Domestic Violence, Health and HIV - Tshwaranang Legal Advocacy ...

Domestic Violence, Health and HIV
A review on progress made in addressing
domestic violence through the HIV & AIDS
and STI National Strategic Plan 2007-2011
Policy Brief # 3 | February 2009
Anneke Meerkotter
Definition of
‘domestic violence’
The Domestic Violence Act 116
of 1998 defines ‘domestic
violence’ as any controlling or
abusive behaviour by a partner
which harms, or may cause
imminent harm to the safety,
health or wellbeing of a person
with whom the abuser is in a
domestic relationship.
Domestic violence includes
physical abuse, sexual abuse,
emotional, verbal and psychological
abuse, intimidation,
harassment, stalking,
damage to property, and entry
into a complainant’s residence
without consent.
1. Executive summary
South Africa has a national HIV prevalence rate of approximately
29.4%, 1 which is one of the highest in the world.
The prevalence of the epidemic is particularly high amongst
women between the ages of 20 and 34. Current research
has shown that domestic violence increases women’s risk of
HIV infection. In light of this, it is important to assess the
extent to which health sector responses to HIV and AIDS
acknowledge the role of domestic violence in driving the
epidemic and how these responses address the intersection
of these factors.
This policy brief explores these questions by analysing
the HIV & AIDS and STI National Strategic Plan 2007-2011
(hereafter referred to as the NSP). The policy brief focuses
on the opportunities created by the NSP to develop more
comprehensive health policies which take into account the
specific needs of survivors of domestic violence.
The electronic version of the complete NSP document can be downloaded from
www.info.gov.za/otherdocs/2007/aidsplan2007
Tshwaranang Legal Advocacy Centre
to End Violence Against Women (TLAC)
Johannesburg
Tel: 011-403-8230/4267, Fax: 011-403-4275
Acornhoek
Tel: 013-795-5294, Fax: 013-795-5024
www.tlac.org.za
1

2. The NSP’s response to
domestic violence
While there is currently no formal health policy addressing
domestic violence and its intersection with HIV-infection,
the NSP attempts to address gender-based violence in a
variety of ways. These include:
1. Implementing all national policies and legislation aimed at
improving the status of women;
2. Developing and implementing strategies to address
gender-based violence; and
3. Addressing the needs of women in abusive relationships.
Unfortunately, many health sector interventions on
gender-based violence, including those espoused in the
NSP, focus on providing post-rape care services and do not
specifically address domestic violence. The NSP primarily
addresses gender-based violence through overlapping
interventions in two priority areas: ‘prevention’ and ‘human
rights and access to justice’.
The following two sections discuss the broad strategies in
the NSP to address domestic violence and reviews how they
translate into policy and practice in the health sector.
1. THE DEVELOPMENT AND IMPLEMENTATION
OF STRATEGIES TO ADDRESS GENDER-
BASED VIOLENCE
Objectives outlined in the NSP on strategies to
address gender-based violence
Priority Area 1: Prevention
Goal 1: Reduce vulnerability to HIV infection and
the impact of AIDS
Objective 1.2 Accelerate programmes to empower women
and educate men, and women on human rights in general
and women’s rights in particular
• Implement all national policies and legislation
aimed at improving the status of women
• Develop and implement a communication strategy
including leadership messages to educate
men, women, boys and girls on women’s rights
and human rights
• Roll-out integrated microfinance and gender
education interventions starting in the poorest
and highest HIV burden areas
Objective 1.3 Develop and implement strategies to address
gender-based violence
• Develop communication strategies including
leadership messages which address the unacceptability
of coercive sex, gender power stereotypes
and the stigmatisation of rape survivors.
It seems feasible that the NSP’s focus should be a public
health response to gender-based violence. This would entail
focusing on primary and secondary prevention of genderbased
violence – i.e. to lower the incidence of domestic
violence and sexual violence by addressing the causes and
risk factors that underlie the perpetration of violence and the
victimisation of women in South Africa.
