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18/May/2024

Introduction

Gender-based violence (GBV) is a profound and widespread problem in South Africa, impacting on almost every aspect of life. GBV (which disproportionately affects women and girls) is systemic, and deeply entrenched in institutions, cultures and traditions in South Africa.

This introduction will explore what GBV is and some of the forms it takes, examine GBV in South Africa, and begin to explore what different actors are doing to respond to GBV.

What is gender-based violence?

There are many different definitions of GBV, but it can be broadly defined as “the general term used to capture violence that occurs as a result of the normative role expectations associated with each gender, along with the unequal power relationships between […] genders, within the context of a specific society.” [1].

The expectations associated with different genders vary from society to society and over time. Patriarchal power structures dominate in many societies, in which male leadership is seen as the norm, and men hold the majority of power. Patriarchy is a social and political system that treats men as superior to women – where women cannot protect their bodies, meet their basic needs, participate fully in society and men perpetrate violence against women with impunity [2].

Forms of gender-based violence

There are many different forms of violence, which you can read more about here. All these types of violence can be – and almost always are – gendered in nature, because of how gendered power inequalities are entrenched in our society.

GBV can be physical, sexual, emotional, financial or structural, and can be perpetrated by intimate partners, acquaintances, strangers and institutions. Most acts of interpersonal gender-based violence are committed by men against women, and the man perpetrating the violence is often known by the woman, such as a partner or family member [3].

Violence against women and girls (VAWG)

GBV is disproportionately directed against women and girls [4]. For this reason, you may find that some definitions use GBV and VAWG interchangeably, and in this article, we focus mainly on VAWG.

Violence against LGBTI people

However, it is possible for people of all genders to be subject to GBV. For example, GBV is often experienced by people who are seen as not conforming to their assigned gender roles, such as lesbian, gay, bisexual, transgender and/or intersex people.

Intimate partner violence (IPV)

IPV is the most common form of GBV and includes physical, sexual, and emotional abuse and controlling behaviours by a current or former intimate partner or spouse, and can occur in heterosexual or same-sex couples [5].

Domestic violence (DV)

Domestic violence refers to violence which is carried out by partners or family members. As such, DV can include IPV, but also encompasses violence against children or other family members.

Sexual violence (SV)

Sexual violence is “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work.” [6]

Indirect (structural) violence

Structural violence is “where violence is built into structures, appearing as unequal power relations and, consequently, as unequal opportunities.

Structural violence exists when certain groups, classes, genders or nationalities have privileged access to goods, resources and opportunities over others, and when this unequal advantage is built into the social, political and economic systems that govern their lives.”

Because of the ways in which this violence is built into systems, political and social change is needed over time to identify and address structural violence.

GBV in South Africa

Societies free of GBV do not exist, and South Africa is no exception [7].

Although accurate statistics are difficult to obtain for many reasons (including the fact that most incidents of GBV are not reported [10] ), it is evident South Africa has particularly high rates of GBV, including VAWG and violence against LGBT people.

Population-based surveys show very high levels of intimate partner violence (IPV) and non-partner sexual violence (SV) in particular, with IPV being the most common form of violence against women.

  • Whilst people of all genders perpetrate and experience intimate partner and or sexual violence, men are most often the perpetrators and women and children the victims [7].
  • More than half of all the women murdered (56%) in 2009 were killed by an intimate male partner [8].
  • Between 25% and 40% of South African women have experienced sexual and/or physical IPV in their lifetime [9, 10].
  • Just under 50% of women report having ever experienced emotional or economic abuse at the hands of their intimate partners in their lifetime [10].
  • Prevalence estimates of rape in South Africa range between 12% and 28% of women ever reporting being raped in their lifetime [10-12].
  • Between 28 and 37% of adult men report having raped a women [10, 13].
  • Non-partner SV is particularly common, but reporting to police is very low. One study found that one in 13 women in Gauteng had reported non-partner rape, and only one in 25  rapes had been reported to the police [10].
  • South Africa also faces a high prevalence of gang rape [14].
  • Most men who rape do so for the first time as teenagers and almost all men who ever rape do so by their mid-20s [15].
  • There is limited research into rape targeting women who have sex with women. One study across four Southern African countries, including South Africa, found that 31.1% of women reported having experienced forced sex [16].
  • Male victims of rape are another under-studied group. One survey in KwaZulu-Natal and the Eastern Cape found that 9.6% of men reported having experienced sexual victimisation by another man [17].

