Objectives To study prevalence at two time points and risk factors for experience of forced or coerced sex among school-going youth in 10 southern African countries.
Design Cross-sectional surveys, by facilitated self-administered questionnaire, of in-school youth in 2003 and 2007.
Setting Schools serving representative communities in eight countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe) in 2003 and with Tanzania and South Africa added in 2007.
Participants Students aged 11–16 years present in the school classes.
Main outcome measures Experience of forced or coerced sex, perpetration of forced sex.
Results In 2007, 19.6% (4432/25 840) of female students and 21.1% (4080/21 613) of male students aged 11–16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were 28.8% in females and 25.4% in males. Comparing the same schools in eight countries, in an analysis age standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males. In multilevel analysis using generalised linear mixed model, individual-level risk factors for forced sex among female students were age over 13 years and insufficient food in the household; school-level factors were a lower proportion of students knowing about child rights and higher proportions experiencing or perpetrating forced sex; and community-level factors were a higher proportion of adults in favour of transactional sex and a higher rate of intimate partner violence. Male risk factors were similar. Some 4.7% of female students and 11.7% of male students reported they had perpetrated forced sex. Experience of forced sex was strongly associated with perpetration and other risk factors for perpetration were similar to those for victimisation.
Conclusions Forced or coerced sex remained common among female and male youth in 2007. Experience of sexual abuse in childhood is recognised to increase the risk of HIV infection. The association the authors found between forced sex and school-level factors suggests preventive interventions in schools could help to tackle the HIV epidemic in southern Africa.
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To cite: Andersson N, Paredes-Solís S, Milne D, et al. Prevalence and risk factors for forced or coerced sex among school-going youth: national cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open 2012;2:e000754. doi:10.1136/bmjopen-2011-000754
Contributors NA designed the studies, provided oversight and training for fieldwork, conducted the analysis and wrote the present manuscript. SPS, DM, KO, NM and DL conducted the fieldwork and contributed to the writing. AC provided training and field supervision for the 2007 study and assisted with writing of the current manuscript. NA and AC are guarantors.
Funding The Soul City commissioned surveys were funded by the European Union. The Tanzania survey was funded by the Global Health Research Initiative through the International Development Research Centre.
Competing interests None.
Ethics approval Health Research and Development Committee, Ministry of Health in Botswana; Research and Ethics Committee, Ministry of Health and Social Welfare in Lesotho; the National Health Sciences Research Committee, Ministry of Health in Malawi; the Comité Nacional de Bioética para a Saude, Ministerio da Saude in Mozambique; the Research Management Committee, Ministry of Health and Social Services in Namibia; the CIET Trust Research Ethics Committee in South Africa; the Scientific and Ethics Committee, Ministry of Health and Social Welfare in Swaziland; the Institutional Review Board, Ifakara Health Research and Development Centre in Tanzania; the Permanent Secretary, Ministry of Health, Zambia and the Medical Research Council of Zimbabwe. In each country, we also received written authority from the Ministry of Education to interview children in school.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this study are not in the public domain.
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