Child sexual abuse (CSA), which is common in sub-Saharan Africa, infringes on children’s rights and dignity. It entails the sexual exploitation of underage boys and girls for commercial gains. CSA has been attributed to four causal factors: “poverty, poor living conditions, migration, and economic and social insecurity” (Kistner, Fox & Parker, 2004, p. 6).
Moreover, child welfare programs are inadequate in sub-Saharan Africa, which makes children vulnerable to sexual exploitation and the impacts of HIV/AIDS infection. Globally, South Africa is ranked among countries with the highest cases of child sexual abuse and rape. Kistner, Fox, and Parker (2004) divide the CSA risk factors into two groups: (1) causes related to inadequate child health care programs and (2) those associated with children vulnerability to sexual abuse.
Child vulnerability entails those factors that make children prone to CSA perpetrators, i.e., individuals who seek sexual gratification from children. Many of the perpetrators have diagnosable psychological disorders. Nevertheless, other factors besides the criminal psychopathologies of the perpetrators can explain the high CSA cases in sub-Saharan African countries such as South Africa.
In South Africa, child sexual abuse has been associated with a number of factors, including socioeconomic problems (extreme poverty), the disintegration of the family unit, single parenthood, inadequate and erratic primary care, and foster childcare.
In particular, the apartheid practices created social and economic disparities between the different races, disrupted families due to “labour migration”, and centralised migrant workers into “dormitory townships” (Kistner, Fox & Parker 2004, p. 11). Some of these practices still exist in South Africa. Currently, flourishing informal settlements in major cities such as Cape Town have robbed families of social cohesion that is characteristic of African families.
This has resulted in fragmented or unregulated child welfare plans, which exposes children to sexual abuse and HIV/AIDS. Young children have to migrate from their rural homes to the informal settlements where their parents reside. This makes children insecure and vulnerable to abuse due to unstable child care plans.
HIV/AIDS is one of the effects of sexual abuse of children. In particular, the vulnerability of orphaned children places them at a greater risk of contracting HIV because of unstable child care plans. Adopted children or those under foster care are also prone to maltreatment and sexual abuse.
Moreover, children who lack parental of foster care end up in city streets where they may engage in prostitution, which exposes them to the risk of contracting HIV/AIDS. Child prostitution, as in other poor countries, is rife in South Africa and it involves young girls. The girls come from economically poor families or neighbourhoods.
Any sexual act involving underage children (below 18 years) amounts to abuse because it does not involve consent. Children, unlike adults, are not considered able to make informed decisions. Therefore, child sexual abuse is considered an abuse of power, as the adult and the child have “differential levels of knowledge, age, and gratification” (Kistner, Fox & Parker 2004, p. 9).
It has been found that child rape is largely motivated by power and dominance, not sexual gratification (Kistner, Fox & Parker 2004). In this regard, child sexual abuse is a form of violence against young children by adults.
This essay analyses CSA in South Africa in relation to the disempowerment of children in socioeconomic and psychological terms, which makes children vulnerable to HIV/AIDS infection. In particular, the paper examines the relationships between CSA, child vulnerability, and HIV transmission. This three-dimensional approach differs from the psychopathological perspective commonly employed in similar analyses. The psychopathological approach is grounded on the evaluation of the abuser’s psychological status to explain his or her actions.
In this paper, the psychological and sociological factors that underlie child sexual abuse will be examined in the context of disempowerment. This will allow a detailed analysis of the specific relationship factors that predispose children to sexual abuse.
It will examine how the failure to meet children’s needs within a familial context increases the risk of child prostitution, which leads to high HIV/AIDS transmission incidences. The paper will also explore how traumatic experiences endured by child victims of sexual abuse affects their ability to form trusting relationships later in life.
Review of Evidence
Definition of Childhood and Child Sexual Abuse
Child sexual abuse describes the participation of minors in sexual acts, which they do not understand, agree to, or ready to engage in. In most countries, a child or a minor is a person who has not attained the age of 18. This age is the legal age that most countries use to describe a person who has the capacity to make informed decisions or give consent to sexual acts in which he or she is involved. This age limit is meant to protect children from exploitation and thus, sexual intercourse involving a minor is illegal in most countries.
In South Africa, child protection laws are rather weak. For instance, a minor, aged 14 years, can give consent to terminate a pregnancy with no parental involvement (Kistner, Fox & Parker 2004, p. 13). Moreover, the South African child protection policy illegalises rape and sexual exploitation involving children under the age of 16. The Sexual Offenses Bill further illegalises sexual intercourse involving a minor (below 16 years) and a person who exceeds him or her by three years or more (Kistner, Fox & Parker 2004).
