIV

HIV testing and disclosure of results

Human rights standards
Abuses and abandonment of HIV-infected women by their partners
Men"s reluctance to test

Poverty as a barrier to the realization of rural women"s right to health

Consequences of poverty for rural women living with HIV
Lack of access to adequate food
Accessibility of health services: distance and transport costs as barriers
Availability and accessibility of health services: barriers to treatment and care
Increasing the availability and accessibility of accredited facilities.

Conclusion
Recommendations to the Government of South Africa

Recommendations to Second Governments and donor institutions

Preface

In South Africa in late 2006 a new spirit seemed to have taken hold in public discussions on how to achieve a more concerted, effective response to the country"s epidemic of HIV infection. The ensuing collaborative efforts, which drew in health department officials, civil society organizations and medical specialists, resulted eventually in agreement on a number of issues: notably that the challenges posed by persistent poverty as well as violence and other forms of discrimination against women had to be addressed as part of an effective overall response to the epidemic and the realization of the right to health of those affected and infected by HIV. The consensus on this and other issues was reflected in a new plan adopted by Cabinet in May 2007 to guide the work of the next five years.2

This report, which reflects research undertaken by Amnesty International (AI) in 2006 and 2007, provides an analysis of patterns of human rights abuses against women who are exposed to the risk of or are already living with HIV in rural contexts of widespread poverty and unemployment. It draws on the testimonies of 37 women who, to varying extents, had experienced incidents of violence from intimate partners or strangers, were unable to secure a stable income, faced periods of hunger, but were striving to maintain their access to health services and adhere to treatment despite the consequences of poverty, stigma and their low social status.

The women involved were interviewed by AI in Mpumalanga and KwaZulu Natal provinces, in collaboration with local service providing organisations with whom AI has worked for some years. The interviews were conducted with the assistance of interpreters in most cases and the support of the organizations" lay-counsellors. The interviewees" identities have been protected throughout this report to ensure their right to privacy and to avoid any possible harmful consequences resulting from their identification. Identifying place names have also been excluded when referring to their testimonies.

While there were singular aspects to each of their stories, some common themes emerged which pointed towards wider, more systemic factors which affected the women"s ability to realize their right to health. In the following chapters some of these factors are examined, including the direct and indirect impact of gender-based violence, discriminatory attitudes and gender stereotypes, and economic marginalisation. In attempting to assess their effects, AI has drawn on information provided to it in meetings and other communications with nongovernmental and government sector service providers, human rights and advocacy organizations, policy development and research institutions, health professionals and government officials.

The report"s analysis has also benefited from some of the extensive published research undertaken by South African and international organizations. Finally, the report"s analysis and conclusions are underpinned by a framework of human rights standards which reflect the consensus of the international community. South Africa since 1994 has participated in the further development of these standards, as well as shown its acceptance of them through its commitments made under key international human rights treaties. This report and associated campaign are intended as contributions towards South African efforts to overcome the legacies of the past and address current human rights abuses.

Introduction

HIV and AIDS in South Africa

South Africa is continuing to experience a severe HIV epidemic.5 Five and a half million South Africans are HIV-infected, the highest number of people in any one country in the world. Fifty-five per cent of them are women.6 UNAIDS estimated that 320,000 people died of AIDS in 2006.7 The epidemic developed rapidly from the first case recorded in 1982,8 to a national prevalence rate of at least 16 per cent in 2005.

The epidemic had begun during a period of extreme state violence and political and racial oppression which included government imposed states of emergency from 1985 to 1990, and continued to develop while the country was largely preoccupied with the efforts to negotiate the end of the apartheid system and National Party rule and securing the transition to nonracial democracy in 1994. Initially perceived in South Africa as a disease particularly affecting gay men and people receiving blood transfusions, it became apparent that HIV and AIDS was not confined to particular "at-risk" groups but was becoming a generalised epidemic in certain communities.9 From 1991 onwards the majority of transmissions in South Africa were through heterosexual intercourse. In 1993 the national prevalence rate amongst pregnant women attending antenatal clinics was 4.0 per cent; in 1996 it was 14.2 per cent; and by 1999 22.4 per cent of pregnant women attending antenatal clinics were HIV-infected.10 In 2005 data from a population survey indicated that 16.2 per cent of adults 15 to 49 years were infected, while UNAIDS, using antenatal clinic data, published an estimate of 18.8 per cent prevalence for adults 15 to 49 years of age.11

