Transcript Presentation to Portfolio Committee on Women, Children and

Presentation to Portfolio Committee on Women, Children and People with Disabilities
31 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 Abrahams
Dr Andreas Plüddemann
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 1849 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
Life-time self-reported drug use: 2008 National Youth Risk Behaviour
Survey (Grades 8-11 learners)
60
54
50
45
Alcohol
Cannabis
40
Cocaine
Methamphetamine
% 30
Heroin
20
Mandrax
18
13
10
9
9
7
9
9
8
OTC-PRE meds
11
5
5
5
6
Club drugs
5
0
Males
Females
3
Treatment demand data based on data from 8291 patients in
9 provinces (primary+secondary drugs): 2011b
50
45
47
42
40
Alcohol
35
Cannabis
30
Cocaine
Methamphetamine
% 25
21
20
15
10
5
Heroin
18
12
Mandrax
OTC-PRE meds
10
Ecstasy
6
2
0
4
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
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
Risk factors for rape perpetration and their relative
importance , young men, Eastern Cape
% cases
with the
exposure
Population
Attributable
Fraction
95%CI
Educated beyond
grade 10
20.1
6.79
0.19
Drug use
52.1
24.09
8+ lifetime partners 38.5
12.49
3.18
19.35
39.3
13.1
3.89
19.94
38.6
11.98
2.53
19.01
Past year physical
IPV
Raped or
attempted rape
previously
11.17
14.62 31.18
• 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
Risk factors for rape perpetration
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
Adverse childhood exposures
 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)
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
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 nonperps.
 Anti-social behaviour and gang
membership are important risk
factors for rape perpetration
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
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
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
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 evidencebased and theoretically grounded