This law applies to all instances regardless of whether consent was given or not. Thus, in South Africa, the legal age, which a person can engage in sexual acts, is 16 years (Kistner, Fox & Parker 2004). Childhood is defined as “the age characterised by rapid growth and development in a person’s life” (Kistner, Fox & Parker 2004, p. 18). This period is also marked with heavy parental dependence for basic needs, including clothing, food, and shelter, as well as for emotional support.
Thus, childhood is essentially the age in life where a person (minor) undergoes rapid growth, develops psychologically, intellectually, emotionally, and socially to become an adult. The growth and development are highly influenced by the social and economic contexts in which a minor is living. Thus, social and economic factors of the households influence a child’s growth and development, as well as his or her psychological wellbeing in adulthood.
Therefore, CSA can be described as the “sexual violence” meted against children by someone who wields more power than they do (Kistner, Fox & Parker 2004). The children in this case are considered vulnerable since they lack the capacity to object to sexual advances made by a person of high authority. Thus, CSA involves a misuse of power by an adult for his or her own sexual gratification. From a psychological viewpoint, CSA is a form of social control over children.
As aforementioned, in South Africa, the statutory law requires that no adult should engage in sexual acts with a minor (below 16 years), nor should the “age difference exceed three years” (Kistner, Fox & Parker 2004, p. 21). The recommended age difference is grounded on social power and control dynamics. In the South African context, it is considered rape to engage in sexual intercourse with a minor who is three years your junior, regardless of whether consent was given or not.
From a psychological perspective, the reason for committing sexual violence against young children is the desire to exercise dominance and power over them. In this regard, social dominance makes children vulnerable and exposes them to the effects of sexual intercourse, including HIV/AIDS. Thus, CSA can be defined as “the inducement of sexual activity in children for the gratification of individuals who are in powerful positions” (Kistner, Fox & Parker 2004, p. 25).
It includes acts such as:
- masturbation involving a minor and an adult;
- sexual acts that do not involve penetration;
- touching of a child’s genitalia;
- sexual advances or threats;
- child pornography;
- child prostitution, among others.
Sexual coercion and incest are also considered forms of child abuse. Forced marriages, abortion, contraception, rape, and genital viewing or contact also amount to sexual abuse.
In most cases, the perpetrators of CSA are people close to the child, such as a relative, foster parents, or family member and friends. It may go unnoticed for a long time exposing the child to the trauma and sexually transmitted infections (STIs). Chronic sexual abuse may leave the child with psychological and emotional wounds, which may lead to psychological disorders like posttraumatic stress disorder or PSTD later in life. Moreover, it may be difficult to detect child abuse if the perpetrator is a family member of a person close to the child.
It is important to note that both young boys and girls are at risk of sexual abuse. Often, victims of CSA are believed to be young girls with “adult males considered the perpetrators” (Kistner, Fox & Parker 2004, p. 22). However, research evidence shows that male children are also at risk of sexual abuse. This underscores the fact that all children are vulnerable to the CSA, which increases their risk of contracting HIV/AIDS.
Child Sexual Abuse: a Historical Perspective
Child sexual abuse is a product of the interactions between “the state, social agencies/institutions, and the individual” (Kistner, Fox & Parker 2004, p. 27). It is a product of the “social problems”, which, historically, have been attributed to inadequate social protection policies.
Kistner, Fox, and Parker (2004) attribute the social problems to “moral panic” that engulfs a society rendering it unable to address emergent issues. They define “moral panic” as the “stereotypical representations”, which form the basis of sustained social regulation (Kistner, Fox & Parker 2004, p. 33). Social regulation entails the treatment of “a deviant act” in a way that reflects the needs and interests of the public.
‘Moral panics’ are constructs of the media, which tend to refocus our attention to or away from the problems affecting the society. In this regard, an adult who perpetrates child sexual abuse is labelled as a person with “deviant behaviour”, a paedophile, or a pervert who threatens the moral fabric of the society (Kistner, Fox & Parker 2004). In social terms, such persons are considered ‘outsiders’ who should be removed from the society.
This shows child sexual abuse is culture specific. Child sexual abuse is a relatively new phenomenon, which emerged in the 1960s. Before this period, child abuse was considered a form of “cruelty to children” (Kistner, Fox & Parker 2004, p. 36). Historically, this vice was prevalent among the lower middle-class citizens. It was considered a threat to national stability because abused children often exhibited criminal tendencies later in life.
