Lillian Artz

Violence, violence prevention, and safety: A research agenda for South Africa

Violence is a serious problem in South Africa with many effects on health services; it presents complex research problems and requires interdisciplinary collaboration. Two key meta-questions emerge: (i) violence must be understood better to develop effective interventions; and (ii) intervention research (evaluating interventions, assessing efficacy and effectiveness, how best to scale up interventions in resource-poor settings) is necessary. A research agenda to address violence is proposed.

Behind the screens: Domestic violence and health care practices

abstract Domestic violence (DV) is one of the most pervasive forms of violence in South Africa with numerous physical and psychological consequences that have severe and enduring impacts on health. This takes a significant toll on women, their families and the health care system. Local and international literature suggests that DV is one of the most common reasons for women to present at health care facilities, placing health care practitioners in a unique position to identify abuse and intervene. As widespread as it is, DV is not a specifically prioritised public health concern and thus suffers from vastly inadequate resource allocation. The Domestic Violence Act, No 116 of 1998, was the first and only South African legislative attempt to recognise DV victims’ rights to seek immediate medical assistance. It did not, however, impose any positive legal duties on health care practitioners to inquire about, screen for or holistically treat DV-related injuries and other health-related consequences of DV or make referrals. The Act only implies that health care practitioners have a duty to attend to DV cases. International codes delineate duties for health care practitioners in providing care for women in abusive relationships, and South Africa has detailed medico-legal protocols for the examination and treatment of survivors of sexual offences. It is therefore curious that a similar treatment protocol does not exist for DV. This Article reviews the literature on the health consequences of DV and the need for screening, and recounts the historical attempts of civil society in South Africa to impose legal duties on the state to assist DV victims who present to health care facilities. We argue that it is time that Parliament review the provisions of the Domestic Violence Act to include legal duties on health care practitioners to properly address the health consequences of DV.

Shelter in the southern Cape: gender violence undermines development

Few, if any, women in rural communities of the southern Cape, own a house or have any form of financial security due to economic and physical abuse. A cycle of poverty and violence has the potential to render benefits of land policy reform meaningless, writes LILLIAN ARTZ

Sexual disorders in DSM-5 and ICD-11: a conceptual framework.

Purpose of review The nature and classification of sexual disorders has been a focus during work on the development of DSM-5 and ICD-11. This article proposes different conceptual approaches to the sexual disorders, including classical, critical and integrative positions. Disorders associated with sexual orientation, gender dysphoria/incongruence and paraphilias/paraphilic disorders are discussed from each of these positions. Recent findings A range of conventional and nonconventional consensual sexual behaviours are prevalent but not necessarily indicative of a mental disorder; there is little diagnostic validity or clinical utility for including these in the nosology. When such behaviours are clinically excessive and associated with distress or impairment, however, a disorder may be present. Debate surrounds the medicalization of some sexual behaviours that are criminal in nature. Summary The classification of sexual behaviour as disordered is necessarily theory-dependent and value-laden. Nevertheless, reasoned debate about the relevant data and values is possible, and will hopefully further improve the diagnostic validity and clinical utility of psychiatric nosology.

Finding solid ground: law enforcement, key populations and their health and rights in South Africa

Sex workers, people who use drugs, men who have sex with men, women who have sex with women and transgender people in South Africa frequently experience high levels of stigma, abuse and discrimination. Evidence suggests that such abuse is sometimes committed by police officers, meaning that those charged with protection are perpetrators. This reinforces cycles of violence, increases the risk of HIV infection, undermines HIV prevention and treatment interventions and violates the constitutional prescriptions that the police are mandated to protect. This paper explores how relationship building can create positive outcomes while taking into account the challenges associated with reforming police strategies in relation to key populations, and vice versa.

