Presentation to Portfolio Committee on Women, Children and People with Disabilities 31 October 12

1. Presentation to Portfolio Committee on Women, Children and People with Disabilities31 October 12 Drugs and violence against women and children: Some findings of MRC research & implications for policy Prof Rachel Jewkes Prof Charles Parry Prof Naeema AbrahamsDr Andreas Plüddemann

2. Problem of drug use in South Africa • Drug use is widespread, with some differences by province • For example, in population- based research among adult men 18-49 years: • 38% had used dagga in the past year in three districts of KwaZulu Natal and the Eastern Cape • 17% in a similar sample of men from Gauteng • Drug use commonly starts in childhood: • 41% of users in KZN & E Cape started before 17 (10% before age 12) • 38% of users in Gauteng started before age 17 ( 8% before age 12) • 8% of male learners (3% of female) in the 2008 National Youth Risk Behaviour Survey reported dagga use before age 13 • There are no national statistics on the general population prevalence of drug use

3. Life-time self-reported drug use: 2008 National Youth Risk Behaviour Survey (Grades 8-11 learners) 3

4. Treatment demand data based on data from 8291 patients in 9 provinces (primary+secondary drugs): 2011b 4

5. Rape reported to the police • Rate of rape and attempted rape among women and girls: • Modest decline : • From 227 per 100 000 in 2000 to 219 per 100 000 in 2010/11 • Rape homicide: • Significant increase in rape and murder from 1999 to 2009 • From 1.1 per 100 000 population to 1.2 per 100 000 (p=0.001) • Notably in 2009, 25% of girl child homicides involved rape

6. Understanding the rape drug linkage • Research on men and rape perpetration consistently shows that men who use drugs are much more likely to rape • Among men in the population in KZN and E.Cape after adjusting for other risk factors, drug using men were 50% more likely to have raped • Research with young men in the Eastern Cape aged 15-26 years shows a quarter of rape would have been prevented in the absence of drug use

8. Critical question: how are rape and drug use linked? • Research suggests that there may be pharmacological links • Inhibition reduction • Enhanced sexual drive • Social connections are incredibly important too • Women and girls using drugs are at increased risk of rape

9. Five groups of amenable risk factors: Adverse childhood exposures attachment and personality disorders social learning and delinquency gender inequitable masculinities substance abuse and firearms Genetic factors may be important but are not amenable Risk factors for rape perpetration

10. Evidence supports the importance of child sexual abuse victimisation and exposure to parental IPV as risk factors Physical or emotional abuse and out of home placements are not risk factors Poverty has no direct relationship but gangs are a feature of impoverished areas Sexual entitlement may stem from expectations of power and social advantage (e.g. South Africans with more education mothers) Adverse childhood exposures

11. Attachment and personality disorders • Evidence links rape and personality factors, rather than mental illness • Personality disorders including psychopathic traits are risk factors for child sex abuse • Insecure attachment in early childhood leads to relationship difficulties in adulthood including aggression, hostility (esp. towards women) and search for intimacy in maladaptive ways

12. Social learning and delinquency • Social learning of the acceptability of sexual violence in sub-cultural contexts • Perceived peer approval is important in youth sexual aggression • Parents of perpetrators are more likely to be supportive of gang membership than those of non-perps. • Anti-social behaviour and gang membership are important risk factors for rape perpetration

13. Gender inequitable masculinities • All rape is a gendered behaviour • Overwhelmingly perpetrated by men • Gender inequitable attitudes, perpetration of physical intimate partner violence, ideas of sexual entitlement and ideals of masculinity linked to emphasised performance of heterosexuality (multiple partners, transactional sex, early sexual initiation) are all risk factors

14. Substance abuse and firearms • Alcohol and drug abuse reduce inhibitions and can heighten aggression and anger • In sub-cultural contexts may be associated with elevated ideas of male sexual entitlement • Drug use is probably mostly linked through a sub-cultural disregard for law etc. that is associated with propensity to rape

15. Reducing drug related violence: Selected interventions for consideration Babor et al., 2009 • Prevent use by youth: • Specific family based & classroom management programmes • Treatment and harm minimisation: • Services for opiate dependent individuals have the strongest supporting evidence (also effective ways to reduce drug-related crime + spread of HIV infection) • Some harm reduction programmes, such as needle exchange programmes, reduce high risk injection practices and engage IDUs in treatment and health services • Supply reduction • Regulatory controls of pharmaceutical products • Precursor chemical controls • Interdiction • But once a drug is illegal, there is a point beyond which increases in enforcement and incarceration yield little added benefit

16. Preventing drug related violence through addressing the social context • Need to develop comprehensive intervention strategies across the life span, with • Strengthening of attachment and parenting, reducing childhood trauma exposure • Interventions for (especially male) youth to get them into gainful recreation when not in school • Interventions to keep male youth in school • Interventions to build more gender equitable and less violent masculinities and reduce the level of social acceptance and tolerance for violence • Interventions to enhance mental health services, including rehabilitation for substance abuse and much more accessible treatment for mental health problems, including PTSD and depression • We need to ensure our prevention programmes are evidence-based and theoretically grounded