However, in the 1960s, child abuse was identified as a widespread social problem requiring urgent psychosocial interventions. This new approach was accompanied by a rise in juvenile delinquency and deaths. As a result, paediatricians investigated child abuse incidences in Denver. They concluded that a ‘battered’ child is likely to perpetrate violence against minors as an adult.
However, in the 1990s, researchers found no correlation between an abused child and child violence perpetration. It is important to note that before 1970s, child abuse did not encompass acts of sexual violence; instead, it denoted any form of bodily harm inflicted on a child. It was in the late 1970s that a broad definition, which included sexual violence, was included. In particular, in Britain and the US, the traditional meaning of child abuse was expanded in the 1990s to include vulnerability.
It was noted that income poverty exacerbates vulnerability to sexual abuse. Moreover, lack of primary care services predisposed children to sexual abuse. In this regard, a nation with inadequate social welfare programs for children was found to have high child abuse incidents. Disintegration of families due to rural-urban migration has also been associated with immorality among adults, which exposed children to early sex.
CSA in South Africa
CSA in South Africa can be explained in the contexts of models, media depictions of abuse, and the effectiveness of the interventions. It was not until the 1980s that South Africa identified child sexual abuse as an infringement upon children’s rights and dignity. Subsequently, policies were adopted to protect the children against sexual exploitation and violence. Before then, CSA was rare and the perpetrators were people with psychiatric problems.
In 1984, a statutory body, the South African Society for the Prevention of Child Abuse and Neglect was founded with the sole mandate of protecting children against acts of violence and sexual abuse. In 1987, the issue of CSA took centre stage in South African politics following a media revelation that child abuse increases the risk of HIV/AIDS transmission among minors. Consequently, Child Protection Units were formed in poor neighbourhoods in cities such as Pretoria, Johannesburg, and Cape Town (Kistner, Fox & Parker 2004).
However, due to the political upheavals of 1980s, many minors were unlawfully detained for security reasons. At the time, the detention of children was not considered unlawful. Nevertheless, the media began a spirited campaign to secure the release of children under detention claiming that they were being abused sexually. To improve the public image of the police, the government raided various detention centres to investigate the allegations of child pornography.
The intention was to protect the society from such vices, as it was believed that abused children would turn to be perpetrators of the same crime in adulthood. As the apartheid era neared its end, the belief that children were the victims of abuse shifted to minors as the sexual violence victims. HIV/AIDS has been linked to the rise in cases of child sexual violence.
In some studies, the spread of the disease has been associated with traditional myths whereby black South Africans rape young children in a bid to cleanse themselves of HIV. Moreover, adolescents engage in risky sexual behaviours because the society portrays them as “hypersexual”, which, according to Kistner, Fox, and Parker (2004), is one of the leading causes of the HIV/AIDS epidemic in South Africa.
Vulnerability among South African Children
The causes of vulnerability (among children) to sexual abuse are many. In most countries, including South Africa, a child is considered vulnerable to abuse. South African’s Department of Social Development considers children who are “sick, orphaned, or abandoned” as prone to acts of sexual violence by adults (Kistner, Fox & Parker 2004, p. 31). In particular, child-headed homes or street settlements expose children to substance abuse and trafficking, and other related vices such as teenage sex.
In a bid to make a living, they engage in “child labour or prostitution” in the city streets. Research has found that children of a single mother are more prone to teenage sex, as the adult parent cannot raise enough income to provide for them. Children under foster parenthood are also vulnerable to maltreatment and sexual exploitation because in such households primary care is often inadequate.
Abused children are at risk of contracting sexually transmitted infections (STIs), including HIV. Those affected or infected by the disease are disadvantaged with regard to “education, primary health care, nutrition, growth and development, and shelter” (Kistner, Fox & Parker 2004, p. 31). The children also suffer from grief and stress following the loss of a parent. They are at a greater risk of developing psychosocial disorders, which will prevent them from leading a normal life in adulthood.
As aforementioned, children who are orphans, disabled, destitute, and under foster care are vulnerable to CSA and HIV/AIDS infections. Orphans are children who have lost a mother, as the primary caregiver (Kistner, Fox & Parker 2004). Often, the loss of a mother has significant emotional and psychological effects. In contrast, the death of a father has significant economic impacts on the family unit.
In South Africa, unlike other developed nations, orphaned children (those whose parent has died from AIDS-related complications) are not beneficiaries of the Child Support Grant. This leaves them vulnerable to exploitation because of lack of child support. The death of a parent(s) leaves the orphans under the care of relatives. In South Africa, the enumeration of orphans during national census is often poor because they are considered members of the extended family.
