Food insecurity and depression: a cross-sectional study of a multi-site urban youth cohort in Durban and Soweto, South Africa.

OBJECTIVE: To assess the prevalence of food insecurity and the independent association between depression and food insecurity among youth living in two urban settings in South Africa. METHODS: Baseline cross-sectional survey data was analysed from a prospective cohort study conducted between 2014 and 2016 among youth (aged 16-24 years) in Soweto and Durban. Interviewer-administered questionnaires collecting socio-demographic, sexual and reproductive health and mental health data were conducted. Household food insecurity was measured using the 3-item Household Hunger Scale, with food insecure participants defined as having 'moderate' or 'severe hunger' compared to 'no hunger'. Depression was assessed using the 10-item Center for Epidemiological Studies Depression (CES-D 10) Scale (range 0-30, probable depression ≥ 10). Multivariable logistic regression models were used to estimate the association between depression and food insecurity. RESULTS: There were 422 participants. Median age was 19 years (interquartile range [IQR] 18-21) and 60% were women. Overall, 18% were food insecure and 42% had probable depression. After adjustment for socio-demographic variables (age, gender, female-headed household, household size and school enrolment), participants with probable depression had higher odds of being food insecure than non-depressed participants (2.79, 95%CI 1.57-4.94). CONCLUSION: Nearly one-fifth of youth in this study were food insecure. Those with probable depression had increased odds of food insecurity. Interventions are needed to address food insecurity among urban youth in South Africa, combining nutritional support and better access to quality food with mental health support.

Motivations for participating in a non-interventional gender-based violence survey in a low-income setting in South Africa.

BACKGROUND: Qualitative study of motivations to participate in research into violence and other sensitive issues can help interpretation of findings from community based quantitative surveys. It is equally important to conduct research that may enable a deeper understanding on what motivates people to participate in GBV studies. To date, not much research has been conducted to investigate the factors that influence non-enrolment and enrolment in GBV studies from the viewpoint of the real participants. The present study sought to explore people's reasons for participating in a non-intervention GBV community-based survey in Gauteng province, South Africa. METHODS: Twenty-two qualitative in-depth interviews were conducted with adult black African men and women who had participated in a gender-based violence survey conducted in a low-income setting in South Africa. RESULTS: Some participants reported motives for survey participation which could be interpreted as altruistic. Their motives included a desire to contribute to advancement of knowledge and to share life experiences so that unknown others could learn from these experiences. Yet, some participants hoped their participation will result in personal benefit or that they may be helped with their socio-economic challenges. The analysis further revealed a complex relationship between altruism and self-interest motives for participating in the survey amongst some of the participants. CONCLUSION: We conclude that it is difficult to discern which motive was primary or preceded the other. This is because such motives are not fixed, probably multiple and owing to their fluidity, may shift in people's minds at different times and depending on the nature of the conversation. Moreover, there may be a shift in the weight given to different motives over time.

"The child can remember your voice": parent-child communication about sexuality in the South African context.

There is a wealth of research on parent-child communication about sexual and reproductive health and rights (SRHR) and its influence on young people's sexual behaviours. However, most of it is from the global North. The aim of this study was to explore parent-child communication in three South African provinces: Eastern Cape, KwaZulu-Natal (KZN) and Mpumalanga. Nine, peer, focus group discussions (FGDs) were conducted with young and adult black African men and women in their spoken languages. Data were analysed thematically. Findings revealed that cultural and religious constructions of taboo silenced direct communication and restricted the discussed topics. Parents' older age, low educational level, lack of knowledge, and discomfort in talking about sexuality matters were reported to restrict conversations with children about sex and sexuality. The influence of these factors differed for parents residing in an urban setting who were more liberal than their counterparts residing in more rural areas. The child's age and gender were also reported to be a consideration in approaching these conversations. There is a need for interventions to assist parents on how to communicate with their children about SRHR topics beyond pregnancy and HIV/AIDS. These interventions should take into account and address factors that seem to influence parent-child communication.

Perpetration of physical and sexual abuse and subsequent fathering of pregnancies among a cohort of young South African men: a longitudinal study.

