One Boy's Experience: Ashamed and Afraid
By Dr. Surinder Jaswal, Associate Professor, Tata Institute of Social Sciences, Mumbai, India
Thirteen-year-old Mukesh (not his real name) was visiting his aunt when an older boy from the neighborhood lured him to a secluded area and forced him to have sexual relations. Ashamed and afraid of the consequences of reporting the incident, Mukesh did not tell his parents. Nor did he ever indicate that the abuse had occurred more than once. But it likely had, based on the fact that he developed painful anal sores and lesions symptomatic of a sexually transmitted infection. Disturbed by those symptoms, Mukesh informed his brother, who brought him to a hospital for treatment.
Mukesh's experience occurs all too frequently. In studies conducted in India, urban, semi-urban, and rural male youth from both institutional and community-based settings not uncommonly report sexual coercion by male peers and older boys and men.1 Approximately a quarter of 23 patients seeking sexual abuse treatment at a health care facility in urban Thane City, India, were boys between ages six and 16 years.2 And a third of 811 higher secondary semi-urban and rural school students (mean age, 16 years) participating in a study in urban Goa, India, reported at least one type of sexual abuse in the previous year. Multiple types of abusive sexual experiences, involving both male and female perpetrators, were common.3
Gender norms in India create a situation that is conducive to such male sexual coercion. Compared with girls, boys are afforded much greater freedom of mobility and are questioned little about their whereabouts. Social taboos against boys congregating at "adaas" (local dens where boys meet) do not exist.
Yet, the sexual coercion that is more apt to occur under these conditions is associated with various harmful consequences for many male youth. The nature of the association is unclear but, compared with boys not experiencing coercive sexual relations, boys who have been forced to have sex have poorer educational performance, poorer physical and mental health, more substance abuse, poorer relationships with their parents, and more consensual sex.4 Sexual abuse has been associated with some young men growing anxious about their sexuality, sexual identity, and how peers perceive them. Many adopt harmful behaviors (such as abusing drugs and alcohol) or engage in risky sexual behaviors (such as unprotected, casual sexual relationships), seemingly to prove their masculinity.5
Given the high prevalence of sexual victimization of males in some settings, educational programs for young men that promote healthy sexual attitudes and development are essential. Workshops conducted by trained peers, counselors, and social workers are also needed to address boys' anxieties about sexual behavior and to educate them about the health risks of coerced sex, such as sexually transmitted infections, including HIV.
In school settings, bullying and violence must be aggressively discouraged, and teachers and significant others need to learn to be sensitive to adolescents' and young men's sexual health needs and concerns. Male students should be informed of the risk of sexual abuse and be taught that it is not acceptable. They need to be encouraged to develop and maintain healthy relationships with peers. Special programs to teach parents and older members of the community how to communicate with adolescents and address issues of sexuality and reproductive health should be organized by community-based organizations. Finally, resource centers are needed in communities to provide youth-friendly sexual health information, counseling, and other related services for boys and young men, such as self-help groups for victims.
In one sense, Mukesh was fortunate. Doctors in the hospital's outpatient department had been taught to screen for sexual abuse and were prepared to provide immediate support and referrals for further counseling and sexual health services at the hospital's adolescent center.
Mukesh asked for outpatient services and was counseled to take advantage of them. However, like many boys in his situation, he did not return for follow-up. As a result, his medical condition was never diagnosed or treated at the hospital. Perhaps he did not return for economic reasons or — more likely — because of the shame and stigma associated with his abuse. As in most cultures, admitting that he had been a victim of sexual abuse by another male could well have called Mukesh's masculinity into question. Like many young men, he may have been more willing to risk his health than to have others doubt his masculinity.6
References
- Andrew G, Patel V. Gender, sexual abuse and risk behaviours in adolescents: a cross-sectional survey in schools in Goa. Natl Med J India 2001;14(5):263-67; Andrew G, Patel V. Sex, studies or strife? What to integrate in adolescent health services. Reprod Health Matters 2003a;11(21):120-29; Andrew G, Patel V. Health Needs of Adolescents: A Study of Health Needs of Adolescents in Higher Secondary Schools in Goa. Research Report. Second Edition. Sangath, India: Resource Centre for Adolescent and Child Health, 2003b; Jaswal S. Child and Adolescent Sexual Abuse in Health Facilities in Thane. Research Report. Mumbai, India: Tata Institute of Social Sciences, 2002; Jaswal S. A Study on Male Sexual and Reproductive Health in Thane City. Research Report. Mumbai, India: Tata Institute of Social Sciences, 2004.
- Jaswal, 2002.
- Andrew and Patel, 2001; Andrew and Patel, 2003a.