It seems feasible that the NSP’s focus should be a public
health response to gender-based violence. This would
entail focusing on primary prevention of gender-based
violence – i.e. to lower the incidence of domestic violence
and sexual violence by addressing the causes and risk
factors that underlie the perpetration of violence and
the victimisation of women in South Africa.
Criminal justice responses to domestic violence and
sexual violence are better classified as tertiary prevention
strategies because they occur in direct response to an incident
of sexual assault or domestic violence. Such responses are
currently addressed through government initiatives which
do not have a specific HIV focus. Three other multi-sector
framework documents were also launched in 2007 to address
gender-based violence and focus primarily on the criminal
justice system: the 365 Days National Action Plan to End Gender
Violence 2007-2009, the 4 th draft of the Integrated Victim
Empowerment Policy and the National 5 year Implementation
Plan for the Service Charter for Victims of Crime 2007-2011.
A recent World Health Organization expert consultation
identified four steps to a public health sector approach to
primary prevention: 2
1. Define domestic violence and sexual violence and
document its scope and magnitude;
2. Identify factors that increase the risk of domestic violence
and sexual violence or insulate its occurrence;
3. Design implementation strategies based on knowledge
of risk and protective factors that are grounded in social
science theory. Evaluate the impact of the strategy; and
4. Implement proved and promising strategies on a larger
scale, in various settings, continuing to evaluate their
impact.
Some of the NSP strategies to address gender-based
violence have followed the above guidelines:
• Research has shown that microfinance and gender education
interventions (objective 1.2 of the NSP) can lead to a
reduction in intimate partner violence. 3 These strategies
have accordingly been incorporated into the NSP with the
objective to roll-out integrated microfinance and gender
education interventions starting in the poorest and highest
HIV burden areas – Objective 1.2 of the NSP).
• Research indicated that certain communication strategies
which address the unacceptability of coercive sex, gendered
power stereotypes and sexual behaviour could reduce
gender-based violence. 4 Objective 1.3 of the NSP focuses on
the development of communication strategies by a whole
range of government departments to address coercive sex,
the perpetuation of gendered power stereotypes and the
stigmatisation of rape survivors. Since the outcome of such
strategies depend on the quality of content and facilitators,
it is a concern that government departments might not
have the capacity to develop and evaluate programmes that
will address this objective adequately.
Unfortunately, many promising strategies developed in
specific locations by non-governmental organisations will
require significant government commitment and resources
before it is implemented by government on a larger scale.
2

2. PROVISION OF COMPREHENSIVE HEALTH
SERVICES ON GENDER-BASED VIOLENCE
Objectives outlined in the NSP on health services
for survivors of gender-based violence
Priority Area 1: Prevention
Goal 2: Reduce sexual transmission of HIV
Objective 2.3 Increase open discussion of HIV and
sexuality between parents and children
• Increase access to youth friendly health services
in the public sector
Objective 2.5 Increase roll out of prevention programmes
for higher risk populations
• Incremental roll-out of comprehensive
customised HIV prevention package in prisons,
including access to voluntary counselling and
testing (VCT), male condoms, lubricants, STI
symptom recognition, PEP and STI treatment
Objective 2.9 Increase accessibility and availability of
comprehensive sexual assault care including PEP and psychosocial
support
Goal 19: Focus on the human rights of women and
children, including people with disabilities, and
mobilise society to promote gender and sexual
equality and address gender-based violence
Objective 19.2 Ensure implementation of existing laws
and policies that protect women and children from genderbased
violence
Objective 19.3 Address the needs of women in abusive
relationships
• Train VCT and adherence counsellors to identify
barriers that prevent women from accessing HIV
prevention, treatment and care services
The NSP also has a specific secondary prevention focus
in addressing gender-based violence by responding to the
emergency health needs of rape survivors. Primarily, the NSP
focuses on the adequate implementation of existing health
policies.