Kistner, Fox, and Parker (2004) outline four factors that contribute to the inaccurate enumeration of orphaned children nationally. First, social stigma associated with foster care makes their enumeration impossible since they are often moved to distant households for care. Second, some children become parents before attaining the legal age of 18 and thus, do not qualify as orphans. Third, over-enumeration can also arise when households headed by a single mother give incorrect information in the hope of getting state assistance.
Fourth, under-enumeration can also arise when an orphan is defined as a child who has lost a mother, not a father. Kistner, Fox, and Parker (2004) estimate that underestimation of South Africa’s orphans ranges between 40 and 70 percent. In South Africa, single-parent families are many.
This has been attributed to a range of factors, including “teenage pregnancy, low rates of marriage, and absent parents due to labour migration” (Kistner, Fox & Parker 2004, p. 37). In this view, by focusing on single-parenthood alone may not give a true picture of the number of orphan children in South Africa.
Besides orphans, children are vulnerable to HIV/AIDS infection when they assume the responsibility of caring for a parent, who may be infected. The illness or death of a parent, as the breadwinner of the family, may affect the children’s education, as they are forced to drop out due to non-payment of fees. Moreover, researchers establish a positive correlation between disability among children and vulnerability (Kistner, Fox & Parker 2004).
Thus, disability and the death of a parent affect social cohesion, which makes young children, especially girls, vulnerable to sexual abuse. On the other hand, boys are prone to abuse as child labourers, which affect their psychological and social wellbeing.
They suffer from stigma, stress, anxiety, and loneliness, which hamper their growth and development. It is important to note that, unlike in the past where the extended family system was the norm, current households tend to be nuclear due to economic constraints. Thus, often, the needs of orphaned children go unfulfilled, which places them at a greater risk of abuse.
Disabled children constitute the other category of minors prone to abuse. They can be abused sexually, emotionally, or physically because of their complex care needs and overreliance on others for support. The Department of Welfare reports that up to 12% of the citizens in South Africa have at least one form of disability (Kistner, Fox & Parker 2004).
This proportion of the population is vulnerable to violence due to high poverty rates and overdependence on others. Normal persons perpetrate the abuse because the disabled rely on them for care and support.
In this regard, disabled people, and especially children, are vulnerable to abuse because they cannot defend themselves or object to sexual advances made by their primary caregiver. In 1998, about 60 percent of South African children were from poor families (Kistner, Fox & Parker 2004). In provinces, such as the Free State and Eastern Cape, the proportion of minors living in poverty was over 70 percent.
The large proportion of poor children in these provinces is attributable to HIV/AIDS pandemic. Infected parents die, leaving the children with no support or care. It is estimated that about “13% of children between the ages of two and fourteen” belong to a single parent household or are orphaned (Kistner, Fox & Parker 2004, p. 41).
In cases where both parents have died, children (below 18 years) take up the responsibility of caring for their younger siblings. It is estimated that South Africa has approximately 885,000 orphans aged 18 years and below with a majority of them (38%) being left alone after the death of both parents due to HIV related complications.
The records about sexual abuse of South African’s children are scanty because most cases go unreported. Children fail to report cases of molestation to the authorities because the abuser is often a relative. Besides, even if the cases are reported, the police may not investigate it further for fear of subjecting the victim to trauma.
It is believed that child abuse has been on the rise since 1998 where “5,500 cases of sexual abuse were reported” (Kistner, Fox & Parker 2004, p. 44). In 2000, 8,044 cases were reported (Kistner, Fox & Parker 2004). The increase in the number of cases reported is attributable to enhanced awareness regarding the vice, education, and expansion in child welfare programs.
Due to enhanced awareness, more cases of CSA are reported monthly in most communities. Social welfare organisations record high cases of child rape and sexual abuse. Baby rape has also been on the rise in rural areas such as Mpumalanga, where at least one case is reported after every two months.
Increased media coverage of cases of child rape has enhanced public awareness and contributed to improvements in reporting of such incidents. More black females (28%) than males (17%) in South Africans report that they engage in sex against their will, which indicates that males often perpetrate CSA.
CSA Reporting in South Africa
Often, CSA cases go unreported because the perpetrator is relative or a person close to the minor. Thus, a child victim may not report sexual abuse because the experience may be scary and traumatic. Furthermore, some children may not understand that they have been sexually abused and thus, may fail to report it. Threats from the perpetrators also make the child not to disclose sexual abuse meted on him/her. They are told to keep the sexual abuse secret lest they are physically harmed.