‘Porn Norms’: A South African feminist conversation about pornography

Earlier this year a discussion entitled ‘‘Porn Talk and Tea’’ was held at the University of Cape Town. The discussion took place as a result of a request made by the Editor of AGENDA, Lou Haysom, for a piece on current debates surrounding pornography in South Africa: one that reflected contemporary feminist conversations on pornography. It had been many years since I had discussed pornography with other feminists, so the opportunity to bring different ‘generations’ of feminists together to discuss it was enthusiastically supported. The talk was widely advertised, but we had our doubts about whether the subject of pornography would manifest an audience. Pornography has scarcely been on political or feminist agendas since the mid-1990s, or at least debated in the same depth as other dimensions of women’s sexuality in South Africa have been. We invited anyone who considered themselves ‘feminist’ however that is defined and who felt they had an opinion to share on pornography. It did not matter whether they were proponents of Robin Morgan’s (1978) dictum ‘‘pornography is the theory, rape is the practice’’ (see Morgan, 1980) or ‘‘feminist(s) [in] defense of pornography’’ (see Wendy McElroy, 1995), or somewhere in between, uncertain and vacillating. Here, amongst scholars, activists, researchers, service providers, doctors and individuals simply interested in the topic, we discussed porn. The basis of the discussion was deceptively simple: When is pornography harmful (if at all)?

Feminism vs. the State?: A Decade of Sexual Offences Law Reform in South Africa

abstract South Africas transition to a democratic state has been accompanied by an intensive focus on the use of the law as an instrument to address high levels of sexual assault as well as other social problems. Feminist legal scholars and activists have been involved in an ongoing critical engagement with government policy and law reform surrounding equality. Many leading feminists have questioned the extent to which the law can ever effectively deter violence against women. Others argue that feminist activists in a transitional democracy are provided with both the space to advocate for substantive law reforms, as well as the opportunity to ensure that the human rights set out in the Constitution are entrenched and interpreted in a way that consciously furthers the rights of women in this country. This article provides the groundwork for a critical analysis of the strategies adopted over the past 10 years.

Legal duties, professional obligations or notional guidelines? Screening, treatment and referral of domestic violence cases in primary health care settings in South Africa

Background Since 2013, approximately 4400 women have been murdered by their partners in South Africa. This is five times higher than the per capita global average. Domestic violence is known to be cyclical, endemic and frequently involves multiple victims. It also becomes progressively more dangerous over time and may lead to fatalities. In 2012, the Health Professions Council of South Africa released a domestic violence protocol for emergency service providers. This protocol, or screening guidelines, includes assessing future risk to domestic violence, providing physical and psychosocial care, documentation of evidence of abuse and informing patients of their rights and the services available to them. The extent to which these guidelines have been circulated and implemented, particularly by general health care practitioners (HCPs), is unknown. Aim We review international treaties to which South Africa is a signatory, as well as national legislation and policies that reinforce the right to care for victims of domestic violence, to delineate the implication of these laws and policies for HCPs. Method We reviewed literature and analysed national and international legislation and policies. Results The ‘norms’ contained in existing guidelines and currently practiced in an ad hoc manner are not only compatible with existing statutory duties of HCPs but are in fact a natural extension of them. Conclusion Proactive interventions such as the use of guidelines for working with victims of domestic violence enable suspected cases of domestic violence to be systematically identified, appropriately managed, properly referred, and should be adopted by all South African HCPs.

Re-Entry Problems: The Post-Prison Challenges and Experiences of Former Political Prisoners in South Africa and Northern Ireland

Re-entry into society after imprisonment is problematic. However, politically motivated prisoners can potentially draw on their collective solidarity and social legitimacy to smooth re-entry. That possibility is examined by focusing on ex-combatants in South Africa and Northern Ireland who organised against the state, but later came to support conflict transformation in a radically altered state. Re-entry was thus a two-way process where ex-prisoners took up opportunities for inclusion while society worked to ensure their inclusion, thus allowing them to manage the problems of re-entry. The evidence is explored to show that this process was more successful in Northern Ireland than in South Africa.

Money matters: structural problems with implementing the DVA

abstract The Domestic Violence Act has been in operation in South Africa for over five years. Studies conducted during this time throw into stark contrast the divergence between well-intended legislative interventions, systemic implementation problems, and the complex social relationships into which this Act seeks to intrude. In this article we focus on two interrelated issues that arise out of this context: economic abuse and the withdrawal of criminal and civil domestic violence related matters by victims of domestic violence. The article focuses its analysis on the impact of womens structured dependency and adverse socio-economic contexts in precipitating economic abuse and the decisions of domestic violence victims to withdraw cases.