- Andrew and Patel, 2001; Andrew and Patel, 2003b; Durham A. Young men living through and with child sexual abuse: a practitioner research study. Br J Soc Work 2003;33:309-23.
- Durham; Jaswal 2004; Verma RK, Rangaiyan G, Singh R, et al. A study of male sexual health problems in a Mumbai slum population. Cult Health Sex 2001;3(3):339-52.
- Rivers K, Aggleton P. Working with Young Men to Promote Sexual and Reproductive Health. London, UK: Department for International Development, 2002.
Marital Sexual Violence Is 'A Terrifying Experience'
By Faizal Haque, Communications and Training Manager, Centre for Operations Research and Training, Vadodara, India; Dr. M.E. Khan, Regional Associate Director, Asia and Near East, FRONTIERS Program, Population Council, New Delhi, India; and Dr. John Townsend, Director, FRONTIERS Program, Population Council, Washington, DC
"It was a terrifying experience. When I tried to resist, he pinned my arms above my head. It was so painful and suffocating that I fainted, for I only remember getting up in the morning and finding stains of blood on the bed sheet. My husband was no longer in the room. I slowly got up and went to the toilet, feeling sick and depressed."
This is how 32-year-old Laxmi (not her real name) recalls her first sexual experience at age 13. Like many of the married women interviewed in a qualitative study conducted in 1996 in two villages of Uttar Pradesh, India,1 Laxmi experienced marital sex as forced and frightening. The study, conducted by the India-based Centre for Operations Research and Training (CORT) among married women ages 15 to 44 years, found that young brides in Uttar Pradesh — where nearly half of all girls are married by the age of 15 — often are unprepared for sex and feel helpless to prevent it. Many girls are simply told one or two days before they are married, "Do not refuse your husband, let him do whatever he does."
Women in the study who had been married for fewer than three years tended to resist sex less than did women who had been married for three or more years. In the first years of marriage, women reported, acquiescing to a husband's sexual demands was the only way they knew to foster a close marital relationship or obtain some power to negotiate family affairs.
When women resisted sex, it was often because they worried about an unintended pregnancy. Ironically, refusing sex often led to sexual coercion and the very outcome they feared: Most of the women in the study who reported sexual violence in their marriages had experienced one or two unintended pregnancies.
In the study, two-thirds of some 100 women reported marital sexual coercion. When women refused sex, most husbands angrily reminded them, "What else have I married you for?" or "What good are you if you cannot do this for me?" Some husbands threatened to have sexual relations with other women or demanded that their wives return to their parents.
These findings are similar to those from studies conducted by the Population Council in Bangladesh and by CORT in Gujarat, India. In the study in Bangladesh, 71 percent of 160 women ages 15 to 35 years reported that forced sex had occurred in their marriages.2 In contrast, the study in Gujarat, India, conducted among newly married men and women, found that only 16 percent of 25 women reported nonconsensual marital sex, while about a third of 25 married men confessed that they had forced sex on their wives.3
In these studies, forced sex had immediate adverse consequences: Women suffered depression, loss of self-esteem, and unintended pregnancies. The Bangladeshi study further revealed that compared with other women, those experiencing domestic and sexual violence did not use oral contraceptives as consistently and did not use emergency contraception as often to prevent unintended pregnancy after unprotected sex. Many women in the Bangladeshi study also reported that they feared acquiring sexually transmitted infections, including HIV. Since they often lacked the ability to negotiate safe sex in their marriages and were likely to experience forced marital sex, they left everything to fate. "I know my husband goes to commercial sex workers," said a 25-year-old woman with three children. "But what I can do? Neither will he stop going to outside women, nor can I convince him to use condom. I know one day he will infect me with AIDS…this is our fate."
Both the Indian and Bangladeshi studies also found that women experiencing sexual coercion lost interest in sex sooner than did those who were not sexually coerced. Consequently, they were more apt to refuse to have sex with their husbands, leading to further sexual coercion and violence.
How can this violence that women face in their own homes be addressed? Over the long term, the root causes of gender inequities must be addressed and eliminated. Systematic and persistent advocacy to mobilize the community against gender-based violence is also needed. Enforcing the law in India that prohibits marriage before the age of 18 would protect more young women from early marriage and the sexual helplessness they feel in such arrangements. In the short term, introducing family life education into schools and having family planning workers counsel newly married couples may deter sexual violence in marriage by preparing adolescents for married life and helping them develop positive attitudes toward sexuality. Young women who were informed about sexual matters and who entered marriage later (at age 19 years or older) were more likely to be able to negotiate sex with their partners and reported better marital sexual lives than did younger, less informed girls, the Bangladeshi study showed.
References
- Khan ME, Townsend J, Sinha R., et al. Sexual violence within marriage. Seminar 1996;447:32-35.