The Department of Health is the lead agency tasked
with ensuring health services for survivors of gender-based
violence. In January 2005 the Department of Health released
its National Sexual Assault Policy and National Management
Guidelines for Sexual Assault Care. 5 This is a progressive
document which has as one of its objectives “to establish
designated, specialised and accessible 24 hour health care
services for the holistic management of patients to improve
health status after sexual assault.” 6 The NSP calls for the
proper implementation of this policy and its guidelines.
Research conducted in 2003 also noted that, although not
required, many health providers believed that patients should
report sexual assault to the police first before they could prescribe
PEP, for example, in the Free State 83% of providers
indicated they would send the patient to the police first. 7 The
above factor acts as a barrier to women in abusive relationships
who are not willing to open a criminal case of rape.
The ability of a rape survivor to manage the health
consequences of the assault and to take PEP and other
medication might be hampered where the rape survivor is in
an ongoing abusive relationship or subjected to child abuse.
The provision of sexual assault services to rape survivors
therefore provide an important opportunity to screen for
domestic violence. This is not currently required by the
National Sexual Assault Policy and Management Guidelines.
The emphasis of the NSP on the provision of psychological
support to rape survivors (Objective 2.9) is also sadly lacking
in current policy initiatives aimed at rape survivors and,
if included, would help to assist rape survivors in abusive
relationships or who are victims of child abuse.
By focusing only on the health needs of rape survivors,
the NSP misses an opportunity to address the link between
HIV and domestic violence by tackling the health needs of
abused women.
If the intention of the NSP is to provide holistic health
services to assist abused women and children and to
prevent further HIV infection, then it is also imperative
that the implementation of the following NSP objectives
consider gender-based violence:
• Interventions to increase access to sexual and reproductive
health services for the youth (Objectives 2.2 and 2.3) should
recognise domestic violence as a possible element of youth
relationships or as a factor in the family life of youth. The
existing Policy Guidelines for Youth and Adolescent Health,
2001 already states that sexual and reproductive health care
includes addressing domestic violence and sexual violence.
The latter policy suggests various health interventions
relating to violence which should be acted upon:
- Give particular attention to parents/guardians who are
at risk of abusing their infants, for example by ensuring
more frequent clinic visits or home visits both before the
birth and after
- Train health care professionals in the identification,
management and referral of victims, to address physical
and psychological aspects of violence
- Have 24-hour youth-friendly emergency services that have
access to psychological services for adolescents and youth
that are victims and perpetrators of abuse and violence.
• The NSP suggests the integration of sexual and reproductive
health and HIV prevention services into all relevant
health services (Objective 2.6) and specifically advocates for
the promotion of male sexual health, including addressing
issues relating to gender and responsible parenting (Objective
2.7). These interventions provide an opportunity to
identify domestic violence in various health settings.
• The scaling up of prevention programmes for people living
with HIV, including programmes that support voluntary
disclosure of HIV status and promote access to female
condoms (Objective 2.10), should incorporate domestic violence.
HIV testing and counselling provides a good avenue
to discuss barriers to HIV status disclosure resulting from
a fear of violence. HIV counsellors should address this fear
when discussing disclosure and be prepared to refer women
to domestic violence services or social workers. 8 An intervention
linked to this is the training of VCT and adherence
counsellors to identify barriers that prevent women in
abusive relationships from accessing HIV prevention, treatment
and care services (Objective 19.3). 9
3

• The NSP aims to broaden existing mother to child transmission
services to include other related services and target
groups (Objective 3.1). Research has shown that pregnant
women are more vulnerable to domestic violence and that
the lowest rates for disclosure of HIV status as a result of
fear from their partners are amongst pregnant women. The
highest rates of disclosure-related violence were reported
among women at antenatal clinics. 8 The Policy and Guidelines
for the Implementation of the Prevention of Mother to Child
Transmission (PMTCT) programme aims to support the implementation
of women empowerment programmes and
fight against gender-based violence, but this objective is not
further elaborated on in the policy and therefore might get
lost during implementation. The policy also fails to address
domestic violence as part of post-HIV test counselling.