Drivers of GBV

Drivers of GBV are the factors which lead to and perpetuate GBV. Ultimately, gendered power inequality rooted in patriarchy is the primary driver of GBV.

GBV (and IPV in particular) is more prevalent in societies where there is a culture of violence, and where male superiority is treated as the norm [18]. A belief in male superiority can manifest in men feeling entitled to sex with women, strict reinforcement of gender roles and hierarchy (and punishment of transgressions), women having low social value and power, and associating masculinity with control of women [18].

These factors interact with a number of drivers, such as social norms (which may be cultural or religious), low levels of women’s empowerment, lack of social support, socio-economic inequality, and substance abuse.

In many cultures, men’s violence against women is considered acceptable within certain settings or situations [18] – this social acceptability of violence makes it particularly challenging to address GBV effectively.

In South Africa in particular, GBV “pervades the political, economic and social structures of society and is driven by strongly patriarchal social norms and complex and intersectional power inequalities, including those of gender, race, class and sexuality.” [19].

Impact of gender-based violence

GBV is a profound human rights violation with major social and developmental impacts for survivors of violence, as well as their families, communities and society more broadly.

On an individual level, GBV leads to psychological trauma, and can have psychological, behavioural and physical consequences for survivors. In many parts of the country, there is poor access to formal psychosocial or even medical support, which means that many survivors are unable to access the help they need. Families and loved ones of survivors can also experience indirect trauma, and many do not know how to provide effective support.

Jewkes and colleagues outline the following impacts of GBV and violence for South Africa as a society more broadly [20]:

  • South African health care facilities – an estimated 1.75 million people annually seek health care for injuries resulting from violence
  • HIV – an estimated 16% of all HIV infections in women could be prevented if women did not experience domestic violence from their partners. Men who have been raped have a long term increased risk of acquiring HIV and are at risk of alcohol abuse, depression and suicide.
  • Reproductive health – women who have been raped are at risk of unwanted pregnancy, HIV and other sexually transmitted infections.
  • Mental health – over a third of women who have been raped develop post-traumatic stress disorder (PTSD), which if untreated persists in the long term and depression, suicidality and substance abuse are common. Men who have been raped are at risk of alcohol abuse, depression and suicide.

Violence also has significant economic consequences. The high rate of GBV places a heavy burden on the health and criminal justice systems, as well as rendering many survivors unable to work or otherwise move freely in society.

2014 study by KPMG also estimated that GBV, and in particular violence against women, cost the South African economy a minimum of between R28.4 billion and R42.4 billion, or between 0.9% and 1.3% of gross domestic product (GDP) in the year 2012/2013. [21]

What do we do?

South Africa is a signatory to a number of international treaties on GBV, and strong legislative framework, for example the Domestic Violence Act (DVA) (1998), the Sexual Offences Act (2007) and the Prevention and Combatting of Trafficking in Human Persons (2013) Act” [22].

Whilst international treaties and legislation is important it is not enough to end GBV and strengthen responses.

Addressing GBV is a complex issue requiring multi-faceted responses and commitment from all stakeholders, including government, civil society and other citizens. There is growing recognition in South Africa of the magnitude and impact of GBV and of the need to strengthen the response across sectors.

Prevention and Response

Broadly speaking, approaches to addressing GBV can be divided into response and prevention. Response services aim to support and help survivors of violence in a variety of ways (for instance medical help, psychosocial support, and shelter). Prevention initiatives look at how GBV can be prevented from happening. Response services can in turn contribute towards preventing violence from occurring or reoccurring.

