The Lived Experienceof Male Intimate Partners of Rape Victims

in Cape Town, South Africa

19th Qualitative Health Research Conferenceat Halifax, Canada, 27-29 October 2013

Dr. E. van WijkWestern Cape College of Nursing, Cape Town, South Africa

Evalina.vanWijk@westerncape.gov.za

Introduction and Related Background

Aim and Research Question

Research Design

Data Analysis / Trustworthiness

Findings / Discussion

Implications of Findings

Recommendations

Outline

Introduction and Related Background

• Sexual violence in South Africa:

Major public health / social problem

• SA statistics inaccurate (under-reported)

Do not reflect extent of sexual assault on women

• Rape - traumatic event - disrupts BOTH partners lives

• The male intimate partner often expected to supportthe female partner

• Both the rape victim and her intimate partner displayed cognitive, behavioural and affective reactions post-rape

• Seldom is he assessed for psychological problems and difficulties he may experience resulting from the trauma

• Lack of adequate interventions / support programsfor male intimate partners of rape victims

• Affects Male Intimate Partners’ daily occupational / social functioning

(Remer 2007 & Smith 2005)

Introduction and Related Background

Aim and Research Question

Aims:

• To explore, analyse and interpret the lived experience of male intimate partners of female rape victims and the meaning of this experience in the six months post-rape

• To develop a conceptual framework

Research Question:

“What constitutes an intimate partner’s experience of living with a rape victim within the first six months post-rape?”

Research Design

• Longitudinal hermeneutic phenomenological study;Male intimate partners (MIP’s) interviewed over six months

• Focus on interpretation of language and meanings of individuals’ experiences

• Why six-month study period ?

• Study Location:

- Recruitment centre for comprehensive treatment / support of rape- & sexual assault victims

- Low socio-economic area of Cape Town

Study Population and Sampling

• Male intimate partners of female rape victims who received treatment at selected rape centre

• Participants sampled / recruited if:

- In intimate relationship with female rape victim beforeand immediately after rape event(as revealed by rape victim to the nursing staff)

- Older than 18 years

- Able to communicate - isiXhosa, English or Afrikaans

- Voluntarily contacted researcher within 14 days of learning of study - willingness to participate for six month period

Difficulties:

• Not all rape victims informed of study

• Others who had been informed of study:

- chose not to participate

- hesitant to inform partners

Nine intimate partners agreed to participate.

Study Population and Sampling

Gaining Access to Rape Victim via RCC

• After ethical approval obtained from UCT

• Medical and Nursing staff informed about nature / purposeof study

• If rape victim not too distressed, staff informed her of study

• If interested, met researcher - private room

• Study explained - information document given

• Potential participants had to contact researcher voluntarily within 14 days

After contacting researcher / expressing interest in study:

• Individual appointments set up to enroll potential participants

At this meeting, the following explained / obtained:

• Study’s aims

• Researcher’s role / responsibilities concerning ethical considerations in the process

• Specific focus:Anonymity, Confidentiality, Informed Consent

• How information gained would be processed

Recruitment Process

At this meeting the following explained / obtained:

• Permission sought - use of digital audio recorder

• Participants reminded of their:

- Right to not answer uncomfortable questions, and

- Option to withdraw from study without giving reasons

• Voluntary informed consent

Pilot study: February - July 2008

Recruitment Process

Ethical Considerations

• Ethical approval obtained from UCT Faculty of Health Sciences Human Research Ethics Committee and the RCC management

• Study conducted according to Declaration of Helsinki principles (World Medical Association October 2008)

- Anonymity / Confidentiality

- Preventing harm to participants

- Autonomy / beneficence / justice of medical research

• Referral to counsellors if needed

• Participants interviewed at mutually agreed-upon timeat safe venue - they preferred not in natural environment.

