Histories of forced sex and health outcomes among Southern African lesbian and bisexual women: a cross-sectional study

Video forced to be a lesbian

Researchers have begun to document the prevalence and effects of forced sex among women in Southern Africa [1,2]. However, the specific experiences of lesbian and bisexual women remain unexplored. Given evidence of high rates of sexual violence in these countries [2,3] and human rights reports documenting the violence that targets lesbian and bisexual women specifically [4-7], experiences of forced sex among lesbian and bisexual women are likely to be prevalent. This study is the first to explore psychosocial and health outcomes of forced sex experiences of Southern African lesbian and bisexual women. Based on the same project, we reported earlier on HIV testing and self-reported HIV prevalence in this population [8].

The four countries included in this study (Botswana, Namibia, South Africa and Zimbabwe) belong to the African global burden of disease (GBD) region as defined by the World Health Organization (WHO). According to a report by WHO, 45.6 percent of women in this region have experienced intimate partner violence and/or non-partner sexual violence, compared to 35 percent world-wide [9]. The four countries included in this study vary in prevalence and incidence of rape and other experiences of sexual violence. Population-based samples suggest that Botswana has a lower incidence of rape than South Africa, Zimbabwe and Namibia. For example, one study found a five-year incidence in Zimbabwe of 2.2% compared to just 0.8% in Botswana [10]. Over a quarter of adult men (28%) in a South African representative sample reported perpetrating a rape of a woman [11]. These studies address women’s experiences of forced sex by men; forced sex experiences by women are understudied.

The negative outcomes of forced sex include psychosocial and physical problems. Alcohol abuse, drug use, mental distress, sexual health problems and poor overall health have been found to be associated with forced sex in various studies conducted in the United States [9,12-14]. Little is known about whether consequences of forced sex by women are different from forced sex by men; studies in the United States of intimate partner violence suggest outcomes are similar whether the couple is heterosexual or same-sex [15].

The legal status of same-sex practices and relationships in the countries included in this study varies, with South Africa held up as an example of favorable legal treatment due to the inclusion of protection based on sexual orientation in the country’s constitution [16-18] and Zimbabwe as a model of criminalization [19]. The criminalization of ‘unnatural acts’ in Botswana is often interpreted as to apply to homosexuality [20]. Namibia has some constitutional protections that have been interpreted to mean that sexual minorities should receive similar non-discriminatory treatment; however, this interpretation is not enshrined in law [21].

The variety in the legal situation is however not reflected in the social acceptance of homosexuality. Compared to Western countries, attitudes towards homosexuality in all four countries included in this study are extremely negative. For example, in a representative South African sample, 78% of respondents said that homosexual sex between two consenting adults was ‘always wrong’ [22]. Further, Southern African scholars and activists have documented instances of ‘corrective rape’, in which men force lesbian and bisexual women to have sex to ‘convert’ them into heterosexual women [4-6,22].

In this paper, we use the term forced sex instead of the more common terms ‘rape’ or ‘sexual violence’. We did so for several reasons. First, ‘rape’ has been understood as non-consensual sex in which penetration occurs [2]. Research in South Africa has suggested that discourses of ‘rape’ are often confined by communities to those acts that are committed by “strangers, particularly violent acts, or, gang rape” (p. 1232). Forced sex includes a wider variety of unwanted sexual experiences, including many female same-sex experiences, that do not involve penetration, but that are non-consensual and can have a lasting impact. Unlike ‘sexual violence’, which implies coercion through physical means, ‘forced sex’ can include sex that is unwanted but experienced because of psychological or other forms of non-physical coercion.

As a first exploration we were particularly interested in the diversity of forced sex experiences that lesbian and bisexual women suffer and in the similarities and differences in the consequences to women victims who experienced force sex by men and by women. In terms of potential outcomes we wanted to explore traditional outcomes associated with forced sex including STIs, problems with substance use, and mental distress. In addition, we were interested in exploring whether forced sex experiences might affect women’s sense of belonging. Sense of belonging is seen as a protective factor in people’s health [23,24]. For lesbian and bisexual women it could be that sense of belonging to a sexual minority community and to the community more generally are both of importance for their wellbeing [25,26]. Both could be negatively affected by forced sex experiences. In a context that is not supportive of sexual and gender minority women, the sense of not belonging to the community may be exacerbated by experiences of violence that are not addressed because women are seen to be deserving of these experiences.

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