BACKGROUND: Young men's involvement in fathering pregnancies has been substantially neglected in unintended pregnancy research. Gender norms give men substantial power and control over sexual encounters, suggesting that understanding men's role is imperative. We tested the hypothesis that young, unmarried South African men who had perpetrated intimate partner violence (IPV) have a greater incidence of fathering pregnancies. METHODS: The data for this study were collected from 983 men aged 15 to 26 who participated in a 2-year community randomized controlled HIV prevention trial in the rural Eastern Cape. Multivariate Poisson models investigated the associations between baseline perpetration of IPV and fathering subsequent pregnancies, while controlling for age, number of sexual partners, socio-economic status, educational attainment, problematic alcohol use, exposure to the intervention, and time between interviews. RESULTS: Of the men in this study, 16.5% (n = 189) had made a girlfriend pregnant over two years of follow up. In addition, 39.1% had perpetrated physical or sexual intimate partner violence and 24.3% had done so more than once. Men who at baseline had perpetrated IPV in the previous year had an increased incidence of fathering, for a first perpetration in that year IRR 1.67 (95% CI 1.14-2.44) and among those who had also been previously violent, IRR 1.97 (95% CI 1.31-2.94). Those who had ever been violent, but not in the past year, did not have an elevated incidence. The incidence among men who had ever perpetrated physical abuse was less elevated than among those who had perpetrated physical and sexual violence IRR 1.64 (95% CI 1.18-2.29) versus IRR 2.59 (95% CI 1.64-4.10) indicating a dose response. CONCLUSION: Young men's perpetration of partner violence is an important predictor of subsequently fathering a pregnancy. The explanation may lie with South African hegemonic masculinity, which valorizes control of women and displays of heterosexuality and virility, and compromises women's reproductive choices.

Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa.

PURPOSE: There is little research on prevalence of depressive symptoms and associated factors among youth in sub-Saharan Africa. This paper explores factors associated with depressive symptomatology in South Africa. METHODS: A cross-sectional analysis of interviews with 1 415 women and 1 368 men aged 15-26 was undertaken. The Centre for Epidemiological Studies on Depression Scale (CESD Scale) was used to establish depressive symptomatology. RESULTS: The prevalence of depressive symptoms was 20.5% in women and 13.5% in men. For women, depressive symptoms were associated with increased childhood adversity (aOR 1.34 95% CI 1.116, 1.55); drug use (aOR 1.98 CI 1.17, 3.35); experience of intimate partner violence (aOR 2.21 CI 1.16, 3.00); sexual violence before the age of 18 years (aOR 1.45 CI 1.02, 2.02) and lower perceptions of community cohesion (aOR 1.23 CI 1.07, 1.40). For men, depressive symptoms were associated with a mother's death (aOR 2.24 CI 1.25, 4.00); childhood adversity (aOR 1.61 CI 1.38, 1.88); alcohol abuse (aOR 1.63 CI 1.13, 2.35), sexual coercion by a woman (aOR 2.36 CI 1.47, 3.80) and relationship conflict (aOR 1.07 CI 1.01, 1.12). CONCLUSIONS: Depressive symptoms were more highly prevalent in women than in men. Depressed mood was associated with childhood adversity, sexual violence and substance misuse in both women and men. This study further suggests gender differences in that for women, depressive symptoms were associated with intimate partner violence and lower perceptions of community cohesion, while for men the associations were with a mother's death and relationship conflict.

Motivations for, and perceptions and experiences of participating in, a cluster randomised controlled trial of a HIV-behavioural intervention in rural South Africa.