Data Collection Methods – Pilot / Main Study

• Data collected over 12 months:August 2008 - August 2009

• Four face-to-face, in-depth interviews conductedwith each participant over six months

• Your partner was raped on [date]Please tell me how you felt when you first heard about it[within 14 days]

• Since your partner was raped, how are you dealing with the experiences related to the incident of your partner’s rape?[End of first month]

• Since your partner was raped, how you are dealing with the experiences related to the incident of your partner’s rape? [After 3/12]

• It is now six months since your partner was raped.Last time you said… [depending on responses from previous interview session]

Today, I would like us to talk about how you are feeling now[End of six months: final reflective interview]

• Throughout study, regular telephonic contact kept with participants to maintain continued interest

Data Collection Methods – Pilot / Main Study

Data Analysis

• Data transcribed / analysed within 24 hours after interview because preliminary findings informed questions for subsequent sessions

• Methods of Colaizzi (1978) and within-case and across-case approach (Ayres, Kavanaugh and Knafl, 2003)

• Interpretive theory of Paul Ricœur (1976)

• Data interpretation involved reflecting on initial reading

• With interpretive lens to ensure comprehensive understanding of findings

Trustworthiness

• Prolonged engagement

• Member checking

• Reflective journal:

Reflexivity

Disclosure of personal feelings

Background

Perceptions

Pre-conceptions

Biases

Assumptions

Role in the study

Findings

Two major themes:

Being-in-the-world as a secondary victim of rape

and

Living in multiple worlds.

1.Being-in-the-world as a secondary victim of rape

• Participant forced to face reality of partner’s violation

• Propelled into a world never believed possible,as secondary victim of rape

• Rape of partner immediately turned own life upside down.

“When I returned home from work, I see the door was halfway closed… I saw the one guy is on top of my pregnant girlfriend while the other one was busy undressing… I can still remember my girlfriend looked so helpless while screaming at them to leave her alone… both the guys appeared drunk… when I see this, I felt so powerless… I couldn‘t move so shocked I was… I couldn‘t believe they did this to my girlfriend; it is so mean.”

Findings

Overwhelming frustration and powerlessness:

“I started shouting to get help, but nobody [starts crying] wanted to help me to look for her… I was feeling so helpless but start searching myself… when I found her, I could not believe what she told me; I was so frustrated and shocked; I couldn‘t believe it when she told me that she was raped while I was in the shop.”

Findings

Humiliation, horror and personal vulnerability:

“I felt very hurt because if you want to hurt a man, the only way is to sleep with his wife. So sleeping with my wife without my consent, raping her, it‘s very hard for one to accept in life, you see; so far, it has changed my life so much because right now I don‘t have that certainty to see — right now I don‘t have that manhood, that I am still a man, you see. I don‘t know how I can explain it, you see. It has changed me so much.”

Findings

A defining moment:

“The rape changed everything that we planned.We have been going out for seven years, and we have a nice relationship, and I am looking forward to make her my wife. So what those guys did, actually they put our relationship at risk.”

Findings

Violation of one’s intimate “property”:

• Talk about “my possession, my intimate property or my pride”

- they had paid ‘lobola’

• “The moment that man raped my wife, he took my pride which belongs to me… you see, in our culture, we pay lobola for our wives, so she is mine, and he cannot do that to me.”

Findings

Guilt and helplessness:

Participants felt they had neglected their roles as men:

“I feel so guilty and blame myself that she was raped here in Cape Town… If I did not put that much pressure on her, she would still be okay… you know; I feel so bad and sorry for her that I was not there to save her out of his claws.”

Findings

2. Being-in-the-world with others:

• Partners:

- Uncertainty about partner’s feelings on sexual intimacy

- Fear of HIV / AIDS

- A desire to continue sexual relations - condoms

“We‘re still using protection… because I know she is my partner, and she knew the same, we didn‘t use protection before, and although the blood results were negative, we rather want to be safe.”

Findings

Avoiding sexual intimacy:

“The people talk about the disease, especially HIV and AIDS... what now if my partner has been infected? You know, it‘s going to affect me for the rest of my life… it’s something that I have to think about… so the thought of HIV really affects my sex life… in fact, I have no sex life on the moment.”