Moreover, the perpetrators use gifts to lure the children into engaging in sexual acts with them. The child may feel that he/she consented to sex by accepting the perpetrator’s presents. When the child reports cases of abuse, not many people believe him or her, which promotes repeated CSA. The child may also feel that by revealing sexual abuse he or she may be rejected by the family members. In this regard, if the abuse involves a family member, as the perpetrator, the child may be pressured not to reveal CSA to the authorities.
Kistner, Fox, and Parker (2004) identify sexual abuse risk factors as poor mother-child relationship and overdependence on the perpetrator for care and support. Such children are prone to sexual abuse and emotional maltreatment. Most CSA victims identify teachers, family member, and friends as the perpetrators of the vice. Although cases of sexual abuse are high, few children inform the authorities. Most individuals deny being victims of abuse or retract earlier reports of abuse.
This makes it difficult to keep correct records of CSA in South Africa. The authors identify two ways that children disclose CSA: intentional and unintentional. Most cases of sexual abuse are identified unintentionally when the child complains of health problems that require medical attention. A healthcare professional can also check for physical injuries, which indicate child abuse.
CSA can also be identified unintentionally through “sexualised behaviour exhibited by the child” (Kistner, Fox & Parker 2004, p. 43). The offender may also confess to others about his or her actions.
In Alexandra, a small urban centre in South Africa, the number of children infected with STIs was found to be high. In this case, unintentional disclosure (STIs) indicated rampant child sexual abuse in this township despite many cases being unreported. Learning, child welfare, and religious institutions can encourage children to report cases of abuse or seek medical treatment when sexually molested. Family support is essential in allowing the child to cope with the CSA experience.
The interaction between the child and family, peers, and teachers at school determines his/her ability to cope with the trauma associated with CSA. If the child does not interact freely with the others, he/she may not get social care or medical treatment. On the other hand, the lack of social and legal services and medical care can hamper the child’s recuperation from CSA.
Kistner, Fox, and Parker (2004) outline five reasons why most CSA cases in South Africa are not reported. First, the criminal justice system in upcountry areas does not provide mechanisms for confidential reporting. Thus, child victims may fear reprisals from perpetrators. Second, CSA often involves family members who may prevent the child from reporting to the authorities. Instead of pursuing legal recourse, CSA cases are resolved through consensus within the family unit.
Third, since children depend on parents or family members for care and financial support, they feel that feel obligated to protect the perpetrators from legal action. Fourth, in most cases, the perpetrators pay money to the victim’s family as a compensation for the abuse committed and thus, no legal action is pursued. Fifth, sometimes the child may feel that he/she contributed to the abuse and as a result, fail to disclose it.
Underreporting of CSA cases is also attributable to the inadequate criminal justice system. Often, the police have been blamed for being insensitive to the child victims. Victimisation of abuse victims also deters them from reporting rape cases to the law enforcement officers. They are subjected to verbal abuse, intimidation, and other acts of aggression when reporting such cases. Children are also reluctant to inform the police because the case may not have sufficient evidence that can lead to the prosecution of the offender.
In 2000, about 45% of CSA cases were brought to the attention of the police with over 40% of them being drawn because they did not meet certain evidential threshold (Kistner, Fox & Parker 2004). The common argument advanced by perpetrators is that minors have poor memory and thus, can give incorrect information regarding the assault. Nevertheless, research evidence indicates that the minor’s memory is reliable and thus, the information given by a child is truthful (Kistner, Fox & Parker 2004).
CSA Risk Factors
Several factors predispose a child to sexual abuse. The authors divide the risk factors into two groups: availability of quality care and child support factors. Income poverty due to unemployment makes children vulnerable to sexual abuse. Violence within the home creates conditions that do not favour CSA reporting and thus, a risk factor for sexual abuse. Another risk factor is family breakdowns, which deprive children of social and emotional support.
Substance abuse involving a parent can also make children vulnerable to sexual exploitation and abuse. In most rural communities, child welfare and protection programs are lacking. In this regard, the children cannot report cases of sexual abuse since the reporting channels are absent. Cultural customs that do not protect the rights of women and children is another CSA risk factor. Other risk factors include limited economic, educational, and social opportunities for children and women, and absence of parental support.
CSA is common among children who are from single parent households, lack primary care services, and live in foster homes. In particular, orphans whose parents have died from HIV/AIDS are highly vulnerable to abuse. The WHO outlines the criteria for evaluating the risk of CSA. The robustness of a country’s criminal justice system, the cultural norms that define interpersonal relationships and the poverty levels are some of the predictors of the level of CSA in a given place.