Empirical research on ethical issues in HIV-prevention and gender-based violence research, critical for honing ethical and safety guidelines, is limited. In this paper we describe South African young people's motivations for participating in randomised controlled trial, the prevalence of negative occurrences, participation regrets and associated factors. This trial partly followed, but also deviated from, the WHO safety guidelines for research on violence against women. A total of 1085 women and 985 men provided information two years after the trial start. Most participated for HIV testing and to help their community. Fewer reported motivation by the financial incentive. Minor adverse events included upset from questions on childhood experiences and arguments at home with siblings. Just under 1 in 10 (8.1% women, 9.8% men) regretted participation. Factors were associated with this were keeping some questions secret from their partners, feeling sad about questions on childhood, quarrelling at home and, for women, being motivated by the incentive. Men who had been physically violent to a partner were twice as likely to regret participation. There were no recorded adverse effects from the deviations from the ethical guidelines. Participation regrets mostly stemmed from problems in participants' families preceding the research. There was no evidence that the research had been unsafe.

Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review.

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

Research Site Anonymity in Context.

This paper utilizes critical theory to interrogate and problematize the practice of anonymising research sites as an ethical imperative. The contributing authors conduct research in and with various communities in southern Africa, position themselves and work from and within diverse areas and specialities of the social sciences. This article is developed from their rich and wide spectrum of field experience with a great diversity of communities, but mainly the poorer, under-resourced, socially and economically marginalized. The authors strongly identify with these communities whose anonymity in published research is seen as marginalizing. Such research sites are places and communities where these researchers grew up and live in, and thus not just as peripheral or 'out there' entities. Therefore, the naming of research sites in this context is deemed as being ethical, out of respect for participants, for a contextually embedded understanding, and for well-targeted interventions and policy influence.

Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.

BACKGROUND: Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women. METHODS: We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions. FINDINGS: 128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3) for intimate partner violence. INTERPRETATION: Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources. FUNDING: National Institute of Mental Health and South African Medical Research Council.

Awareness and Rejection Accounts of Intimate Partner Violence by Young Women in Soweto, Johannesburg, South Africa.

Intimate partner violence (IPV) is the most prevalent form of interpersonal violence experienced by women in South Africa. A study conducted with young women from South Africa, aged 13 to 23 years, estimated that 42% experienced physical violence from their intimate partners. The subtle and nuanced social dynamics of IPV are less understood owing to little qualitative research on this subject. This study qualitatively explored how young women perceive and experience IPV. Participants were recruited through snowballing from townships in Soweto, outside Johannesburg. In-depth, face-to-face, and semistructured interviews were conducted with seven young women aged 15 to 20 years. The discourse analysis was implemented to understand participants' construction of IPV. Participants reported direct experiences of IPV and indirect through exposure to interparental and interpersonal violence. Findings indicate a progressive shift of perceptions from absolute tolerance of relationship violence to rejection. However, victim blaming and relegating relationship violence to the private realm still existed. Essentialisation of masculine qualities such as anger was used to construct and understand men's use of violence. Young women highlighted infidelity, pregnancy, and sex demands from their partners as reasons for them being subjected to IPV.

Domesticated Poly-Violence Against Women During the 2020 Covid-19 Lockdown in South Africa.

Globally, increased domestic violence against women during the 2020 Covid-19 lockdowns concerned researchers, policymakers, governments and the civil society. In South Africa, an increased risk for gender-based domestic violence against women during the lockdown period was reported by various sources including the national gender-based violence call centre (GBVCC), the South African Police Service (SAPS) and the civil society. Covid-19 lockdown encouraged spatial distance: a public health measure. This measure inadvertently created social distance and social disconnection. Public life, which is frequently a coping mechanism and an escape for some women and girls at risk of domestic violence, was curtailed by the lockdown rules that forbade movements. Informal sources of help for victims of abuse were limited due to closed economic activities, and community-based helping services for domestic violence were not permitted to open. Some victims of domestic violence struggled with public transportation to access informal help, visit the police, social workers and other sources of help. Some organisations offered online and telephone services. The increased risk of gender-based domestic violence during the lockdown is indicative of poly-violence that women are exposed to. The risk of the domesticated poly-violence during crisis periods could be averted by focussing on risk reduction for all forms of violations against women.

Factors associated with consistent condom use among rural young women in South Africa.

