Naeemah Abrahams

• Senior Researcher at South African Medical Research Council

Background: Posttraumatic stress disorder (PTSD) is a common sequela of rape. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a core regulator of the stress response, has been implicated in the aetiology and chronicity of PTSD. FK506 binding protein (FKBP5) is a co-chaperone and functional regulator of the glucocorticoid receptor and...

In South Africa, after two decades of national femicide surveillance, we know comparatively little about what places women who experience intimate partner violence (IPV) at risk of intimate partner femicide. Further we have not mapped the multi-generational health, social and economic impact of severe IPV on women subjected to it, and their childre...

Background Not much is known about the perpetrators of male homicide in South Africa, which has rates seven times the global average. Objective For the country’s first ever male homicide study we describe the epidemiology of perpetrators, their relationship with victims, and victim profiles of males killed by male versus female perpetrators. Meth...

Background Injuries, often preventable, prompted urgent action within the United Nations’ 2030 Agenda for Sustainable Development Goals (SDGs) to improve global health. South Africa (SA) has high rates of injury mortality, but accurate reporting of official national data is hindered by death misclassification. Objective Two nationally representati...

Not much is known about the perpetrators of male homicide in South Africa, which has rates seven times the global average. For the country’s first ever male homicide study we describe the epidemiology of perpetrators, their relationship with victims and victim profiles of men killed by male versus female perpetrators. We conducted a retrospective d...

Sexual femicide, an abhorrent crime, is not well described and reported. The aim of the study was to describe sexual and non-sexual femicide in South Africa and compare the 2009 with the 2017 study presenting sociodemographic characteristics of victims, perpetrators, crime and forensic findings. The same retrospective study design using proportiona...

Background In most countries, reliable national statistics on femicide, intimate partner femicide (IPF), and non-intimate partner femicide (NIPF) are not available. Surveys are required to collect robust data on this most extreme consequence of intimate partner violence (IPV). We analysed 3 national surveys to compare femicide, IPF, and NIPF from 1...

South Africa has an overall homicide rate six times the global average. Males are predominantly the victims and perpetrators, but little is known about the male victims. For the country’s first ever study on male homicide we compared 2017 male and female victim profiles for selected covariates, against global average and previous estimates for 2009...

A paucity of research has been conducted within South Africa on abused women’s experiences of motherhood, even though abused women tend to be at increased risk of negative physical and mental health difficulties, which can interfere with their ability to take care of themselves and their children. The aim of this qualitative study was to explore wo...

Background The association of traumatic experiences with problematic alcohol use has been described, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol use. Method We analysed cross-sectional data from a sample...

Objective Alcohol misuse is among modifiable risk factors of hypertension and cardiovascular diseases. Previous studies have described the associations of a range of traumatic experiences with problematic alcohol use, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association...

Background: Sexual violence is associated with poor cardiometabolic outcomes, yet the etiopathogenic pathways remain unclear. Adipokines may contribute to pathways in the development of cardiometabolic disease (CMD), including in vulnerable populations. Further investigation of adipokines among sexually traumatized individuals may inform cardiometa...

Objectives To examine the associations of childhood maltreatment (CM) with hypertension, and the mediating effects of hypertension risk factors on the associations in South African women, using baseline data of the Rape Impact Cohort Evaluation longitudinal study. Design Cross-sectional Setting and participants Self-reported data on CM exposure a...

Background: Rape is a common traumatic event which may result in the development of posttraumatic stress disorder (PTSD), yet few studies have investigated risk biomarkers in sexually traumatised individuals. Adiponectin is a novel cytokine within inflammatory and cardiometabolic pathways with evidence of involvement in PTSD. Objective: This prospe...

Background Accumulative evidence indicates a role for adiponectin, a polypeptide secreted by adipose tissue, in the pathophysiology of posttraumatic disorder (PTSD) via metabolic and inflammatory pathways. This study examined adiponectin as a potential predictive biomarker for PTSD among female rape survivors. Methods We evaluated the relationship...