Responses are important. Major strides are being made internationally on how to best respond and provide services for survivors of violence. WHO guidelines describe an appropriate health sector response to VAW – including providing post-rape care and training health professionals to provide these services [32].

WHO does not recommend routine case identification (or screening) in health services for VAW exposure, but stresses the importance of mental health services for victims of trauma.

Need to address underlying causes

Much of our effort in South Africa has been focused on response. However – our response efforts need to be supported and complemented by prevention programming and policy development. By addressing the underlying, interlinked causes of GBV, we can work towards preventing it from happening in the first place.

Violence prevention policies and programmes should be informed by the best evidence we have available. Programmes that are evidence based are [35]:

  • built on what has been done before and has been found to be effective;
  • informed by a theoretical model;
  • guided by formative research and successful pilots; and
  • multi-faceted and address several causal factors.

Several GBV prevention programmes which have support for effectiveness have been implemented in South Africa. A summary of the prevention programmes mentioned below can be found in the South African Crime Quarterly 51: Primary prevention (see table on pgs. 35-38):

  • Thula Sana: Promote mothers’ engagement in sensitive, responsive interactions with their infants
  • The Sinovuyo Caring Families Programme: Improve the parent–child relationship, emotional regulation, and positive behaviour management approaches
  • Prepare: Reduce sexual risk behaviour and intimate partner violence, which contribute to the spread of sexually transmitted diseases (STIs)
  • Skhokho Supporting Success: Prevent IPV among young teenagers
  • Stepping Stones: Promote sexual health, improve psychological wellbeing and prevent HIV
  • Stepping Stones / Creating Futures: Reduce HIV risk behaviour and victimisation and perpetration of different forms of IPV and strengthen livelihoods
  • IMAGE (Intervention with Microfinance for AIDS and Gender Equity): Improve household economic wellbeing, social capital and empowerment and thus reduce vulnerability to IPV and HIV infection

Importance to develop evidence base

At the same time, it is important to develop the evidence base further by exploring a range of other interventions that have the potential to be effective in a South African context. Many actors, including government, civil society and funders, as well as community members, are working in creative and innovative ways every day to address GBV.

For example, several civil society organisations are working with women’s groups to build their agency and empower them to address the issues that impact their lives, such as structural and interpersonal violence. Others are tackling specific drivers of GBV, such as substance abuse and gangsterism. Still others take a “whole community” approach to dealing with GBV, involving community members and leaders in the fight against violence in their communities.

Many of these interventions have not yet been formally documented, but they are nevertheless promising models which play an important role in the overall fight against GBV.

While South Africa has high levels of GBV, we are also a leader in the field of prevention interventions in low and middle income countries [36].

We are identifying models which work to respond to and prevent violence, and we can work on scaling those up to reach more people. At the same time, as a society, we can work together to find new ways to address GBV, building the current evidence base and responding to this national crisis.

References

[1] Bloom, Shelah S. 2008. “Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators.” Carolina Population Center, MEASURE Evaluation, Chapel Hill, North Carolina. https://www.measureevaluation.org/resources/publications/ms-08-30

[2] Sultana, Abeda, Patriarchy and Women’s Subordination: A Theoretical Analysis, The Arts Faculty Journal, July 2010-June 2011 http://www.bdresearch.org/home/attachments/article/nArt/A5_12929-47213-1-PB.pdf

[3] World Health Organisation, 2005, WHO multi-country study on women’s health and domestic violence against women. REPORT – Initial results on prevalence, health outcomes and women’s responses http://www.who.int/reproductivehealth/publications/violence/24159358X/en/

[4] Decker MR et al., Gender-based violence against adolescent and young adult women in low- and middle-income countries, The Journal of Adolescent Health, 2015. 56(2): p. 188-96.

