Lorna J. Martin

Mortality of Women From Intimate Partner Violence in South Africa: A National Epidemiological Study

The purpose of this article is to describe mortality of women from intimate partner violence (IPV) in South Africa using a retrospective national study in a proportionate random sample of 25 mortuaries. Homicides identified from mortuary, autopsy, and police records. There were 3,797 female homicides, of which 50.3% were from IPV. The mortality rate from IPV was 8.8 per 100,000 women. Mortality from IPV were elevated among those 14 to 44 years and women of color. Blunt force injuries were more common, while strangulation or asphyxiation were less common. The national IPV mortality rate was more than twice that found in the United States. The study highlights the value of collecting reliable data across the globe to develop interventions for advocacy of which gender equity is critical.

Rape and HIV Post-Exposure Prophylaxis: Addressing the Dual Epidemics in South Africa

Abstract In South Africa, a country notable for both a rapidly escalating AIDS epidemic and high levels of sexual violence, the issue of HIV post-exposure prophylaxis (PEP) following rape has recently come to the fore, and a policy supporting provision of PEP has been approved by the national government. This paper compares the conditions for providing PEP in Europe and North America with the conditions faced by two initiatives in South Africa, one serving a primarily rural base, and one urban. It is based on a review of the literature on sexual violence in South Africa and use of PEP following occupational and non-occupational exposure. It incorporates perspectives from in-depth interviews in 2000 with 18 key informants, including survivors of sexual violence, gender and HIV activists, domestic violence NGOs, rape crisis centres, physicians, lawyers, researchers and HIV/AIDS advisors in the Department of Health. The paper argues that given the scientific evidence for PEP, and the nature of the dual epidemics of HIV and sexual violence in South Africa, the public health and social justice rationale for implementing PEP equals and indeed exceeds that put forward in industrialised countries. However, delays in accessing PEP caused by the public justice system and lack of training for service providers constitute significant obstacles to effective implementation. In this respect, provision of PEP presents an opportunity to reform and strengthen existing services for post-rape care and to link attention to the epidemic of sexual violence to HIV/AIDS prevention.

Intimate femicide-suicide in South Africa: a cross-sectional study

OBJECTIVE To examine the incidence and patterns of intimate femicide-suicide in South Africa and to describe the factors associated with an increase in the risk of suicide after intimate femicide (i.e. the killing of an intimate female partner). METHODS A cross-sectional retrospective national mortuary-based study was conducted at a proportionate random sample of 25 legal laboratories to identify all homicides committed in 1999 of women aged over 13 years. Data were collected from the mortuary file, autopsy report and a police interview. FINDINGS Among 1349 perpetrators of intimate femicide,19.4% committed suicide within a week of the murder. Suicide after intimate femicide was more likely if the perpetrator was from a white rather than an African racial background (odds ratio, OR: 5.8; 95% confidence interval, CI: 1.21-27.84); was employed as a professional or white-collar worker rather than a blue-collar worker (OR: 37.28; 95% CI: 5.82-238.93); and owned a legal gun rather than not owning a legal gun (OR: 45.26; 95% CI: 8.33-245.8). The attributable fraction shows that 91.5% of the deaths of legal gun-owning perpetrators and their victims may have been averted if this group of perpetrators did not own a legal gun. CONCLUSION South Africa has a rate of intimate femicide-suicide that exceeds reported rates for other countries. This study highlights the public health impact of legal gun ownership in cases of intimate femicide-suicide.

Intimate Partner Femicide in South Africa in 1999 and 2009

Naeemah Abrahams and colleagues compare the incidence of female homicide in women aged over 14 years in South Africa in 1999 and 2009 and analyze the fatal violent attacks perpetrated by intimate partners.

The virgin cleansing myth: cases of child rape are not exotic.

This letter to the editor disputes the suggestion that the myth of having sex with a virgin will cure an HIV-1 infected man is an important cause of child rape. There is no evidence overall that infant rapes are increasing in South Africa nor that rape perpetrators know that they have HIV-1 infection. Perhaps the perception of a rising rate may be related to the media giving a few cases prominence. The root of the problem of infant rape should be seen as part of the spectrum of sexual violence against women and girls. Thus community definitions of rape need to be reframed so that all acts of coercive sex are viewed as rape irrespective of the circumstances and develop an environment in which men are deterred from rape through threat of punishment.