Objective: South African women suffer from a dual burden of gender-based violence and hypertension. Studies suggest abuse exposures may increase the risk of hypertension by contributing to psychological stress, but this association has not been clearly described. This study described the associations of intimate partner violence (IPV), non-partner...

Introduction The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design. Methods In a sample of 639 rape-exposed women who were assesse...

This study describes associations of intimate partner violence (IPV), non-partner sexual violence (NPSV) and sexual harassment (SH) exposures with hypertension in South African women aged 18–40 years. Baseline data (n = 1742) from the Rape Impact Cohort Evaluation study, including a history of sexual, physical, emotional and economic IPV, NPSV and...

Rape is associated with a high risk for posttraumatic stress disorder (PTSD). DNA methylation changes may confer risk or protection for PTSD following rape by regulating the expression of genes implicated in pathways affected by PTSD. We aimed to: (1) identify epigenome-wide differences in methylation profiles between rape-exposed women with and wi...

Background In April 2020, the United Nations predicted that the COVID-19 pandemic will have a ‘calamitous’ impact on the lives of women. This was based on concerns about an upsurge in Intimate Partner Violence (IPV) arising from increased opportunities for relational conflict due to forced co-existence and therefore additional time spent with abusi...

Objective Childhood abuse (CA), which affected at least half of the children globally, has increasingly been shown to adversely impact physical health in adulthood. We investigated the associations of CA with hypertension in 18–40-year-old South African women in the Kwazulu-Natal Province of South Africa, using the baseline data of the Rape Impact...

Background At 109 per 100 000 population, South Africa’s injury mortality rate is approximately 1.6 times higher than the global rate of 66.2 per 100 000. Although homicide rates declined since the 1990’s, they remain high along with road traffic injury deaths. Two injury mortality surveys for 2009 and 2017 will be utilised to determine if there wa...

Background Little is known about women who have experienced a recent rape, and how they differ from women without this exposure. Identifying factors linked to rape is important for preventing rape and developing effective responses in countries like South Africa with high levels of sexual violence. Objective To describe the socio-demographic and h...

Objective: To determine the incidence of HIV acquisition in women post-rape compared with t a cohort of women who had not been raped. Design: A prospective cohort study. Methods: The Rape Impact Cohort Evaluation (RICE) study based in Durban, South Africa, enrolled women aged 16-40 years from post-rape care services, and a control group of wom...

Aim: To systematically assess the association between adult sexual abuse (ASA) and cardiovascular diseases (CVDs) of heart attack and stroke, and their risk factors of hypertension, diabetes, dyslipidaemia and obesity. Methods: Two authors conducted a PubMed, Scopus and Web of Science review of the literature published prior to 1 October 2019. R...

Experiencing adversities has been associated with the use of violence but this has not been explored with filicide offenders in South Africa. Individual, semi-structured interviews were conducted with 22 parents/stepparents/caregivers convicted of child homicide in South Africa, resulting in 49 in-depth interviews. Data were analyzed by means of gr...

Globally, South Africa has one of the highest rates of gender based violence (GBV). While little is known about the levels of GBV against women with disabilities in the country, less is known about the accessibility or inclusivity of post-violence support and services. The paper draws on data from interviews and focus group discussions with thirty...

Objective: To describe the prevalence of recent physical, sexual, and emotional violence against children 0 - 19 years of age in Latin America and the Caribbean (LAC) by age, sex, and perpetrator. Methods: A systematic review and analysis of published literature and large international datasets was conducted. Eligible sources from first record t...

Background Large numbers of young people die yearly due to homicide, but little is known about homicide during adolescence. Research primarily focuses on youth violence among young men and masks important gender-related factors inherent in the adolescent age group. Although young women are less likely to be victims of homicide, violence against wom...

Background Estimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18–49 years) living in Rust...