[5] 1 Garcia-Moreno, C., Responding to intimate partner violence and sexual violence against women. WHO clinical and policy guidelines – what’s new?, in SVRI Forum 2013: Evidence into Action, 14 – 17 October 2013. 2013, Sexual Violence Research Initiative: Bangkok, Thailand.

[6] 2 Jewkes, R., P. Sen, and C. Garcia-Moreno, Sexual Violence in World Report on Violence and Health, E. Krug, et al., Editors. 2002, World Health Organization: Geneva.

[7] 3 Dartnall, E. and R. Jewkes, Sexual Violence against Women: The scope of the problem. Best Practice & Research Clinical Obstetrics & Gynaecology, 2012. Special Issue.

[8] 4 Abrahams, N., et al., Intimate Partner Femicide in South Africa in 1999 and 2009. PLoS medicine, 2013. 10(4).

[9] 5 Jewkes, R., J. Levin, and L. Penn-Kekana, Risk factors for domestic violence: findings from a South African cross-sectional study. Social science & medicine, 2002. 55(9): p. 1603-17.

[10] 6 Machisa, M., et al., The War at Home. 2011, Genderlinks, and Gender and Health Research Unit, South African Medical Research Council (MRC) Johannesburg.

[11] 7 Dunkle, K.L., et al., Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. American journal of epidemiology, 2004. 160(3): p. 230-9.

[12] 8 Jewkes, R., et al., Understanding Men’s Health and Use of Violence: Interface of rape and HIV in South Africa. 2009.

[13] 9 Jewkes, R., et al., Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study. PloS One, 2011. 6(12).

[14] 10 Jewkes, R., Streamlining: understanding gang rape in South Africa. 2012: Forensic Psychological Services, Middlesex University.

[15] 11 Jewkes, R., et al., Why, when and how men rape? Understanding rape perpetration in South Africa. South African Crime Quarterly, 2010. 34(December).

[16] Sandfort, TGM, et al, Forced sexual experiences as risk factor for self-reported HIV Infection among Southern African lesbian and bisexual women, PLoS ONE, 8:1, 2013.

[17] Dunkle, K, et al, Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: a population-based cross-sectional study, PLoS Medicine, 10:6, 2013.

[18] Jewkes, R, Intimate partner violence: causes and prevention. Lancet, 2002. 359: 1423–29.

[19] Cornelius R., T. Shahrokh and E. Mills. Coming Together to End Gender Violence: Report of Deliberative Engagements with Stakeholders on the Issue of Collective Action to Address Sexual and Gender-based Violence, and the Role of Men and Boys. Evidence Report, 2014. 12 (February), Institute of Development Studies.

[20] 12 Jewkes, R., et al. Preventing Rape and Violence in South Africa: Call for Leadership in A New Agenda For Action. MRC Policy Brief, 2009.

[21] Muller R, Gahan L & Brooks L (2014). Too costly to ignore – the economic impact of gender-based violence in South Africa. Available online. Accessed 16 July 2015.

[22] Moolman, B. Human Sciences Research Council (HRSC) (2016). Research Report on the Status of Gender-based Violence Civil Society Funding in South Africa.

[23] Van Dorn, R., J. Volavka, and N. Johnson, Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol, 2012. Mar(47(3)): p. 487-503.

[24] Eckenrode, J., M. Laird, and D. J., School performance and disciplinary problems among abused and neglected children. Dev Psychol., 1993. 29: p. 53-62.

[25] Anda, R.F. and V.J. Felliti, The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare., in The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease., L.R.a.V. E, Editor. 2009, Cambridge University Press: Cambridge.

[26] Anda RF, et al., The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry Clin Neurosci, 2006. 256: p. 174-186.

[27] Westad, C. and D. McConnell, Child welfare involvement of mothers with mental health issues. . Community Mental Health Journal, 2012. 48: p. 29-37.

[28] Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade: Phase II; , A.C. Petersen, J. Joseph, and M. Feit, Editors. 2014 Board on Children, Youth, and Families; Committee on Law and Justice; Institute of Medicine; National Research Council: Washington (DC).