• Scaling up the coverage of the comprehensive care and treatment
package (Objective 6.1) provides another opportunity
to screen for domestic violence in various ways. It includes
interventions aimed at improving the quality of wellness
programmes, providing psychosocial support including
disclosure, implementing integrated contraceptive services
for women and implementing facility and community based
adherence support strategies and programmes.
• Access to contraceptive services that suit the needs of
abused women are crucial in any HIV prevention strategy
and are included in almost all intervention packages
proposed by the NSP. It makes sense for female condoms,
the only contraceptive method that is both femalecontrolled
and can prevent HIV, to be widely available. A
recent health survey however indicated that while about 53
percent of women have knowledge of female condoms, they
are used by only 0.3 percent of sexually active women. 11
There is an internal contradiction between the inclusion
of female condoms in the intervention packages touted by
the NSP and the failure of the NSP to include strategies
to increase access to female condoms through marketing,
production, distribution and affordability.
Intervention Packages outlined in the NSP
NSP Intervention Packages that include reference to
gender rights, gender-based violence and child abuse:
• HIV prevention programme, interventions and
curricula
• Prevention package for sex workers and their clients
• Early Childhood Development Care Package
• OVC package
NSP Intervention Packages that omit reference to
gender-based violence and child abuse:
• Expanded PMTCT package
• Youth-friendly sexual and reproductive health services
• Unwanted pregnancy package
• Positive prevention package
• Workplace prevention package
• Prison prevention package
• Wellness care package
• Food support package
• Incremental roll-out of comprehensive customised HIV
prevention package to higher risk occupational groups
3. Domestic violence and
HIV
The link between domestic violence and the
increased risk of HIV infection is widely
acknowledged:
- International and local research has shown
that women with violent partners are
significantly more likely to report that they
knew their partners had had other sexual
partners while in a relationship with
them, than women whose partners were
not violent. 2 Various studies have shown
that abusive partners generally engage in
more high-risk sexual behaviour such as
simultaneous partners and transactional
sex. Accordingly, they are more at risk of
contracting HIV, 12 placing their partners at
increased risk of HIV infection. 13
- Research has indicated that men who
argue that the use of condoms negates
trust in a relationship are generally more
controlling than other men. 14 The 2003
South African Demographic and Health
Survey points to women’s varying levels of
condom negotiation skills depending on
their level of education. This suggests that
many women in South Africa still find it
difficult to negotiate safer sex and would
be especially vulnerable to HIV infection
in the context of an abusive relationship. 15
The associated powerlessness felt by women
in abusive relationships is also linked
to more frequent sex and a reduction in
condom use. 16
Little research has been done about the
impact of domestic violence on women and
children already living with HIV/AIDS.
Concerns exist about the risk of violence and
abandonment following disclosure of HIV
status to a partner. 17 The fear of violence and
its impact was reported in a Zambian study as
a key barrier to many women being tested for
HIV, returning to a health facility to access
their HIV results, disclosing their HIV status
and accessing ARV treatment. 18
Policy responses to domestic violence must
take these circumstances into account.
Various studies have shown that abusive partners
generally engage in more high-risk sexual
behaviour such as simultaneous partners and
transactional sex. Accordingly, they are more at
risk of contracting HIV, 12 placing their partners
at increased risk of HIV infection. 13
4

4. Current health policy on
domestic violence
Domestic violence is widespread in South Africa 19 and there
is an urgent need to create a response capable of preventing
domestic violence, as well as addressing its consequences.
South Africa’s health sector response to domestic violence
is however under-developed and fragmented. Threads of a
response are scattered throughout the following policies:
• The Primary Health Care Package for South Africa (2000) 20 - This
policy provides for the counselling and referral of survivors of
domestic violence and sexual assault, STI prophylaxis and HIV
testing, emergency contraception, care of injuries, medico-legal
advice and documentation of evidence.
• The National Guideline on prevention, early detection/identification
and intervention of physical abuse of older persons at primary level was
passed in March 2000 but has not yet been properly implemented.