Other predictors include political instability, the presence of organised criminal gangs, and lack of child support systems. Most sexual violence victims belong to the lower middle class because they lack primary support services. Overall, in South Africa, CSA transcends racial, economic, and social lines.
CSA offenders exhibit certain behaviours that set them apart from the other members of the society. They are often “protective and strongly attached to the child” (Kistner, Fox & Parker 2004, p. 53). They also tend to be drug addicts and are sexually suggestive to the child. Victims of child abuse often become the perpetrators in adulthood. In other words, most CSA perpetrators experienced sexual molestation during their childhood. Nevertheless, not all offenders were victims of CSA during their childhood.
Some just witnessed sexual abuse being perpetrated on other children. In South Africa, over 60 percent of CSA offenders are “family members, teachers, or friends” (p. 56). With regard to family members, fathers, stepfathers, brothers, and other males known to the child are the leading abusers. Abuse by family members is often repeated for a long time, as the child victim may be afraid to report the abuse.
Often, the abuser is the breadwinner of the family and thus, child victims may find it difficult to report him or her. Prolonged abuse of a child by a family member increases the risk of contracting HIV and other STIs. Teachers can also perpetrate child abuse. Teachers exercise power and control over children in schools. Parental control in schools is minimal or absent. Teachers can access the children’s dormitories and thus, students are vulnerable to abuse.
Teachers can also seek sexual favours from underperforming students to give them better grades. In some schools, sexual abuse incidents are not reported because of most principals’ reluctance to address such cases. Instead, they refer abuse victims to police stations. ‘Cover-ups’ are also common when the perpetrator is a teacher, which means that less cases of abuse can be pursued at the school level.
The South African Council for Educators (SACE), a non-governmental organisation involved in child welfare, reports students engaged in a sexual relationship with their teachers are at a high risk of contracting HIV (Kistner, Fox & Parker 2004). The agency further reports that teachers in rural areas are at a greater risk of contracting the disease, as their income levels are relatively high.
Besides teachers, other students in a school can also perpetrate child sexual abuse. In 2001, about 43 percent of CSA offenders in Durban were children below the age of 18 (Kistner, Fox & Parker 2004). In schools, children are vulnerable to rape and sexual assault by classmates. Teenage dating can also lead to sexual abuse, especially when one of the partners is not ready for sexual intercourse. Often, boys harass girls sexually in hostels, hallways, or classrooms.
The absence of elaborate systems to monitor harassment cases result in underreporting of assault cases. CSA perpetrators can also be community members. Neighbours, by virtue of being close to the child, can perpetrate the offense. Domestic workers can also abuse young children under their care.
The Role of Non-Governmental Organisations in Preventing CSA in South Africa
As already indicated, CSA in South Africa is influenced by poverty and family dislocation. HIV/AIDS is one of the effects of child abuse. Therefore, to prevent CSA, interventions must focus on reducing stigmatisation, providing psychosocial support for child victims, and promoting public awareness to promote reporting.
In South Africa, CSA interventions have focused on informing children on how to protect themselves from abuse. Teachers and parents have also been taught on how to detect sexual abuse and provide counselling services to victims (Kistner, Fox & Parker 2004).
In general, the programmes educate children about inappropriate touching, individual rights, assertiveness skills, the importance of disclosing sexual abuse cases, self-defense strategies, and available support systems. Public awareness programmes also help identify CSA as a societal problem that needs concerted efforts to eliminate it. Kistner, Fox, and Parker (2004) suggest that public awareness programmes regarding CSA should focus on HIV transmission, child rape, and sexual assault.
In South Africa, CSA prevention involves multi-agency cooperation. Non-governmental organisations such as RAPCAN, CRC, and CEDAW provide parents and children with a variety of avenues for reporting. Moreover, various legislations have been enacted to protect children from abuse.
Legislations such as the National Health Bill, the Guardianship Act, the Educational Law Amendment, the Children’s Bill, and the South African Schools law, among others, protect minors aged 18 years and below against the CSA and assault. The Children’s Bill provides for child support grants for minors under the age of 18.
In South Africa, NGOs help victims of sexual abuse obtain medical care and report the matter to the police. They offer a supportive environment that encourages victims to give statements regarding the abuse in order to lodge a legal complaint. Counselling services are also offered to rape victims who are then taken to hospital centres for HIV and STI testing. Victims are advised to visit a medical centre for PEP treatment to reduce the risk of HIV infection.