Findings

Avoiding communication re sexual intimacy:

“You know, when you don‘t have a sexual appetite, penetration is always difficult… does she not think that I also have needs? Her attitude discourages me to ask her for sex… this is not a good sign for our marriage and future.”

Difficulties discussing feelings:

“We hardy communicate with each other and I really miss those precious moments of the past when we were being able to share our thoughts with each other… if we start talking to each other now it always ends up in a mess…then we will not talk to each other for days.”

Findings

Unsuccessful attempts to re-establish communication; Abandoned & divided:

“Me and my wife can‘t talk about the rape without arguing about it… because when I start talking to her about how the rape affected both our lives and marriage, the one moment, she start to cry, the other moment, she is so agitated and accuses me that I don‘t care about how she is feeling and that I don‘t know what she is going through.”

Findings

Being-in-the-World With Others

Little or no support:

Employer:

“It is only you and my boss I trust… My boss is now very supportive after I followed your advice to inform him that what had happened to me is the reason why I was not myself for the past weeks.”

Family:

“My family and her family don’t support me at all; they rather blame me for not looking after my girlfriend which is not good for me… Every time I think I am getting better, they accuse me for not looking after their daughter.”

Professionals:

• The negative responses reflect lack of counselling for secondary victims.

• Participants reported being ignored / neglected by police and health professionals.

“I felt very angry and left out. Everybody at the hospital cared about her and what had happened to her, but nobody asked me how I was feeling… Nobody told me anything, and yet I am her partner who must live with her.”

Being-in-the-World With Others

Discussion

• Rape - immediate crisis for both victims

• Participants felt violated too

• The trauma shattered their assumptions about themselves, their relationships and the world around them, which were unchallenged prior the crisis

• Rape - a crippling effect on their lives / relationships

1. Trauma awareness (secondary victimisation)

2. Crisis and disorientation

• Vulnerability • Violation of one‘s intimate property • Guilt • Anger • Blame • Fear for safety • Unhappiness about injustice • Strong desire to take law into their own hands • Need for rapist to be arrested

Phases

3. Outward adjustment

Difficulty coping with:• Own feelings• Partner’s responses • Child care / domestic chores

Attempts to cope with daily routines / circumstances• Emergency problem-solving mechanisms • Comforting partners vs containing own pain • Relief when able to talk about feelings• Displacement of feelings• Substance abuse • Denial

Phases

4. Coping difficulties - personal / relationship:

• Re-experiencing disclosure of partners‘ rape

• Reduced concentration / attention span

• Avoiding / withdrawing from situations / activitiesthat remind them of partners‘ rape

• Sleep disturbances

• Appetite changes

• Lack of energy

• Concerns of poor impulse control

• Self-isolation

Phases

5. Re-organising Life on Personal / Relationship

Search for integration / resolution

• Accepting / not accepting the rape of their partners

• Not ready for closure

• Expressing need for professional support

Phases

The findings have implications for:

• Policy makers

• Police / justice system

• Health care professionals

• Nursing education

Implications

1. Early interventions for intimate partners of female rape victims required to prevent on-going emotional trauma that partners endure after rape

2. Supportive interventions could prevent/ reduce effectsof chronic PTSD and silent suffering evident on personal / relationship / social levels.

Recommendations

Acknowledgements

• 19th Qualitative Health Research (QHR) Conference Organisers;

• African Population and Health Research Centre (APHRC)in partnership with the International Development Research Centre (IDRC);

• Cape Peninsula University of Technology, Cape Town,Republic of South-Africa;

• Department of Health, Western Cape Province,Republic of South Africa;

• Margaret McNamara Research Foundation;

• Prof. S. Duma & Prof. P. Myers (supervisors / co-authors from UCT, Republic of South Africa).

References

See hand-outs provided

Thank you