21 In November 2007 the Department of Social Development
published a draft National Elder Abuse Protocol as an annexure to
the draft Regulations on the Older Persons’ Act 13 of 2006. The Protocol
is based on the Department of Health’s Guidelines. The Protocol
sets out abuse indicators and the steps to be taken in identifying,
reporting, assessing and managing abuse. Medical practitioners,
nurses, emergency services and community health services are
included in the list of professionals who must be able to identify,
assess and report abuse. The Protocol sets out guidelines for the
management of suspected elder abuse which should be followed by
service providers including the ambulance, hospital casualty department,
general practitioners, medical doctors and nurses.
• The 5-year National Implementation Plan for the Service Charter
for Victims of Crime 2007-2011, elaborates on the Department of
Health’s responsibilities towards victims of crime and violence. 22
The Implementation Plan intended to identify or establish
dedicated units to provide services for victims of crime and to
develop standardised records on physical abuse by April 2007. The
Implementation Plan also requires health providers to document
physical abuse, open files for all patients of violence and inform
them of their right to request prosecution. 23 The Implementation
Plan has unfortunately not been disseminated well at Provincial
Level and many of the 2007/2008 timeframes for implementation
were not met.
In practice, health workers have a bio-medical approach
to domestic violence and seldom record the presence of
domestic violence, enquire into whom had caused the assault,
or refer the patient to other support services. The inadequate
response by the health sector to domestic violence negates
the Department of Health’s stated intention to strengthen
the response to gender-based violence. 24
5. Policy recommendations
In 2005, the World Health Organization urged governments
to address violence against women as part of its work towards
achieving the Millennium Development Goals. 25 Specific
health recommendations include:
• Efforts to improve maternal health should include measures
to reduce intimate partner violence (MDG 5 – improve maternal
health);
• Providers of reproductive health care should be trained to recognise
signs of violence against women and referral systems put in
place to ensure that appropriate care, follow-up and support services
are available (MDG 5 – improve maternal health);
• National HIV prevention strategies should include components
that aim to reduce violence against women, challenge social
norms that condone such violence and empower women and girls
to protect themselves against unwanted or forced sex (MDG 6 –
combat HIV/AIDS, malaria and other diseases);
• HIV/AIDS awareness campaigns should include information
about the relationship between violence against women and HIV/
AIDS and the HIV-related health risks of harmful traditional and
formal practices (MDG 6 – combat HIV/AIDS, malaria and other
diseases); and
• AIDS treatment initiatives should address intimate partner
violence as an obstacle to both testing and treatment and ensure
confidentiality and support for women who seek either (MDG 6 –
combat HIV/AIDS, malaria and other diseases).
Since South Africa has committed itself to the attainment
of the Millennium Development Goals, the above recommendations
provide a useful framework for a South African
health policy which is more nuanced and reflects a better understanding
of the health consequences of domestic violence.
This policy brief does not recommend any amendments
to the NSP, instead it urges the Department of Health to
integrate domestic violence into its policies, programmes
and interventions. There are various opportunities within
the NSP for the health sector to address domestic violence
through both primary and secondary intervention strategies.
The Department of Health has a duty to develop an array of
health policies and programmes which address the needs of
women and children who are being abused.
It is equally important for civil society to lobby for such
policy and programme developments and to monitor its
implementation. Unfortunately civil society interventions
relating to the NSP are often only focused on access to health
services for rape survivors and on the criminal justice system.
At the end of 2008, the targets that were set for the implementation
of many of the NSP objectives remain elusive. A key
focus of the South African National AIDS Council (SANAC)
and all its sectors for 2009 should be on finalising the policy
and strategy commitments made in the NSP and allocating
sufficient resources for the implementation of the NSP.
The systems that will be set up by SANAC to monitor and
evaluate the implementation of the NSP are not currently
geared towards giving a clear picture of the implementation
of the NSP. In the absence of a proper monitoring and evaluation
system, it becomes difficult for civil society to evaluate
the accessibility and quality of intervention programmes.
Such systems should include mechanisms for civil society
to evaluate the extent to which gender-based violence is addressed
through various NSP interventions and to propose
changes where necessary.