However, in rural areas, such medical services are largely lacking, resulting in delayed reporting that places the victims of rape at a greater risk of contracting STIs. In South Africa, most rape incidents, which happen at night, go unreported because there no vehicles to transport a victim to a health facility or a police station for forensic examination.
In sum, community-based NGOs facilitate rape reporting, medical treatment of victims, and therapy. They have put up rape centres where victims can report abuse cases and get medical and legal assistance. Examples of such organisations are GRIP and Masisukumeni (Kistner, Fox & Parker 2004).
Some NGOs and hospitals perform medical examinations on rape victims. Usually, a parental consent is sought before medical examination and treatment. In particular, the parent or guardian must permit the medical staff to do HIV testing, share the information with the police, test for pregnancy, and refer the child to specialised care. The initial examination involves checking for any signs of physical injury on the genitalia.
Subsequent tests involve screening for HIV and other STIs. Counselling is also offered to victims throughout the medical examination process. In some organisations such as Natalspruit Hospital, anaesthetics are given to child victims before conducting the medical examination. On its part, GRIP gives play toys to victims undergoing therapy for sexual abuse.
Organisations also give HIV counselling and testing services to rape victims. They undergo counselling before and after the HIV test. The pre-test counselling is meant to inform victims on the testing procedures, whereas the post-test one helps victims to handle the outcomes. For child victims, no clear guidelines or medical protocols exist. Most organisations require victims aged 14 years and above to give consent before receiving HIV counselling and testing.
In some organisations, post-test counselling in a case where the child victim is HIV positive is conducted three days after the initial test. The child can also undergo confirmatory tests to ascertain his or her status. PEP medication is administered to rape victims who test negative.
In many organisations, PEP is offered for a period of seven days before an HIV test is done on a rape victim. Some organisations offer follow-up counselling services to victims in their homes. However, due to limitation of resources, follow-up services are lacking in many rural areas. GRIP uses social workers who visit child victims in their homes for follow-up counselling.
NGOs also run campaigns to encourage the use of post-exposure (PEP) by rape victims to prevent HIV transmission. Child victims often receive a combination of AZT and 3TC medications in syrup form for an extended period of 28 days. It is recommended that rape victims get PEP early to prevent HIV transmission. However, these medications have some side effects on children, which include “anaemia, tiredness, nausea, and joint pains” (Kistner, Fox & Parker 2004, p. 55).
In this regard, a child should be under constant medical evaluation to monitor his/her response to these drugs. Follow-ups ensure that child victims adhere to the medication. Most organisations lack the capacity to follow-up on medication adherence by users because most homes are located far from the medical centres. Natalspruit organises return visits by its counsellors to the victim’s homes at regular intervals during treatment.
NGOs have also been involved in lobbying for enhanced availability of PEP medication to rape victims in rural South Africa as a way of reducing HIV infection rates. For instance, 25 organisations undertook a ‘PEP Talk’ in 2003, which lasted for two weeks, to campaign against sexual violence and PEP availability in local medical centres.
Organisations also assist victims through the court process. GRIP reports that sexual abuse case can take up to two years before it can appear in court during which the offender may be out on bond and thus, a threat to the victim’s security (Kistner, Fox & Parker 2004). Masisukumeni reports that the court process in South Africa is very complicated for most children, which explains why many rape victims do not seek legal redress.
Often, the evidence given does not meet the threshold for a prosecution leading to the release of the perpetrator. GRIP helps children and parents through the court process through training. The training of the child involves the use of illustrations to represent the judge, the offender, and the victim. The aim is to familiarise him or her with the court process (Kistner, Fox & Parker 2004). The organisation also provides free transportation and food to child victims throughout the entire court process.
Other organisations use ‘friends of the court’ to help the child during the legal proceedings. Nevertheless, the conviction rate is often low due to legal technicalities and inadequate evidence. ‘Child-friendly’ courts have been put up in rural South Africa. The courts offer “assistance and counselling services” to victims of abuse.
In this court model, the child is monitored during the legal proceedings. An intermediary guides the child when testifying in court. The intermediary also responds to questions raised in court. Many NGOs help children prepare and present their testimony in court. They are advised to present it objectively without emotions.
Implications for Practice
The prevention of CSA and HIV transmission requires a multi-pronged strategy. Social workers should address this problem from multiple perspectives, including economic inequality, educational opportunities, family dislocation, and child welfare services, among others. In South Africa, rising unemployment coupled with high cases of HIV/AIDS transmission and diminishing familial resources have exacerbated child sexual abuse.