Objectives: Multiple, chronic and repeated trauma exposure in childhood is associated with adverse mental health outcomes in adulthood. In this paper we synthesise the literature on epigenetic modifications in childhood trauma (CT) and the mediating effects of differential epigenetic mechanisms on the association between CT and the later onset of...

Background Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women. Met...

Anonymised data set. (DTA)

Violence against women and violence against children are distinct research fields. Quantitative studies have demonstrated their intersection, but qualitative data provides an opportunity for a comprehensive understanding of this interface. Interviews with 22 parents/caregivers convicted of child homicide provided an opportunity to explore the conte...

This review describes research on the homicide of infants (aged 0-1 year), pertaining to victim and perpetrator characteristics. A search of eighteen databases, yielded fifty-three included articles, of which, thirty-nine were cases studies, two qualitative, and twelve quantitative. The diversity of study methods and shortage of robust, dedicated s...

Globally, women with disabilities experience heightened and unique forms of violence compared to men with disabilities and women without disabilities. Yet formalised guidelines for their inclusion in gender-based violence (GBV) research is lacking. This paper draws on ethical guidelines for researching violence against women, and studies on the eth...

Introduction: Alterations to the epigenome in response to psychological trauma have been reported as a mechanism mediating gene and environmental interaction. Differentially methylated genes involved in the biological pathways associated with the adverse phenotypic behavioural presentations in post-traumatic stress disorder (PTSD) have previously b...

Notions of womanhood inculcate naturalised ideologies of femininity, sexuality, motherhood and caregiving. The paper asks how disability stigma intersects with womanhood to characterise intimate partnerships in South Africa. In-depth interviews with 30 women with a range of disabilities were conducted in informal settlements in Cape Town. Findings...

Background: Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women. Met...

Child homicide is the most extreme form of violence against children. Within South Africa, children face the highest risk of homicide by parents/caregivers. It is suggested that prolonged exposure to adverse relationships with one’s own parents may be linked to committing child homicide as it may lead to psychological damage and disturb neurologica...

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes. Methods: A cross sectional study was conducted with 2042 women aged 15-49 ye...

Objective The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of childhood violence across these dimensions. We produced the first age-specific and sex-specific prev...

This chapter provides further context for understanding filicide through a focus on South Africa. The chapter draws on data collected for the national child homicide study and the pilot child death review project to explore this phenomenon in a developing country context. Through a combination of these data sources, the authors find that filicide i...

Sexual homicides of women and children are extreme forms of violence against women and children and are located within the broader context of gender inequality and social norms that condone sexual violence and gender based violence against women and children. The aim of this study is to describe the prevalence and characteristics of sexual homicide...

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 ou...

Objective This study aims to describe child homicide perpetrators and estimate their global and regional proportion to inform prevention strategies to reduce child homicide mortality worldwide. Design A systematic review of 9431 studies derived from 18 databases led to the inclusion of 126 studies after double screening. All included studies repor...

Developing interventions that address psychosocial wellbeing of people living with HIV is critical to ensure strong linkages to and retention in HIV care. This paper describes the development of Sondela, an HIV adjustment and coping intervention for heterosexual men and women living with HIV, and its relevance and feasibility in the South African c...

Evaluation discussion with intervention participants. (PDF)

Background: Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. Objectives: To examine the effectiveness of ps...

Historical and current patterns documenting intimate partner violence (IPV) consistently demonstrate higher prevalence in Southeast Asia, the Eastern Mediterranean, and African world regions (Devries et al. 2013) as well as among indigenous women around the world (see Chapter 10 this volume). Focusing specifically on intimate partner homicide, inte...

Child sexual abuse is endemic in South Africa, driven by high levels of gender-based violence and underscored by structural and social factors. This article aims to develop an understanding of the process of disclosure in a sample of female children and their caregivers. In-depth semistructured interviews were conducted with 31 female children aged...

Background: The low number of firearm assaults and overall assault-related deaths in Statistics South Africa's death notification reports is incongruous with other recently released data, including police crime statistics. Methods: We conducted a review of all gunshot injuries recorded in death notifications from 1997 to 2013, including all case...