This policy brief further recommends that the
Department of Health develop a domestic violence policy
which ensures that domestic violence is acknowledged
and addressed within the health sector. In addition, there
is an urgent need to train health services providers at all
levels to recognise abuse (whether it is child abuse, abuse of
elder persons or domestic violence), to document the abuse
properly, and to respond appropriately and with sensitivity.
The Department of Health has a duty to develop an
array of health policies and programmes which address
the needs of women and children who are being abused.
5

Additional Reading
1. The recent report “Developing a Health Sector Response to Domestic Violence – A
Roundtable Discussion” will provide readers with an overview of some of the key
issues relating to the development of a health sector response to domestic violence.
The discussion was hosted by Tshwaranang Legal Advocacy Centre and the Centre for
Health Policy on 11 and 12 August 2008 at Wits University.
2. A literature review on domestic violence screening and a summary of existing South
African health policies on domestic is also available.
The above documents are available from the TLAC website at www.tlac.org.za
Endnotes
1 Dorrington R (2008) “Has HIV prevalence peaked in South Africa?
Can the report on the latest antenatal survey be trusted to answer this
question?” Available at http://www.samj.org.za/index.php.samj/article/
viewFile/2885/2093
2 World Health Organization (2007) Report on the Expert meeting on the
primary prevention of intimate partner violence and sexual violence, 2-3 May
2007, Geneva, Switzerland, page 3.
3 Pronyk P et al (2006) “Effect of a structural intervention for the
prevention of intimate partner violence and HIV in rural South Africa:
results of a cluster randomized trial” The Lancet Vol 368, 1973-1983,
South African IMAGE Study on violence and HIV. Available at http://web.
wits.ac.za/Academic/Health/PublicHealth/Radar/SocialInterventions/
InterventionwithMicrofinanceforAIDSGenderEquity.htm
4 Jewkes R et al (2007) “Evaluation of Stepping Stones: A gender
transformative HIV prevention intervention” Policy Brief, Gender &
Health Research Unit, Medical Research Council. Available at http://www.
mrc.co.za/gender/reports.htm
5 Reference to the term “sexual assault” in the NSP and Department of
Health documents refers to all sexual offences including rape, whilst the
term “sexual assault” in the Criminal Law (Sexual Offences) Amendment Act
replaces and goes beyond the previous definition of indecent assault, and
is different from rape.
6 The National Sexual Assault Policy identifies the following strategies to
achieve this objective: 1. Provision of health care immediately after sexual
assault; 2. Sexual Assault examination kits should be available at facilities
that provide sexual assault services; 3. Providing proper treatment of
injuries; 4. Ensuring safety and avoiding re-victimisation; 5. Preventing
unwanted pregnancy; 6. Providing post-exposure prophylaxis for HIV; 7.
Preventing and treating sexually transmitted infections; 8. Preventing and
treating psychological distress; 9. Providing access to psychological/psychiatric
care; 10. Medical certificates for sick leave; 11. On discharging the
patient ensure that proper follow-up arrangements are in place; 12. Ensuring
the integrity of the evidence chain; 13. Clinical management guidelines
for health care professionals; 14. Provision of information to the
patient; 15. Documentation of evidence;16. Reporting of forensic evidence;
17. Giving evidence in court; 18. Accreditation of Providers of the service;
19. Provisions of support services for health providers to prevent vicarious
trauma; 20. Services have to be supervised, monitored and evaluated on a
regular basis; 21. Provision of adequate 24 hour facilities.
7 Christofides, C., Webster, N., Jewkes, R., Penn-Kekana, L., Martin, L.,
Abrahams, N. and Kim, J. (2003). The State of Sexual Assault Services:
Findings from a Situation Analysis of Services in South Africa. The South
African Gender-based Violence and Health Initiative, page 16
8 Maman S and Medley A (2004) Gender Dimensions of HIV status disclosure
to sexual partners: Rates, barriers and outcomes, a review paper, World Health
Organization.