- Khan ME, D'Costa S, Rahman M. Prevalence and nature of violence against women in Bangladesh. The 129th Annual Meeting of the American Public Health Association, Atlanta, GA, October 21-25, 2001.
- Khan ME, Barge S, Sadhwani H, et al. Reflections on Marriage and Sexuality: Experience of Newly Married Men and Women in Gujarat, India. Vadodara, India: Centre for Operations Research and Training, 2004.
'I Was Alive But Not Living...'
By Trish Hiddleston, Head of Protection, United Nations Children's Fund (UNICEF)/Democratic Republic of Congo
It was April 2002. They knocked on the door of our home and we opened it up because we thought it must be the neighbors stopping by to say hello. But it wasn't the neighbors. It was six armed men. They pushed their way into our home with their guns. . . . They forced me to have sex with them many times." Safi (not her real name), 19, was then taken by the men to their camp in the forest where she was held for more than a year. "During that whole time, I felt like I was going crazy. I was like a person unconscious. I was alive but not living. . . . Every day they raped me. Before going out to steal or kill, they would rape me — sometimes one, sometimes all. . . ."1
During more than five years of outright war in the Democratic Republic of Congo (DRC), rape and other forms of sexual abuse greatly increased as armed groups used sexual violence to weaken communities and force them into submission. And, despite the creation of a transitional government in 2003, conflict and sexual violence continue, particularly in the eastern DRC.
Women raped in this conflict situation have suffered many immediate, serious, and sometimes life-threatening health consequences. Safi was impregnated by one of her rapists. At a hospital in Goma where she was treated after escaping her captors, other girls and women have given birth to babies conceived during rape. But a considerable number of patients seen at the hospital, which is run by Doctors on Call for Service and receives substantial support from the United Nations Children's Fund (UNICEF), have come for surgical operations to repair a stigmatizing injury. The injury, called a fistula, is a hole torn between the bladder and the vagina or between the rectum and the vagina, leaving a woman incontinent.
Many girls and young women in the DRC are prone to developing a fistula for a number of reasons. Commonly in poor health and married before their bodies have matured, their vaginal or rectal walls may be weakened or damaged by even non-violent marital sexual intercourse. Repeated, violent rape (sometimes by insertion of sharp objects into the vagina) can exacerbate this damage, if not cause it directly. Also, girls who are impregnated during rape and give birth before their bodies have fully matured may develop a fistula as a result. Between April and September 2003, more than 150 fistula operations were performed on girls and women referred to the hospital in Goma. During that period, the hospital registered 973 female victims of sexual violence, ranging from 7-year-old girls to 80-year-old great-grandmothers. Twelve percent of the hospital's female patients had been infected with HIV, and nearly 40 percent had other sexually transmitted infections.2
Emergency contraception can help prevent unwanted pregnancy, and postexposure prophylaxis may help prevent HIV infection. However, the treatments are seldom available in the DRC. Even when they are available, medical workers there rarely know how to provide them. Furthermore, many rape victims do not know of the benefits of these treatments. Even if they do, such obstacles as ongoing conflict, lack of transportation, or inability to pay prevent most victims from accessing available services in time for them to be effective. (Emergency contraception should be provided within 120 hours; postexposure prophylaxis, within 72 hours.)
There are other reasons why many victims do not seek medical, let alone legal, help. They may fear retribution by their perpetrators. And, because rape carries enormous stigma in the DRC, victims try to keep it secret. Disclosure may lead to ostracism by family and community. Such fierce stigmatization and resulting isolation means that many rape victims have no way to ensure their basic survival and thus may often feel compelled to begin exchanging sex for basic necessities: food, money, shelter, or security.
A combination of factors sustains sexual violence in this setting. First, the displacement, family separation, and community disintegration resulting from conflict weaken such traditional protective mechanisms as asking family members, neighbors, chiefs, or elders for help. And war establishes violence as the norm. As a result, sexual violence by those in positions of relative power and strength — soldiers, police, teachers, and common criminals — has increased.
However, rape — rarely reported in the DRC due, in part, to an ineffective judicial system as well as gender norms that maintain women's low status and lack of power — is increasingly gaining attention. And strategies to prevent it and to alleviate its consequences are being undertaken, including:
- Neighborhood watch collaborations are being created.
- The DRC government, the United Nations, and nongovernmental agencies have joined in a national initiative to fight sexual violence.
- When populations are displaced, UNICEF staff and nongovernmental agencies try to prevent family separation, ensure speedy family reunification, and ensure that camp design does not facilitate rape.
- Post-rape kits are being supplied by UNICEF, the United Nations Population Fund, the World Health Organization, and nongovernmental agencies to a few health centers. Mobile teams are being created to care for victims when conflict areas become accessible.