South Africa has unprecedented levels of violence and many South African women are exposed to violence during their lifetime. This article explores how gender and disability intersect in women’s experiences of violence during their lifetime. Repeat in-depth qualitative interviews with 30 physically disabled women in Cape Town reveal that women with...

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Introduction: Intimate partner violence (IPV) is a common form of violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. Metho...

To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We...

Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and i...

Background HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women. Methods In this cross sectional study we interviewed 195...

Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence. We searched for articles publish...

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness of psychosocial group interventions for improving psychological health, psychosocial adjustment and QOL in adults living with HIV/AIDS.

Large numbers of children are affected by child sexual abuse in South Africa. This study aimed to assess psychological adjustment of children post sexual assault. In-depth, semistructured interviews were conducted with caretakers, and structured interviews using mental health assessment screening tools were given to children at three intervals over...

To describe age- and sex-specific rates of child homicide in South Africa. A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500-1499 or > 14...

Data from 81 countries was used to estimate global prevalence of intimate partner violence against women.

Homicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of missing information about the victim-offender relationship. The objective of the study was to estimate global and regional prevalence of intimate partner homicide. A systemati...

Death is the most extreme consequence of intimate partner violence. Female homicide studies with data on the perpetrator-victim relationship can provide insights. We compare the results of two South African national studies of female homicide with similar sampling done 10 y apart. We conducted a retrospective national survey using a weighted cluste...

Pregnancy offers an opportunity for midwives to recognise and respond to women experiencing intimate partner violence (IPV). However, most antenatal care interventions have been conducted in private specialist services in high-income countries and do not address the structural and cultural realities of developing country settings. We report on an e...

Background There is a lack of national data on child homicides in South Africa and child abuse is considered to be a major problem. Yet, there is a limited understanding of the relationship between child deaths and abuse. Aim To describe the incidence of both overall child homicide and fatal child abuse by age and gender. Methods A national retrosp...

Globally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women's and health workers' perspectives and experiences of sexuality and sexual violence in pregna...

Living with HIV is of daily concern for many South Africans and poses challenges including adapting to a chronic illness and continuing to achieve and meet social expectations. This study explored experiences of being HIV-positive and how people manage stigma in their daily social interactions. Using qualitative methods we did repeat interviewed wi...

The distribution of indicators off forensic pathology variables and forensic management of female homicide cases by suspect/perpetrator charged and suspect/perpetrator convicted (weighted data/unadjusted odds ratios). (DOCX)

Characteristics of the victim, suspect/perpetrator and case investigation by whether or not the suspect/perpetrator was charged and whether there was a conviction among those charged (weighted data/unadjusted odds ratios). (DOCX)

Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was t...

Flow Diagram (DOCX)

Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women. A key-word...

Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behav...

South Africa has one of the highest rates of both rape and HIV infections. Of great concern is the possibility of HIV transmission during the assault, but adherence to post-exposure prophylaxis (PEP) has been varied and low. We developed a telephonic psycho-social support, leaflet and adherence diary intervention for rape victims and tested its imp...

The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of...

Sexual violence and HIV are two serious public health problems in South Africa. Post exposure prophylaxis (PEP) to prevent HIV after rape was introduced into the South African public health services in 2002 but many questions on the completion of PEP medication remain. A qualitative study involving in-depth interviews was conducted with 29 women at...

Injury patterns and interpretation of injuries in homicidal deaths are important components of medicolegal autopsies. The objective of this article is to describe the incidence of female homicides and their related injury patterns with reference to autopsy practices in South Africa. A national retrospective mortuary-based study of homicides in wome...

Levels of alcohol use are high in South Africa and not much is known about women's use of alcohol when murdered. The aim of this article is to describe the patterns of blood alcohol concentration (BAC) at the time of death for female homicide victims and to explore the factors associated with having an elevated BAC. A subsample of a national, repre...