Rape myths,alcohol intoxication and condom use among males accused of sexual assault in Kabale,rural Uganda

Introduction

Sexual assault is a major public health issue due to the associated violence, transmission of sexually transmitted infections (STIs), substance or alcohol abuse, post-traumatic complications and risky sexual behaviour. ^1–3 Both date rape and acquaintance rape can lead to serious health and adjustment problems for the victims. Many sexual assaults are committed by known offenders (including friends, acquaintances, intimate partners and relatives), although how often this occurs is not well documented. ^3–6 Assault survivors may be treated differently depending on their relationship to the perpetrator. The circumstances of the sexual assault experience influence the coping and adjustment of survivors and stranger assaults may be associated with a greater perceived future threat by the victims. ^1,2,5–7 Victims of stranger rape report more negative social reactions than victims of acquaintances or romantic partners and assaults by strangers and relatives are associated with more post-traumatic stress disorder symptoms than assaults by acquaintances or romantic partners. ^3–6 The objective was to assess whether the characteristics of the perpetrators and the circumstances of the alleged sexual assault differ in acquaintance and stranger rape.

Methods

Conducted at the Kabale Regional Hospital from June 2009 to June 2010, this cross-sectional study assessed suspected (accused) rape offenders who were referred to the hospital from police stations for forensic medical examination in order to provide evidence of the rape allegations. This assessment was not part of the routine care or a routine requirement by the judicio-legal system. Participants, who were recruited by nurses in the unit, were subsequently interviewed using a semi-structured interviewer-administered questionnaire in private and, specifically, in the absence of any police or judicial officers. Data were collected on the socio-demographic variables, social habits and circumstances under which the allegations were made. From the medical records, interviewers were assessed for the presence of genital tears, bruises or any forensic marks on the body of the accused. Data were analysed using the SPSS software. Ethical approval was obtained from the Ethics Committee of Kabale Regional Hospital, and the authority to interview the respondents was obtained from the Police Commander. Respondents received assurances that the interview was not part of routine care, their individual identities were not to be disclosed and that confidential information given was not to be produced as evidence against them in a court of law. All received counselling on sexuality, condom use and HIV.

Results

The mean age of the 111 men accused of sexual assault was 26.6 years (±10.1 years): 67.2% knew their accuser; 73.0% were the sole accused; 25.0% were involved in gang rape; and 16.2% were caught red-handed. The mean age differed significantly between acquaintance and stranger rape (26.3 and 23.3 years, respectively; P = 0.012; Table 1). However, there was no difference in the socio-demographic and lifestyle characteristics between stranger rape and acquaintance rape and between intimate partner rape and non-intimate partner rape. There were no differences regarding the awareness of the risk of the acquisition or transmission of HIV or STIs and awareness that rape was a serious crime. When perpetrators of stranger and acquaintance accused were compared, there were no differences regarding the knowledge by the respondents of the survivor's HIV status or the use of condoms. In contrast, the comparison between intimate partner and non-intimate partner sexual assault showed a markedly lower knowledge by the respondents of the survivor's HIV status and use of condoms.

Table 2 shows that, when an accusation of rape by a stranger and by an acquaintance was claimed, there was no difference in presence of genital or extra-genital injuries or in the time lapse between the alleged crime and the forensic examination. Gang rape was significantly more common in non-intimate partner sexual assault. In intimate partner sexual assault, the crime was less likely to have occurred outside either the assailant's or the survivor's home settings and the arrest occurred much earlier (within 24 h). Reasons as to why the accused committed the offence included: the need for sexual gratification and to change partners; failure to recognize that the partner refused sex; failure to resist the temptation; being drunk; trying to pay back for money spent on the woman; or thinking that the victim had consented. There was no difference in these reasons across the different types of sexual assault.

Discussion

Overall, our study shows no major differences in characteristics of alleged perpetrators of sexual assault or the circumstances associated with the episode, irrespective of whether this was stranger rape or acquaintance rape, and that many sexual offenders knew their victims (as neighbours, teachers, friends or relatives). Our findings indicate the pervasive role of alcohol in sexual offenses (many of the accused were drunk or could not remember being sober at the time of the alleged crime) and that possibly the victims were also drunk. Alcohol is the most commonly abused substance in sexual assaults and its use is related to severity or frequency of injuries. ^1,7,8 Injuries to perpetrators may arise from the victims fighting back in self defence. Assaults where only the offender is under the influence of alcohol involve more use of weapons, force, profane language and threats than assaults without substance use or assaults with both parties using substances. ^7,8

Our study shows that there is a pervasiveness of rape myths among sexual offenders – such as myths that women are to blame for rape experiences, that no woman can be raped if she does not want to be, and that when a woman says ‘no’ she really means ‘yes’. ^3,4,6,9 Sexual assault is associated with the misperception of friendliness from the opposite sex as a sign of sexual interest, flirtation or promiscuity, mistakenly imputed from attire, verbal and nonverbal cues. ^3–4

Our findings indicate that condom use was uncommon during sexual assault. Compared to consensual sexual activity, sexual assault is more likely to involve genital injury and non-use of condoms and, therefore, more likely to result in the transmission or acquisition of STIs. ^1,5,8,10 Our findings also indicate that sexual assault perpetrators tend to normalize their actions, trivialize the offense, shift the blame to the victims, seek to absolve themselves from full responsibility for their actions or position their victims' sexual behaviour as provocation or justification for the crime.

Conclusion

Despite the presence of several typologies that have been suggested, we found that the characteristics of stranger and acquaintance sexual assault perpetrators were similar.

Authors' contributions

DKK and OK conceptualized the study. DKK, OK and MOO designed the study instrument. MOO piloted the study instruments and collected the data. DKK and OK conducted the data analysis. DKK wrote the first draft of the manuscript. All co-authors contributed to revision of the subsequent drafts and approved the final version of the manuscript.

Competing interests

The authors declare no competing interests.