SPEAK OUT

AIDS
Commentary: Rape of individuals with disability: AIDS and the folk belief of virgin cleansing

Lancet,Volume 363, Number 9422 22 May 2004
Virgin cleansing--the belief that people who have a sexually transmitted disease can rid themselves of the condition by transferring the infective organism by having sexual intercourse with a virgin--has been discussed in The Lancet in relation to HIV/AIDS.1-3 The practice was first reported in the 16th century in relation to syphilis and gonorrhoea in Europe.4 Although the prevalence of virgin cleansing is unclear,1-3 accounts of the belief are reported from sub-Saharan Africa, Asia, Europe, and the Americas.5
We have identified a variation of this practice in our Global Survey on HIV/AIDS and Disability6 that warrants attention--"virgin rape" of individuals with disability, by people who believe themselves positive for HIV. Although the evidence for virgin rape of infants and young children has been debated,1-3 we have identified numerous reports of rape of individuals who are blind, deaf, physically impaired, intellectually disabled, or who have mental-health disabilities.6 The belief that sex with an individual who is disabled can rid one of a sexually transmitted disease is an old one. According to Smith,7 brothels in Victorian England were "stocked with intellectually disabled 'virgins' because it was believed that a syphilitic man could lose the infection by having sex with them".
Individuals with disability are presumably at risk both because they are, incorrectly, often assumed to be sexually inactive, hence virgins,4 and because they might be easy targets. Even before the advent of AIDS, women and men with disability suffered an equal, or up to three times greater, risk of rape by a stranger or acquaintance, than their non-disabled peers.8-10 Many individuals with disability are physically vulnerable.8 Some must relegate part or all of their care to attendants, family members, or others, or live in institutions; situations in which abuse is rife worldwide.9,10 Additionally some researchers argue that individuals with disability are often psychologically vulnerable. Nosek et al,11 for example, suggest that overprotection and internalised societal expectations make women with disability more vulnerable to psychological pressure for sex and intimacy. Womendez and Schneiderman12 note that young disabled individuals have few opportunities to learn to set boundaries for physical contact. Studies from the UK13 report that men with intellectual disabilities who live in the community are often pressured into having sex with non-disabled men whom they meet in public toilets; participating because they are lonely and anxious to please their new supposed friends.
A variation of this practice has been reported by six women with disabilities from southern Europe and North America who responded to our survey6 with reports that they had slept with men from Africa and south Asia. These women believed they were in long-term relationships, but stated they later learned that the relationships had been started because their partners assumed them to be virgins, capable of ridding them of their infection. The men did not inform the women of their HIV status and abandoned them once these women began to show symptoms of infection with the virus.
Individuals with disability are also at increased risk of virgin rape because of a lack of legal protection. Police, lawyers, judges, and even rape-crisis counsellors often have no knowledge of how to help people with a disability. Officials often dismiss individuals with disability who report rape, assuming them to be confused or victims of a misunderstanding.8 In many countries, people with disability are not allowed to submit police reports, take oaths, or give testimony in court. Police stations and courts are often inaccessible, lacking sign-language interpreters, ramps, and support systems for individuals with intellectual impairments or mental-health disabilities.10 Because of these barriers, reporting of sexual abuse by individuals with disability is infrequent, and perpetrators can expect to go unpunished.14 Low rates of reporting not only have legal implications but can mean that potential antiretroviral prophylaxis is not made available to disabled men and women.
Although no epidemiological data are available, interviews with disability advocates and service providers, as well as a review of published reports, found reports of virgin rape of disabled individuals in association with HIV/AIDS in 14 of the 21 countries reviewed.6 Moreover, in 12 of those 14 countries, from sub-Saharan Africa, south and southeast Asia, North America, and Europe, more and more such rapes have been reported over the past 5 years.6 For example, the Downs Syndrome Association of South Africa15 reports this problem as now being a serious concern among the young people with whom they work. Additionally, field studies in conjunction with our survey6 elicited many personal accounts of this practice. A wheelchair user from southern Africa, for instance, reported being raped three times within a month by men in her neighbourhood who believed themselves HIV positive. The woman interviewed stated that several disabled women in her township had experienced similar assaults.
Research is needed to ascertain how widespread the problem of virgin rape is among people with disabilities, and what legal, social, and medical interventions can be implemented. Training is needed for medical personnel, police, and judges to make them aware of the issue and more knowledgeable about how to serve individuals with disabilities. Educational campaigns are also needed to inform individuals with disabilities and their families about the risk, and to debunk the myth of virgin cleansing within the general population.
We thank the World Bank's Office of the Advisor on Disability and Development and Global HIV/AIDS Program for funding the Global Survey on HIV/AIDS and Disability, and Yale University's Center for the Interdisciplinary Research on AIDS for on-going support. We have no conflict of interest to declare.
*Nora Ellen Groce, Reshma Trasi
Global Health Division, Yale School of Public Health, New Haven, CT 06520, USA (e-mail:nora.groce@yale.edu)
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