This desperate situation was unfolding while the country from 1994 was engaged in remarkable legal and institutional transformations which began to affect every sphere of life. These changes included the finalisation and adoption in 1996 of a constitution with a legally enforceable bill of rights protecting, among others, the right to equality, to bodily and psychological integrity, to freedom from violence from either public or private sources, and to the realization of the right to health without discrimination on any grounds. Within this framework institutional reforms were initiated, for instance, to improve access to education and to employment for "historically disadvantaged groups", to integrate and reform the health services,12 as well as the policing and criminal justice systems with the intention to improve service delivery for all South Africans without discrimination.

Despite the relentless upward trend in HIV infection rates, the government"s initial responses to the epidemic were slow and erratic during the Mandela presidency.13 From late 1999 the government of President Thabo Mbeki took a direction which turned a public health emergency into a matter of political conflict. For whatever complex reasons, President Mbeki"s decision publicly to question the link between the virus and the onset of AIDS, as well as the efficacy and safety of the then known drug treatments, precipitated a period of confusion and demoralisation within government departments and the public health services and disputes between national and some provincial governments over responses to the epidemic. Adding to these consequences was a growing bitter conflict with sectors of civil society, including medical practitioners, who were pressing for access to antiretroviral treatment for HIV-infected pregnant women and others with AIDS. There was a loss of strong unified leadership at a critical juncture in the life of the epidemic and a further delay in access to life-saving medicines for those with AIDS who were dependent on the public sector for health services.14

In late 2001 the Treatment Action Campaign (TAC)15 obtained an order in the Pretoria High Court requiring the government to supply antiretroviral medication to pregnant women to prevent transmission of the virus to their babies. The High Court ruling was confirmed by the Constitutional Court in July 2002 after the Department of Health appealed the High Court decision.16 The Constitutional Court held that "Sections 27(1) and (2) of the Constitution require the government to devise and implement within its available resources a comprehensive and co-ordinated programme to realize progressively the rights of pregnant women and their newborn children to have access to health services to combat mother-tochild transmission of HIV".

In November 2003 the Minister of Health, Dr Manto Tshabalala-Msimang, announced the government"s decision to provide antiretroviral treatment in the public health sector within the framework of the National Operational Plan for Comprehensive HIV and AIDS Management, Treatment, Care and Support (NOP). Antiretroviral therapy (ART) finally and slowly began to be provided in public sector hospitals from 2004.17 The "roll-out" of treatment occurred at a pace below the targets indicated in the NOP and was dogged by an atmosphere of distrust of government intentions. Advocacy groups observed that the Cabinet-approved NOP had "committed the state in 2003 to placing approximately 645,740 people on ARV treatment in the public sector by the end of 2006/7 financial year,"18 but according to Department of Health information, "approximately 250,000 people had been initiated on ARV treatment in the public health sector by this time."19 By mid-2006, 200,000 adults were on treatment while an estimated 511,000 still needed to begin ART.20 The numbers had risen to 303,788 patients on treatment by May 2007, according to the government"s MDGs Mid-Term report, and to 408, 218 by the following November.21

The tensions between government and civil society over responses to the HIV epidemic appeared to reach a nadir at the XVI International AIDS Conference in Toronto in August 2006. The promotion by the Minister of Health at the conference of a diet-based treatment for AIDS led to further national and international pressure and criticism of the government. 22 The Deputy President, Phumzile Mlambo-Ngcuka, as Chairperson of the reconstituted South African National AIDS Council (SANAC), began to have an increasingly prominent role in the oversight of the response to the epidemic and the development of the new national strategic plan.23 As described in the NSP which was adopted by SANAC in April 2007 and the Cabinet in the following month, the final version of the plan had been developed through an intensive and consultative process over a six month period.24 SANAC symbolised the changes with its membership and co-chairing role for civil society. 25 The process of developing the new NSP was described to AI as genuinely participatory by civil society organizations.26 As summarised by the Joint Civil Society Monitoring Forum, the new plan proposed to expand the access to appropriate treatment, care and support to 80 per cent of all HIV positive individuals by 2011; create a social environment which encouraged HIV testing, and promote, protect and monitor human rights involved in these interventions.