The epidemiology of child homicides in South Africa.

OBJECTIVE To describe age- and sex-specific rates of child homicide in South Africa. METHODS A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500-1499 or > 1499 annual autopsies. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Cause of death, evidence of abuse and neglect or of sexual assault, perpetrator characteristics and circumstances surrounding the death were investigated. FINDINGS An estimated 1018 (95% confidence interval, CI: 843-1187) child homicides occurred in 2009, for a rate of 5.5 (95% CI: 4.6-6.4) homicides per 100 000 children younger than 18 years. The homicide rate was much higher in boys (6.9 per 100 000; 95% CI: 5.6-8.3) than in girls (3.9 per 100 000; 95% CI: 3.2-4.7). Child abuse and neglect had preceded nearly half (44.5%) of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys (21.7 per 100 000; 95% CI: 14.2-29.2) was nearly five times higher than the homicide rate among girls (4.6 per 100 000; 95% CI: 2.4-6.8). CONCLUSION South Africas child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, improvement of parenting skills should be part of primary prevention efforts.

Rape Surveillance through District Surgeon Offices in Johannesburg, 1996–1998: Findings, Evaluation and Prevention Implications

Rape prevention efforts are hampered by a chronic lack of adequate epidemiological and surveillance data. Information on identifying factors such as the who, when, where and how of rape is needed to inform the design of effective intervention programmes. Results from a demonstration Rape Surveillance Project show that records of rape cases presenting at three medico-legal clinics provide a valuable source for the epidemiological surveillance of rape. From January 1996 to December 1998 a surveillance questionnaire was completed for rape victims presenting at the Hillbrow, Lenasia South, and Chris Hani Baragwanath Medico-Legal Clinics in Gauteng. Analysis of the data suggests which women are most at risk for being raped, by whom they are raped, the areas where attacks most often occur, and the day and time when rapes are mostly committed. Despite the limited database and difficulties with generalizing findings beyond the three clinics, it is apparent that surveillance procedures have enormous import for sexual violence prevention and intervention. Implications for prevention strategies, aftercare, policy formulation, and future research are discussed. Methodological issues and institutional constraints are also discussed with a view to strengthening and developing such information management systems.

Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations.

Abstract Objective To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. Methods We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death. Findings Postmortem reports revealed 52 493 injury-related deaths in 2009 (95% confidence interval, CI: 46 930–58 057). Almost half (25 499) were intentionally inflicted. Age-standardized mortality rates per 100 000 population were as follows: all injuries: 109.0 (95% CI: 97.1–121.0); homicide 38.4 (95% CI: 33.8–43.0; suicide 13.4 (95% CI: 11.6–15.2) and road-traffic injury 36.1 (95% CI: 30.9–41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher. Conclusion This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.

Injury patterns of female homicide victims in South Africa.

BACKGROUND Injury patterns and interpretation of injuries in homicidal deaths are important components of medicolegal autopsies. The objective of this article is to describe the incidence of female homicides and their related injury patterns with reference to autopsy practices in South Africa. METHODS A national retrospective mortuary-based study of homicides in women of 14 years and older in 1999 was conducted. Data were gathered from medical legal laboratory records, autopsy reports, and police interviews from a stratified multistage sample of 25 mortuaries. RESULTS The most common cause of homicide was a gunshot wound injury, with a firearm mortality rate of 7.5/100,000 women, 14 years and older, in 1999, followed by sharp force injury (6.8/100,000) and blunt force injury (6.1/100,000). Gunshot victims were more likely to be African, and those killed by sharp force injury were more likely colored. Significantly, blunt force injury deaths occurred predominantly in intimate partner homicides. A full autopsy was performed only in 70% of cases. An assessment of postmortem reports revealed poor descriptions of the anatomic location of injuries and the specifications of wound dimensions. CONCLUSIONS South Africa has a high female homicide rate that exceeds reported rates with the cause of homicide varying by social group. Assessment of injury description suggests weaknesses in the documentation of injuries at autopsy. This weakens the forensic investigation and undermines the strength of evidence presented in court. Further measures are needed to strengthen forensic pathology services in South Africa.

Perpetration of violence against intimate partners: health care implications from global data

Intimate partner violence is a widespread global phenomenon engendering serious health problems for women and children.[1][1]–[3][2] Consequently, there have been many recommendations to identify and intervene with victims in the health care system. Although evidence of the efficacy of