Despite high levels of awareness of HIV, condom use, particularly consistent use, is suboptimal among young South African women. This paper aims to investigate the factors associated with both any condom use and consistent use by young rural women. In this study 1204 sexually active female volunteers, aged 15-26 years, were selected using a two-stage procedure in which firstly 70 clusters were selected and thereafter up to 20 women per cluster were selected, to participate in a cluster randomised controlled trial of an HIV behavioural intervention. This study is analysing cross-sectional data from a baseline survey thus no causal inferences can be drawn. A structured questionnaire was administered at a baseline interview. An estimated 19.9% of young women reported consistent condom use in the 12 months before the interview, while 44.5% reported inconsistent use. Any condom use was associated with higher condom use self-efficacy (adjusted odds ratio (aOR) 1.59; 95% CI 1.41, 1.77), less association of trust with suggested condom use (aOR 0.86; 95% CI 0.82, 0.91), knowing one's HIV status (aOR 2.86; 95% CI 1.52, 5.39) and having a more educated mother (aOR 1.71; 95% CI 1.26, 2.33). Having had just one partner was associated with a lesser likelihood of any condom use (aOR 0.14; 95% CI 0.10, 0.20). Consistent use, compared with inconsistent use, was associated with having just one partner (aOR 3.25; 95% CI 2.23, 4.73), less relationship conflict (aOR 0.84; 95% CI 0.75, 0.91) and higher gender equity in relationships with a male partner (aOR 1.43; 95% CI 1.15, 1.77). Our findings suggest that gender equity, monogamy and harmonious relationships play a positive role in enabling women to reduce their risk for HIV infection. Such aspects of relationship context could form a significant part of the progressive strategies required for HIV-prevention interventions to be successful.

Women living with HIV in South Africa and their concerns about fertility.

Health and quality of life benefits accrued from the availability of highly active antiretroviral therapy (HAART) are commendable, but the social milieu continues to pose challenges for women's decision making around having children. This paper qualitatively explored women's questions and concerns around living with HIV, being on HAART and pregnancy. Women of reproductive age were recruited from Eastern Cape and Gauteng Provinces, South Africa. Information on women's fertility desires and pregnancy planning was collected through participatory workshop, focus groups, and one-on-one interviews. Three main themes emerged. Women living with HIV require information on the impact of HIV on pregnancy outcomes and vice versa. Women who are young, lost a child, not consistently using contraception or who have not been seriously ill have positive reproductive aspirations. Ambivalent attitudes of health care workers towards pregnancy impacts women's fertility aspirations. Unbiased pre-conceptual communication should form part of HIV treatment and care services, despite expressed pregnancy intentions.

Responding to her question: a review of the influence of pregnancy on HIV disease progression in the context of expanded access to HAART in sub-Saharan Africa.

In 2007, sub-Saharan Africa was home to over half of all women living with HIV. The vast majority of these women are of reproductive age, which raises concerns about the high incidence of pregnancy. As access to antiretroviral treatment is rapidly scaled up, two important questions must be answered: (1) Does pregnancy impact HIV disease progression?; (2) Does pregnancy modify the highly active antiretroviral therapy (HAART) response on HIV disease progression? A systematic review of the biomedical literature was conducted and seven relevant studies were identified. To date, it appears that there is no effect of pregnancy on HIV disease progression. Furthermore, initial studies in high-income countries suggest that pregnancy may positively modify the HAART response. These findings, however, must be interpreted with caution as it remains unclear how other factors, such as adherence, may influence the relationship between pregnancy, HIV disease progression, and HAART.

Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence.

We explored the prevalence and predictors of transactional sex with casual partners and main girlfriends among 1288 men aged 15-26 from 70 villages in the rural Eastern Cape province of South Africa. Data were collected through face-to-face interviews with young men enroling in the Stepping Stones HIV prevention trial. A total of 17.7% of participants reported giving material resources or money to casual sex partners and 6.6% received resources from a casual partner. Transactionally motivated relationships with main girlfriends were more balanced between giving (14.9%) and getting (14.3%). We constructed multivariable models to identify the predictors for giving and for getting material resources in casual and in main relationships. Each model resulted in remarkably similar predictors. All four types of exchange were associated with higher socio-economic status, more adverse childhood experiences, more lifetime sexual partners, and alcohol use. Men who were more resistant to peer pressure to have sex were less likely to report transactional sex with casual partners, and men who reported more equitable gender attitudes were less likely to report main partnerships underpinned by exchange. The most consistent predictors of all four types of transaction were perpetration of intimate partner violence and rape against women other than a main partner. The strong and consistent association between perpetration of gender-based violence and both giving and getting material goods from female partners suggests that transactional sex in both main and casual relationships should be viewed within a broader continuum of men's exercise of gendered power and control. HIV prevention interventions need to explicitly address transactional sex in the context of ideas about masculinity, which place a high emphasis on heterosexual success with, and control of, women.

Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa.

OBJECTIVES: To examine associations between the perpetration of intimate partner violence and HIV risk behaviour among young men in rural South Africa. DESIGN: An analysis of baseline data from men enrolling in a randomized controlled trial of the behavioural intervention, Stepping Stones. METHODS: Structured interviews with 1275 sexually experienced men aged 15-26 years from 70 villages in the rural Eastern Cape. Participants were asked about the type, frequency, and timing of violence against female partners, as well as a range of questions about HIV risk behaviours. RESULTS: A total of 31.8% of men reported the perpetration of physical or sexual violence against female main partners. Perpetration was correlated with higher numbers of past year and lifetime sexual partners, more recent intercourse, and a greater likelihood of reporting casual sex partners, problematic substance use, sexual assault of non-partners, and transactional sex. Men who reported both physical and sexual violence against a partner, perpetration both before and within the past 12 months, or more than one episode of perpetration reported significantly higher levels of HIV risk behaviour than men who reported less severe or less frequent perpetration of violence. CONCLUSION: Young men who perpetrate partner violence engage in significantly higher levels of HIV risk behaviour than non-perpetrators, and more severe violence is associated with higher levels of risky behaviour. HIV prevention interventions must explicitly address the links between the perpetration of intimate partner violence and HIV risk behaviour among men, as well as the underlying gender and power dynamics that contribute to both.

Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors.

Sexual violence is a well-recognised global health problem, but there has been remarkably little research on men as perpetrators. The objectives of this paper are to describe the prevalence, patterns and factors associated with rape of an intimate partner and a woman who was not a partner with men aged 15-26 years in rural South Africa. The analysis presented here is of data collected during a baseline survey of participants in a cluster randomised controlled trial of an HIV behavioural intervention. A total of 1370 male volunteers were recruited from 70 rural South African villages. They completed a questionnaire asking about background, sexual practices and perpetration of rape and intimate partner violence. Among these men 16.3% had raped a non-partner, or participated in a form of gang rape; 8.4% had been sexually violent towards an intimate partner; and 79.1% had done neither. The mean age of first rape was 17 years. There was overlap between rape of a non-partner and partner, in that 44.3% of men who raped an intimate partner had also raped a non-partner, but overall the great majority of men who raped did not disclose both types of rape. The factors associated with rape of an intimate partner and non-partner had similarities and differences. After adjusting for the other variables, both forms of rape were strongly associated with ever having been physically violent to a partner, having had transactional sex with a casual partner and more sexual partners. Non-partner rape was also associated with peer-related variables, including gang membership and peer pressure to have sex, and also drug use. Non-partner rape was more common among wealthier and relatively more socially advantaged men. Both types of rape were associated with having more adverse childhood experiences. There was considerable overlap between rape-associated factors and known HIV risk factors, suggesting a need for further research on the interface of rape and HIV, and integrated prevention programming.

Gender-based violence and absent fathers: a scoping review protocol.

INTRODUCTION: Gender-based violence (GBV) and absent fathers are two epidemics that affect women and children in sub-Saharan Africa. However, the understanding of the complex links between GBV and absent fathers is currently inadequate. The aim of the study is to provide an overview of documented evidence that links GBV and absent fathers as well as identifies areas that require systematic review and where more primary research is needed. METHODS AND ANALYSIS: The search strategy for this scoping review study will involve electronic databases including: Academic Search Premier, Ingenta, Kluwer Online, PsycARTICLES (EBSCO), PsycINFO (EBSCO), Social Work Abstracts and Sociological Collection. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by two reviewers in parallel. A thematic analysis of the studies will be carried out to extract relevant outcomes using NVIVO. DISCUSSION: We anticipate finding a large number of studies on GBV diagnostic interventions in sub-Saharan Africa which, once summarised, will be useful to guide future research. The protocol for the scoping review has been registered in PROSPERO. DISSEMINATION: The study will be disseminated electronically and in print. It will also be presented to conferences related to GBV, Father Connections and Children's Health. PROSPERO REGISTRATION NUMBER: CRD42015022094.