[29] Messman-Moore, T.L. and P.J. Long, The role of childhood sexual abuse sequelae in the sexual revictimization of women. Clinical psychology review, 2003. 23(4): p. 537-571.

[30] Millett, L.S., et al., Child maltreatment victimization and subsequent perpetration of young adult intimate partner violence: an exploration of mediating factors. Child Maltreat. , 2013. 18(2)(May): p. 71-84.

[31] Jewkes, R., Rape Perpetration: A review. 2012, Sexual Violence Research Initiative, hosted by the South African Medical Research Council: Pretoria.

[32] WHO, Responding to intimate partner and sexual violence against women: WHO clinical and policy guidelines., D.o.R.H.a. Research, Editor. 2013, World Health Organisation: Geneva.

[33] Jewkes, R., et al., Prospective study of rape perpetration by young South African men: incidence & risk factors for rape perpetration. PLoS ONE, 2012. 7(5): p. e38210.

[34] Jewkes, R., Intimate partner violence: causes and prevention. Lancet, 2002. 359(9315): p. 1423-9.

[35] Dartnall, E. and A. Gevers, Editorial. South African Crime Quarterly, 2015. In press.

[36] Shai NJ and Y. Sikweyiya, Programmes for change: Addressing sexual and intimate partner violence in South Africa. South African Crime Quarterly, 2015. 51(March).


18/May/2024

Violence against women and children

Government hosts an on-going campaign to voice our anger against violence against women and children. We have to find ways of making our homes and communities safe for all, especially for women and children.

Violence against women takes many forms – physical, sexual, economic, psychological – but all of these represent a violation of human dignity and human rights and have lasting consequences both for women themselves and for their communities.

Research shows that domestic violence against women remains widespread and under-reported, and that victims of violence are not effectively supported by public services. Insufficient specialised services for women and children who are victims of violence and the absence of professional services to victims is only a few of the reasons for non-reporting.

Measures in place to help women and children to fight abuse.

  • The Department of Social Development has established the Gender-based Violence Command Centre with a toll free number 0800 428 428 and ‘a please call me’ number *120*7867#.
  • The Department of Justice and Constitutional Development has established 11 Sexual Offences Court in 2016/17.
  • Eight Khuseleka One Stop Centres offer a continuum of support services to victims of crime as a single service point.
  • The Department of Social Development is funding 102 shelters for victims of gender-based violence and has also established 19 White Doors (safe houses) to provide safety and shelter services to mostly victims of domestic violence.
  • Thuthuzela care centres(link is external) are one-stop centres which enable rape victims to lodge a case with the police and receive counselling and medical care. They are located in various areas in the country marred by high incidence of violence against women and children.
  • By 31 March 2016, the South African Police Service has established 1 027 victim-friendly rooms (VFRs) at certain police stations. The VFRs are private rooms where victims of gender-based violence are interviewed for statement taking. They provide a friendly environment that assures confidentiality, respect and dignity.
  • The Department of Justice and Constitutional Development  has developed a My Safety Plan [PDF] to assist victims of domestic violence to escape unharmed from violent attacks and reach for the much needed social and economic support. The Safety Plan programme is being rolled out in rural communities through the Ndabezitha Programme, and with the assistance of the senior traditional leaders and their wives.

