CHILD RAPE & ABUSE
BABY RAPE

The motivation behind infant rape in South Africa.

Douglas MG Bowley, Graeme J Pitcher
University of the Witwatersrand, Johannesburg, South Africa.
Response to Lancet, letters column, April, 2002
Address of author for correspondence: Douglas MG Bowley, Johannesburg Hospital Trauma Unit, Postnet Suite 235, Private Bag X2600, Houghton, 2041, South Africa.
Telephone: +27 11 488 3373
Fax: +27 11 488 4322
Email: [email protected]

Rachel Jewkes and colleagues write that child rape is "not exotic";1 however, our purpose was to highlight infant rape with associated perineal injury. In our practice in Johannesburg, perineal mutilation of infants (hardly an injury that fails to present for medical treatment) has escalated in incidence from being unknown to being commonplace. Jewkes disputes the assertion that the 'virgin cleansing myth' is an important cause of child sexual abuse; however, the idea that sex with a virgin will cure men of sexually transmitted infection is not new, nor is it exclusively African. In renaissance Europe, it was widely believed that syphilis could be cured by intercourse with a virgin. In 1925, Samuel Cameron, Professor of Gynaecology in Glasgow, wrote: "The disgusting superstition, surviving amongst ignorant and vicious men, that contact with an immature vulva will cure venereal disease, is still responsible (for transmission of gonorrhoea) in many cases."2 In a South African sexual health workshop reported by Jewkes herself in 2000, 32.7% of participants believed sex with a virgin could cure HIV infection. After 14 sessions of 2-3 hours each, this myth was still believed by 20% of the participants!3 Jewkes believes that a 1% seroconversion rate in raped children from Cape Town4 disproves the 'cleansing myth' as it is too low. This reported rate is falsely low as HIV testing in early years of the study was haphazard and since 1997 all children have received post-exposure prophylaxis. (Personal communication: Dr van As) In consensual sex in the western world, the average risk of transmission per-contact for unprotected receptive anal intercourse with an HIV-positive man is approximately 5%; for unprotected receptive vaginal intercourse this risk is less than 1%.5 The risk after rape is much greater and although multiple penetrations by multiple perpetrators, dry sex, the presence of other sexually transmitted infections and the occurrence of perineal injury increase the risk after rape, a "low" seroconversion rate is still consistent with a high HIV positivity rate amongst perpetrators. The fact that few perpetrators admit that the myth motivated their actions is hardly surprising given that approximately 63% of traced offenders are not even tried for their crimes in South Africa and only 7% receive a prison sentence.4

We agree with Jewkes and her colleagues that rape in South Africa occurs in the context of a society inured to very high levels of violence, with fractured families and communities and extreme gender inequality. However, the high level of poverty that Jewkes correctly refers to as a contributory factor cannot be divorced from high levels of ignorance and illiteracy, which we believe potentiate dangerous beliefs and traditions. We concur that the 'virgin cleansing myth' is not the only motivation behind the appalling levels of rape in South Africa, but we believe it is important. We add our voices to that of Charlene Smith, the noted South African rape activist, who has questioned why there is a paucity of research on this practice or vociferous advocacy to challenge it.6
References
1. Jewkes R, Martin L, Penn-Kekana L. The virgin cleansing myth: cases of child rape are not exotic. Lancet 2002;359(9307):
2. Davidson R. This pernicious delusion: law, medicine and child sexual abuse in early 20th Century Scotland. J Hist Sex 2001;10(1):62-7.
3. Jewkes R, Matubatuba C, Metsing D, Ngcobo E, Makaota F, Mbhalati G, Frohlich J, Wood K, Kabi K, Ncube L, Nduna M, Jama N, Moumakoe P, Raletsemo S. Stepping Stones: feedback from the field. )
4. van As AB, Withers M, Dutoit N, Millar AJW, Rode H. Child rape-patterns of injury, management and outcome. S Afr Med J 2001;91:1035-38.
5. Roland M. Prophylaxis following non-occupational exposure to HIV.
6. Smith C. Chair of session D22: Violence Against Women. XIII International Aids Conference, Durban 2000.

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