Physical and sexual intimate partner violence (IPV) and forced-sex or sexual acts by non-partners (NP-rape) are common in South Africa. Access to effective medical services for survivors, such as post exposure prophylaxis (PEP) for HIV prevention and sexually transmitted infections (STIs), counseling and social services is often severely limited by individual (e.g. awareness) and service-level factors (e.g. location), leaving health consequences of rape and IPV largely unaddressed. Rustenburg Municipality (RM) is South Africa’s platinum mining capital and one of Africa’s fastest growing cities, with a population of 301,795 men and 247,780 women living in informal settlements near the mines. We quantified the prevalence of IPV and NP-rape in this setting, and estimated the associated disease burden. By considering this alongside levels of access to services, we describe the extent to which opportunities to address this disease burden are realized.
Cluster-randomized household survey of women 18-49 years living in RM conducted (Nov– Dec, 2015) to determine the prevalence of IPV and NP-rape. We used WHO estimates of disease risk to determine population attributable fractions (PAF) and applied the PAFs to the population distribution (2011 Statistics SA Census) and local disease prevalence estimates obtained through literature review to determine burden of disease.
Eighty-five percent (n=882) of eligible women participated. Lifetime prevalence of IPV was 45% – >82000 women. Lifetime prevalence of NP-rape was 18% – >28000 women and girls. Very few sought care – 5% told a health care professional about their experiences, 4% a counselor, and 3% a social worker. Of the estimated 35,680 women in RM living with HIV, 6765 cases can be attributed to IPV (19%; Table 1). The burden of IPV on induced abortion is 1296. IPV resulted in 5022 major depression disorder (MDD) cases and 2 suicides. An additional 2012 MDD cases are attributed to NP-rape.
IPV and NP-rape were extremely common among women and girls living in RM, contributing to a large disease burden, including 1/5 of HIV prevalence and more than 1/3 of major depressive disorders. Much of this disease burden could be prevented, through improved access to quality medical services including PEP for HIV and STI prevention, counseling and social services. Current low levels of access mean that this is not achieved, leaving major opportunities for improved health of this very vulnerable population unrealized.