Some uncertainties still remained, however, when in August 2007 the goodwill developed during this process was put at risk by the dismissal by President Mbeki of the Deputy Minister of Health, Nozizwe Madlala-Routledge, after she participated in an AIDS conference in Spain without his formal approval.27 The Deputy Minister had been an active participant in the development of the NSP. In a further sign of unresolved issues, public controversy intensified in late 2007 over the delays in producing new guidelines and budget for the provision of dual therapy treatment to pregnant women prior to labour and to their new born babies to prevent HIV transmission, consistent with revised WHO guidelines and in compliance with the ruling of the Constitutional Court in 2002. Approval of the new guidelines appeared imminent in September, but they had still not been produced by the following February. While the Western Cape Province had implemented since 2004 the dual therapy regime and had reduced infant infection rates reportedly to less than 10 per cent, other provinces continued to use single therapy treatment while awaiting national authorisation. The Southern African HIV Clinicians Society expressed concern that children were continuing to be infected unnecessarily. In KwaZulu Natal Province, a hospital doctor, who in 2007 had raised concerns with the Department of Health about the delays, was charged in February with misconduct for accepting outside funds to implement dual therapy at his hospital. Although the departmental charge was later dropped, the incident and associated public outcry indicated that the new spirit of collaboration which had helped create the NSP was still fragile.28

The female face of the HIV epidemic: the impact of discrimination, violence and poverty

"The HIV epidemic and AIDS [in South Africa] is clearly feminized, pointing to gender vulnerability that demands urgent attention as part of the broader women empowerment and protection. In view of the high prevalence and incidence of HIV amongst women, it is critical that their strong involvement in and benefiting from the HIV and AIDS response becomes a priority." (NSP)36

Women are particularly affected by HIV and AIDS. As noted by the Executive Director of UNAIDS in his opening address at the July 2007 International Women"s Summit, "the most significant development of the AIDS epidemic is its growing feminization. What entered history 25 years ago as a disease of white gay men is now increasingly affecting women all over the world."37 Of the 40 million people living with HIV globally in 2007, almost half are women - reaching 60 per cent in sub-Saharan Africa.38 In South Africa, women under 25 are three to four times more likely to be HIV-infected than men in the same age group.39 Significantly, the level of new HIV infections amongst women in South Africa continues to increase, while overall incidence of the disease has levelled off.40 Data presented to the Third South African AIDS Conference in June 2007 indicated that of the more than 500,000 new infections in 2005, the highest incidence occurred in young women aged 15 to 24 years.41 Provincial antenatal clinic prevalence rates vary considerably, ranging from 15.7 per cent in the Western Cape to 39.1 per cent in KwaZulu Natal.42

The NSP notes that while the immediate determinants of the spread of HIV relates to behaviours such as unprotected sexual intercourse, multiple sexual partnerships, and some biological factors such as concurrent sexually transmitted infections (STIs), women"s socioeconomic disempowerment and the impact of gender-based violence contributed to women"s significantly higher infection rates. 43 Women are biologically more vulnerable than men to contracting the virus through unprotected vaginal intercourse.44 Available evidence globally, as well as evidence presented in this report, suggests that women are also put a greater risk of transmission due to the discriminatory impact of gender roles and stereotypes.

