Sexual violence is frequently used during war and is recognised as a major public health issue due to the associated long term adverse effects. It is particularly prevalent across the war-torn territories of Northern Africa, with girls and young women being the predominant targets. A new study from the Department of Psychiatry, lead by Professor Peter Jones, focused on the long-term outcomes of incidences of sexual violence on girls and women in Northern Uganda.
The project focused primarily on cases of sexual violence against young women who were held in captivity by the Lord’s Resistance Army (LRA: a rebel group in Northern Uganda). In the publication, the authors emphasise the importance of such research, stating that research on the long-term adverse effects of sexual violence in war are relatively sparse. The study used data from a the War-Affected YouthS (WAYS) survey, a longitudinal collaboration project between Gulu University in Northern Uganda and the University of Cambridge.
The study cohort was made up of 539 former child soldiers and abductees aged between 18 and 25 at the time of the start of the study. Due to the lower incidence of sexual abuse in males, only females were included in the study. Recruitment was carried out through sample lists from UNICEF. Individuals who were recruited for the study had a history of abduction and had lived in rebel captivity for a minimum of 6 months. The study looked at general functioning as an outcome measure, which the authors defined as the level of self-care maintained by individuals in areas such as hygiene, feeding, housing and living in harmony with other members of the community.
In addition to the general relationship between sexual violence and general function, the authors also examined the mediating role of both stigma and community relations on this relationship. Stigma refers to any labelling or negative stereotypes that may be applied to the individual whereas community relations is define as how other members of the community treat and perceive young women who have previously been abducted and victims of sexual violence. Accounts of sexual violence were assessed retrospectively, with the researchers asking participants about their experiences of sexual violence in the past 6 years. Stigma, community relations and general function were all assessed by taking recent accounts that focused on experiences occurring within 6 months prior of the interviews.
The researchers used semi structured face-to-face interviews with all individuals in the study as well as administering questionnaire measures. Several different screening questionnaires were used to assess individuals for their general functioning, their perception of stigma towards them and their relations with their community. The authors conducted a mediation analysis on their data. This is a statistical process that allows you to assess whether the relationship between two related measures can be explained by an overlapping association with an additional measure. In this case, the study looked at whether the relationship between history of exposure to sexual violence and reduced general function is explained indirectly by the effects of the stigma associated with sexual violence and differences in relationships with the community caused by sexual violence.
The study found, as had previously been reported in the literature, that women and girls who reported a history of sexual violence were more likely to report higher levels of stigma and worse relationships with their community. Additionally, variation in reports of both stigma and community relations were found to account for a large proportion of the association between sexual violence and general functioning. This suggests that past history of sexual violence might lead to negative changes in how the victim is perceived by the community, which in turn may lead to lower general functioning in the victims.
These findings will help shine light on possible intervention methods for war-affected victims of sexual violence. They suggest that one possible route of intervention could be achieved through targeting stigma and negative relationships within the community. However, the authors note that the relatively small strength of the correlations suggest that the therapeutic benefits for general functioning might be modest. Nonetheless, these findings provide an important platform from which further empirical assessments of interventions can be launched.
We spoke to principle investigator Professor Peter Jones who talked about the work done by the studies lead author, Kennedy Amone-P’Olak: “This report is from the remarkable War-Affected Youth Study undertaken by Kennedy Amone-P’Olak who worked in Cambridge after data collection. He was supported by the Wellcome Trust Thrive Programme to increase health research capacity in Africa. He’s now back in the University of Botswana.” Professor Jones further emphasised the potential widespread applications of the research: “[The study] shows that the long-term mental health damage and general disability following sexual violence towards girls involved in this inhuman business is, in large part, mediated by this ostracism and stigma acting in addition to the earlier trauma. The results are generalisable to many conflicts around the globe where children get embroiled as protagonists and victims.”
Written by Owen Parsons.