There is a need for urgent attention to address the CSA risk factors. In particular, social care services should focus on promoting public awareness (through education), economic support, and prevention of CSA for vulnerable groups as well as counselling for rape victims. Social workers should also provide “home-based and palliative care” services to children vulnerable to sexual abuse (Kistner, Fox & Parker 2004, p. 51).
Social services should also be directed towards protecting the children’s rights to familial inheritance. The death of a parent due to HIV/AIDS leaves children vulnerable and economically poor. Thus, measures should be taken to ensure that the dependants inherit the property of their parents.
In addition, when providing social services to children, professionals should address the stigmatisation associated with HIV/AIDS. Orphans are vulnerable to the social stigma that may affect their ability to report cases of sexual abuse. Social workers should also ensure that vulnerable children receive food, clothing, and shelter. Psychosocial support is considered “crucial for survival” of children whose parents have died from HIV/AIDS. Deterioration in a parent’s health has adverse emotional effects on children.
The feelings of “helplessness, anxiety, and fear” are common in such children (Kistner, Fox & Parker 2004). Moreover, others undergo depression due to the responsibility of caring for their younger siblings. These children need counselling to cope with the loss of their parents.
Other children develop aggressive behaviour, which is a symptom of depression. They need support and counselling to develop effective coping strategies. Health workers should also focus on trauma counselling, particularly before and after HIV testing for abused children. Not many health workers possess the requisite skills and training to carry out trauma counselling.
Health workers have the responsibility of “identifying vulnerable children” and marshalling various agencies to provide care and support (Kistner, Fox & Parker 2004). Often, CSA victims cannot receive care services without consent from the parent. However, since AIDS-related deaths have been on the rise, heath workers should provide services without demanding for parental consent.
Caregivers should also offer age-appropriate therapy, as adult counselling models cannot apply to children. Therapy for children should focus on trauma counselling to help them cope with their loss or abuse. Parents, especially mothers, by virtue of their closeness to the children, should be taught on how to look out for symptoms of PTSD in CSA victims.
In this way, they can monitor their progress following a therapy session. Moreover, a counsellor should seek to understand the child’s verbal and non-verbal communication in order to determine his/her response to therapy. Therapy sessions should involve the use of toys and illustrations to facilitate communication.
Parents should also be counselled in order to effectively support and care for a sexually abused child. Studies have established that familial support speeds up a child’s recovery from traumatic experiences associated with sexual abuse. The psychological reactions of the parents, including fear, guilt, feelings of inadequacy as a parent, and helplessness, can hamper the healing process. These feelings worsen the stress and trauma experienced by CSA victims. In this regard, counselling is essential for parents or guardians.
Self-evaluation in Relation to Personal Learning
As stated in the learning contract, one of my learning outcomes is to gain a deeper understanding of child sexual abuse and the role of NGOs in preventing it. The analysis provided in this paper gives important insights into the issue of CSA in the South African context.
It underscores the effects of sexual abuse and HIV/AIDs on children, how they can be mitigated, and the role of NGOs in preventing the vice. The role of education and training in preventing sexual abuse among vulnerable children is now clear to me. Caregivers can be taught on how to report rape incidents, seek legal redress, and offer support to child victims.
I have also learnt the importance of counselling to both the children and the caregivers. A parent’s psychological reactions towards sexual abuse can mitigate or exacerbate the effects of CSA on the child. With regard to HIV/AIDS transmission, teachers and parents should be made aware of its consequences on the society.
HIV-related deaths make children vulnerable to sexual abuse because of lack of social and economic support. In this regard, social workers, besides counselling the children to enable them to cope with their loss, should mobilise various agencies to support the child economically and socially. Some organisations offer free legal assistance to victims of CSA. A concerted effort involving the courts, the social workers and medical personnel, the government, and the community can help reduce CSA among vulnerable groups.
Based on statistics, it is evident that child sexual abuse is rampant in South Africa. Vulnerable children include those whose parents have died from HIV/AIDS who lack social and economic support. In most rural areas, the absence of child welfare programs and family dislocation predisposes children to sexual abuse. Despite being prevalent, reporting of CSA is low in South Africa due to reasons such as the inadequacy of the law enforcement to gather evidence that can lead to prosecution.
Therefore, it is important to address the issue of reporting and prosecution to deter adults from sexually abusing minors under their care. In addition, social care services empower children economically and socially to enable them to develop effective coping strategies to deal with the trauma associated with CSA.
Kistner, U. Fox, S. & Parker, W. 2004, Child Sexual Abuse and HIV/AIDS in South Africa: a Review. Web.