They are frequently unable to insist on condom use to protect themselves against the risk of HIV transmission by a male partner where they are economically, socially or culturally dependent on that partner or his family, or risk being subjected to violence as a result of suggesting condom use.45 Their exposure to sexual violence and intimate partner violence increases their risk of HIV infection over time.46 Women are less likely to have independent access to economic resources and recent research in South Africa has shown the direct positive correlation between women"s access to economic resources and their ability to protect themselves from HIV infection and against violence.47 In many countries, women also carry a disproportionate burden as carers once members of a household fall sick - a particular concern in a country like South Africa where AIDS affects a large part of the population. ...

As examined in the following chapters of this report, the scale of incidents of sexual and other forms of violence against women has remained persistently high in South Africa, continuing to place women at risk of HIV in the immediate or longer term. Considerable effort has been put into reforming the legal framework, medico-legal, police and criminal justice responses to gender-based violence. Nevertheless, women"s lives continue to be scarred by violence or the threat of violence in under-policed, unsafe communities and in their homes. Nearly ten years after the Domestic Violence Act 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 South African Police Service (SAPS) do not understand their legal responsibilities or do not feel under sufficient pressure to fulfil them. For women in abusive relationships, their access to places of safety also remains very difficult.

Violence against women is a persistent and devastating manifestation of gender-based discrimination. Other forms of discrimination in the social and cultural spheres can also act as barriers to women"s access to prevention, treatment and care for HIV. There has been extensive transformation since 1994 of the legal framework to entrench gender equality, protect women"s sexual and reproductive rights and their right not to be subjected to violence. However, the rural women whom AI interviewed were continuing to experience oppression in their relationships with male partners, within families and the wider community as a result of their low social status, economic marginalisation, and also in some cases because of their HIV status. These manifestations of their inequality as women were associated with a range of consequences, including abandonment, loss of their homes, failure to complete their education, inability to secure maintenance for their children, violations of their sexual and reproductive rights with an associated increased risk of HIV infection, and barriers to access to HIV-related health services and treatment adherence.

While there are many good reasons to test, and sound medical grounds for scaling up testing for HIV as recommended in the NSP, it is more complex in a context of gender inequality, poverty and violence. Where women are tested in greater numbers than men and with limited support, it can leave them vulnerable to stigma, discrimination, abandonment and violence.49 The women AI interviewed spoke of their own experiences of powerlessness, verbal and physical abuse, threats of violence and abandonment in response to disclosing their HIV status.

Finally, poverty is a powerful factor acting as a barrier to access to health services, particularly for rural women who are disproportionately represented among the poor and unemployed. There has been a gradual improvement in the provision of HIV testing and counselling and preventative antiretroviral drugs to rape survivors, along with other initiatives to improve emergency medical and medico-legal services, but some survivors who lack economic resources and the support of NGOs still experience difficulties in adhering to treatment and remain at risk of HIV infection.

While ART and other essential treatments for people living with HIV and AIDS are available free of charge, the circumstances of the women whom AI interviewed in KwaZulu Natal and Mpumalanga provinces indicate that women living in rural areas who do not have a secure income face serious challenges and in some cases complete inability to access treatment and ongoing care because they cannot afford the transport costs to get to the hospitals. Their ability to adhere to treatment is also jeopardised because they cannot afford adequate food with which to take ART twice daily. Although some of the women did receive temporary disability grants, food supplements or other social assistance for their children"s welfare, their economic circumstances remained precarious and affected their ability to access or continue their treatment. In addition their access to health services is further compromised by systemic challenges within the health system, in particular shortages of staffing and delays in government implementation of aspects of the HIV and AIDS treatment programme,such as providing sufficient accessible health care facilities to provide ART.

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

For previous AfricaFocus Bulletins on related issues, see http://www.africafocus.org/healtexp.php

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[Excerpts For full 124-page report, including footnotes and references, see
http://www.amnesty.org/en/library/info/AFR53/001/2008/en For additional excerpts, including table of contents, see http://www.africafocus.org/docs08/ai0804a.php]

Violence against women and HIV

"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 formα.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

...
Conclusion

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.

from africafocus@igc.org
date Mon, Apr 28, 2008 at 11:09 AM subject South Africa: Women, Aids, and Violence, 1, 2

Page Editor: Ali B. Ali-Dinar, Ph.D.