Understanding the Relationships between Gender Inequitable Behaviours, Childhood Trauma and Socio-Economic Status in Single and Multiple Perpetrator Rape in Rural South Africa: Structural Equation Modelling.

BACKGROUND: Interventions to prevent rape perpetration must be designed to address its drivers. This paper seeks to extend understanding of drivers of single and multiple perpetrator rape (referred to here as SPR and MPR respectively) and the relationships between socio-economic status, childhood trauma, peer pressure, other masculine behaviours and rape. METHOD: 1370 young men aged 15 to 26 were interviewed as part of the randomised controlled trial evaluation of Stepping Stones in the rural Eastern Cape. We used multinomial to compare the characteristics of men who reported rape perpetration at baseline. We used structural equation modelling (SEM) to examine pathways to rape perpetration. RESULTS: 76.1% of young men had never raped, 10.0% had perpetrated SPR and 13.9% MPR. The factors associated with both MPR and SPR (compared to never having raped) were indicators of socio-economic status (SES), childhood trauma, sexual coercion by a woman, drug and alcohol use, peer pressure susceptibility, having had transactional sex, multiple sexual partners and being physically violent towards a partner. The SEM showed the relationship between SES and rape perpetration to be mediated by gender inequitable masculinity. It was complex as there was a direct path indicating that SES correlated with the masculinity variable directly such that men of higher SES had more gender inequitable masculinities, and indirect path mediated by peer pressure resistance indicated that the former pertained so long as men lacked peer pressure resistance. Having a higher SES conveyed greater resistance for some men. There was also a path mediated through childhood trauma, such that men of lower SES were more likely to have a higher childhood trauma exposure and this correlated with a higher likelihood of having the gender inequitable masculinity (with or without the mediating effect of peer pressure resistance). DISCUSSION: Both higher and lower socio-economic status were associated with raping. Prevention of rape perpetration must focus on changing men's gender ideals, entitlements and inequitable practices. Reducing poverty and adverse childhood experiences should also be of benefit.

The second wave of violence scholarship: South African synergies with a global research agenda.

Violence is a serious public health and human rights challenge with global psychosocial impacts across the human lifespan. As a middle-income country (MIC), South Africa experiences high levels of interpersonal, self-directed and collective violence, taking physical, sexual and/or psychological forms. Careful epidemiological research has consistently shown that complex causal pathways bind the social fabric of structural inequality, socio-cultural tolerance of violence, militarized masculinity, disrupted community and family life, and erosion of social capital, to individual-level biological, developmental and personality-related risk factors to produce this polymorphic profile of violence in the country. Engaging with a concern that violence studies may have reached something of a theoretical impasse, 'second wave' violence scholars have argued that the future of violence research may not lie primarily in merely amassing more data on risk but rather in better theorizing the mechanisms that translate risk into enactment, and that mobilize individual and collective aspects of subjectivity within these enactments. With reference to several illustrative forms of violence in South Africa, in this article we suggest revisiting two conceptual orientations to violence, arguing that this may be useful in developing thinking in line with this new global agenda. Firstly, the definition of our object of enquiry requires revisiting to fully capture its complexity. Secondly, we advocate for the utility of specific incident analyses/case studies of violent encounters to explore the mechanisms of translation and mobilization of multiple interactive factors in enactments of violence. We argue that addressing some of the moral and methodological challenges highlighted in revisiting these orientations requires integrating critical social science theory with insights derived from epidemiology and, that combining these approaches may take us further in understanding and addressing the recalcitrant range of forms and manifestations of violence.