Source: Deputy Minister John Jeffery: Launch of Thembalethu Sexual Offences Court

  • The Domestic Violence Act, 1998 was enacted to give survivors of violence maximum protection from domestic abuse. Women, who are mostly at the receiving end of domestic violence, now have a legal recourse that will ensure their protection.
  • Government has established the National Council Against Gender Based Violence (NCAGBV) to provide strategic leadership, coordination and management of gender-based violence initiatives in South Africa. The Council is chaired by the Deputy President and championed by the Minister of Women.
  • Furthermore, Government has in place legislative provisions that specifically address violence and abuse of women and children.
    • The Children’s Act, 2005 and Children’s Amendment Act, 2007 were enacted to, among other things, protect a child from maltreatment, neglect, abuse or degradation.
    • The Women Empowerment and Gender Equality Bill will bring about the realisation of women empowerment in all spheres of our society by enforcing compliance in both government and the private sector.
  • The National Action Plan commits the country to a sustained long-term commitment to ensure that the dynamism of changing norms and attitudes is addressed.
  • Government is working on holistic and comprehensive approach that is multi-sectoral in its drive to achieve women empowerment and gender equality.
  • We will continue to involve men and boys as campaigners and survivors who prove that the cycle of violence can be broken.
  • Prevention and Combating of Trafficking in Persons seeks to prevent trafficking and also fights practices such as Ukuthwala a form of abduction that involves kidnapping a girl or a young woman by a man and his friends or peers with the intention of compelling the girl or young woman’s family to agree into marriage.

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KEY ISSUES

18/May/2024

                                                                                                                                                                                       17 September is World Patient Safety Day

World Patient Safety Day calls for global solidarity and concerted action by all countries and international partners to improve patient safety.

The Day brings together patients, families, caregivers, communities, health workers, health care leaders and policy-makers to show their commitment to patient safety.

The resolution WHA 72.6 ‘Global action on patient safety’ recognizes patient safety as a global health priority and endorses the establishment of World Patient Safety Day to be observed annually on 17 September.


18/May/2024

What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood. It is sometimes referred to as Attention Deficit Disorder (ADD). It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviours (may act without thinking about what the result will be), or be overly active.

What are some of the signs of ADHD?
Many children have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviours. The symptoms continue and can cause difficulty at school, at home, or with friends.

A child with ADHD might:
• daydream a lot
• forget or lose things
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, other caregivers, and sometimes, the child.

What can I do if I think my child may have ADHD?
Talk with your child’s doctor or nurse. If you or your doctor has concerns about ADHD, you can take your child to a specialist
such as a child psychologist or developmental paediatrician, or you can contact your local early intervention agency (for children under age 3 years) or public school (for children 3 years and older). To make sure your child reaches their full potential, it is very important to get help for ADHD as early as possible.


18/May/2024

Hepatitis A, B, C, D, E Nursing Symptoms, Treatment, Causes, NCLEX

https://www.youtube.com/watch?v=UU9s4hb15g4

Hepatitis A, B, C, D, E nursing review for nursing school and NCLEX. Learn the causes, symptoms, treatment, and vaccine options for viral hepatitis.

This lecture will cover viral hepatitis (A, B, C, D, E) for nursing lecture exams. After watching this video, you will be familiar with the differences and similarities between all these 5 types of viral hepatitis, treatment, nursing interventions, and symptoms.

Hepatitis is a condition that presents with liver inflammation. Hepatitis can occur due to over usage of drugs or medications, excessive alcohol usage, or (most common) a viral attack.

The liver is an amazing organ that protects, filters, breaks substances, plays a role in clotting, and produces of bile etc.

-Hepatitis A: transmitted fecal-oral in contaminated food or water, vaccine is available, anti-HAV IgM or IgG to diagnose, post-exposure: immune globulin (2 weeks after exposure), acute only

-Hepatitis B: transmitted via blood and body fluids…most commonly sexual intercourse and IV drug use, HBsAg (infectious) and anti-HAV (immune), vaccine available, acute and chronic

-Hepatitis C: transmitted via blood and body fluids…most commonly IV drug use, NO vaccine available, acute and chronic

-Hepatitis D: transmitted via blood and body fluids, only occurs in the person has Hepatitis B, NO vaccine available but advantageous for the person to receive Hepatitis B vaccine, acute and chronic

-Hepatitis E: transmitted fecal-oral in contaminated food or water, NO vaccine is available, complications for pregnant women in, the 3rd trimester, mainly in developing countries, acute only


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