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Study protocol for a longitudinal study evaluating the impact of rape on women’s health and their use of health services in South Africa
  1. Naeemah Abrahams1,
  2. Soraya Seedat2,
  3. Carl Lombard3,
  4. Andre P Kengne4,
  5. Bronwyn Myers5,
  6. Alesha Sewnath1,
  7. Shibe Mhlongo1,
  8. Gita Ramjee6,
  9. Nasheeta Peer7,
  10. Claudia Garcia-Moreno8,
  11. Rachel Jewkes1
  1. 1 Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
  2. 2 Anxiety and Stress Disorder Unit, University of Stellenbosch, Cape Town, South Africa
  3. 3 Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
  4. 4 Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  5. 5 Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
  6. 6 HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
  7. 7 Non-Communicable Disease Research Unit, South African Medical Research Council, Durban, South Africa
  8. 8 Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
  1. Correspondence to Dr Naeemah Abrahams; nabraham{at}


Introduction South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care.

Methods and analysis This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied.

Ethics and dissemination The South African Medical Research Council’s Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.

  • rape
  • HIV
  • health impact

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors NA and RJ conceptualised the study and wrote the first draft of the proposal. CL, SS, APK, GR, BM, AS, SM, NP and CG-M contributed to the completion of the study protocol. NA wrote the first draft of this manuscript, and all authors contributed to and approved the final version to be published.

  • Funding This research and the publication thereof is the result of funding provided by the South African Medical Research Council (SAMRC) in terms of the SAMRC’s Flagships Awards Project SAMRC-RFA-IFSP-01-2013/ RAPE COHORT.

  • Competing interests None declared.

  • Ethics approval South African Medical Research Council Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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