9 World Health Organization (2006) Addressing violence against women in
HIV testing and counselling, a meeting report, 16-18 January 2006, Geneva,
page 23. Jacobs T, Jewkes R (2002) Vezimfihlo: a model for health sector
response to gender violence in South Africa. International Journal of
Obstetrics and Gynaecology 2002; Sep;78 Suppl 1:S51-6.
10 Pages 85-86 of the NSP.
11 Department of Health, Medical Research Council, OrcMacro (2007)
South Africa Demographic and Health Survey 2003 (SADHS), Pretoria:
Department of Health, page 62.
12 Dunkle K, Jewkes R, Nduna M et al (2007) “Transactional sex and
economic exchange with partners among young South African men in
the rural Eastern Cape: prevalence, predictors, and associations with
gender-based violence” Social Science and medicine 65(6), 1235-48.
13 Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD
(2004) “Gender-based violence, relationship power and risk of prevalent
HIV infection among women attending antenatal clinics in Soweto,
South Africa” The Lancet, 2004;363: 1415-1421.
14 Jama PN, Jewkes R, Nduna M, Levin J, Dunkle K (submitted) “Factors
associated with consistent condom use in young rural South African
women” AIDS Care.
15 SADHS, footnote 11, page 96. Education played a strong role in
perceptions about women’s right to request condom use - 71 percent of
both men and woman who had no education said a woman could propose
condom use compared to 90 percent of men and 92 percent of women
with higher education.
16 Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss
M, Puern A, Duvvury N (2006) “Factors associated with HIV serostatus
in young rural South African women: connections between
intimate partner violence and HIV” International Journal of Epidemiology
35(6):1461-8.
17 Amnesty International (2008) ‘I am at the lowest end of all’ Rural women
living with HIV face human rights abuses in South Africa, pages 64-65.
18 Human Rights Watch (2007) Hidden in the mealie meal: Gender-based
abuses and women’s HIV treatment in Zambia, Research Report.
19 Jewkes, R, Penn-Kekana, L, Levin, J, Ratsaka, M and Schrieber, M
(1999) “He must give me money, he mustn’t beat me”: Violence against women
in three South African Provinces, Pretoria: CERSA (Women’s Health)
Medical Research Council. Abrahams, N, Jewkes, R and Laubsher,
R (1999) “I do not believe in democracy in the home” Men’s relationships
with and abuse of women, Tygerberg: CERSA (Women’s Health) Medical
Research Council. Mathews, S, Abrahams, N, Martin, LJ, Vetten, L, van
der Merwe, L and Jewkes, R (2004) “Every six hours a woman is killed by
her intimate partner”: A National Study of Female Homicide in South Africa,
MRC Policy brief no. 5, June 2004.
20 Available at http://www.doh.gov.za/docs/policy/norms/contents.html
21 Available at http://www.doh.gov.za/docs/index.html
22 Available at http://www.doj.gov.za/VC/VCdocs_implplan.htm
23 This latter duty could be met by providing patients with the same
information sheet that Regulations to the Domestic Violence Act
requires clerks and police to provide survivors of domestic violence; i.e
information about the right to either lay a criminal charge or to apply
for a protection order, or to do both.
24 Department of Health Strategic Plan 2007/08 to 2009/10, available at
http://www.doh.gov.za/docs/discuss-f.html
25 World Health Organization (2005) Addressing violence against women and
achieving the Millennium Development Goals. Available at http://www.who.
int/gender/en
This policy brief was made possible by the generous support of the American, Swedish and Norwegian people through the President's Emergency
Plan for AIDS Relief through the United States Agency for International Development (USAID), Sida and the Norwegian Ministry of Foreign Affairs.
The USAID funding was provided under the terms of the USAID Cooperative Agreement No. 674-A-00-08-00002-00, Academy for Educational
Development Grant No. 3828-00-PopCoun-01. The contents are the responsibility of the Population Council and the Tshwaranang Legal Advocacy
Centre and do not necessarily reflect the views of the above mentioned funders or the governments of the United States, Sweden and Norway.
Design: Ellen Papciak-Rose (Soweto Spaza cc) www.ellenpapciakrose.com
6