These organizations and agencies are also providing training on basic principles of confidentiality, security, respect, and nondiscrimination — as well as medical and psychosocial care — to health centers, religious groups, community-based organizations, law enforcement agents, and others.
Still, the needs of Congolese women who have been raped or are at high risk of being raped remain largely unmet. Increased funding for a coordinated, multidimensional approach to preventing and responding to sexual violence in the DRC is sorely needed.
References
- Page K. Safi's Story: A Courageous Young Woman Moves Beyond Her Past Experience of Sexual Violence. Democratic Republic of Congo: United Nations Children's Fund, 2003.
- Page.
Virginity Testing Raises Many Questions
By Cleopatra Ndlovu, Communications Officer, Women's Action Group, Zimbabwe
Imagine being Rudo (not her real name), a 16-year-old girl living in an area of Zimbabwe where girls are tested for virginity.
Rudo's turn to be examined comes. An elderly woman asks her to lie down, opens her legs, and then inserts into her vagina a finger — which has been inserted in other girls' private parts that day — to see if she is still a virgin. How do you think Rudo feels?
Unfortunately, the practice of virginity testing has been resuscitated over the years, with people claiming that it preserves their African identity, their culture. Various groups — sometimes tribes, churches, or families — perform virginity testing in Malawi, South Africa, Swaziland, Zimbabwe, and other African countries. Girls as young as five years old may be tested. If a girl is found to be a nonvirgin, the price a man pays for her as his bride will be lower, or he may refuse to marry her. Even if the man agrees to marry her, the girl and her family are often shamed and ridiculed.
Boys, in contrast, are not subjected to such intimate examinations. Boys and men are not even expected to remain abstinent before or faithful during marriage. Their sexual "purity" is not questioned. In Zimbabwe, as in many other places, male sexual experience is often encouraged and male infidelity tends to be condoned.
Why is virginity testing done? First, it is meant to ascertain girls' sexual purity at marriage. Second, it is intended to discourage girls from engaging in sexual activities prior to marriage and, thus, may be considered a way to combat the spread of HIV/AIDS.
This is the case in Zimbabwe, which has one of the highest HIV infection rates in the world. For example, Chief Naboth Makoni of the Makoni district 180 kilometers from Harare includes virginity testing as part of his anti-AIDS campaign. He has said virginity testing of girls helps prevent HIV infection in his district (which, ironically, has the highest rate of HIV infection in the country) by making premarital sex shameful and thus discouraging it. Thousands of young girls have been tested in Chief Makoni's area.
It is true that — for both girls and boys — abstaining from sex until entering a mutually monogamous marriage protects against the sexual transmission of HIV. But virginity testing is not necessarily an effective way to achieve this goal. Nor is it fair. For example, some girls fail the test because they have been victims of rape or incest. When their loss of virginity is discovered during testing, they become stigmatized while the perpetrators often go unpunished. In other cases, girls may have had to exchange sex for food just to survive. Also, a girl's hymen may have broken naturally. Although she has never had sexual relations, she may be declared a nonvirgin and suffer the consequences. Finally, the practice of virginity testing implies that girls' sexuality, but not that of boys, is the root cause of HIV transmission.
Virginity testing is likely to be harmful for many girls, regardless of whether they pass the test. First, this intimate examination strips a girl of her dignity. Virginity testing is said to be voluntary, but parents under societal pressure may coerce or persuade their daughters to undergo the practice. Girls who fail the test are often stigmatized by their families and the community for months or years, and their marital value falls. To preserve their virginity, girls and young women sometimes will have anal sexual intercourse, which — if the sexual partner is HIV-infected — poses more risk of HIV infection than vaginal sexual intercourse.
Some girls say that they feel happy when they pass a virginity test. In a newspaper interview, a young school girl in Zimbabwe said, "If you are a virgin, you feel proud and have self-esteem and confidence in what you are doing." However, some girls who pass the test are at risk: They may be married off to older men whose virginity and HIV status were not tested and who may already be infected with HIV. In fact, HIV-infected men may seek young virgins for marriage because they believe the myth that having sexual intercourse with a virgin can cure the infection.
Virginity testing in Zimbabwe is controversial, and people have different opinions about it. But let us ask ourselves these questions: Is virginity testing really a good way to curb the spread of HIV/AIDS? Does it not violate young women's rights and deprive them of power and control over their bodies and sexuality? What is being done to help girls who have lost their virginity due to rape? What are the health risks posed by using on several girls the same gloves or fingers not necessarily washed well? To whom are these girls married after being tested? Are their husbands HIV-negative? Why is the virginity of boys not being questioned? Why do these double standards of sexual purity for boys and girls exist?
So many questions: Let's think about them.
