Childhood sexual abuse and HIV positive status among South African women : the role of revictimization

Abstract

South Africa has a very high rate of HIV infection, particularly among women. This exploratory study investigated the role of revictimization in the relationship between childhood sexual abuse and adult HIV positive status among women being treated at district clinics in Cape Town The present study utilized both psychological and feminist theories to understand internal psychological dynamics and contextual factors that impact on revictimization leading to increased HIV risk. A qualitative feminist methodology with a collective case study design utilizing five in-depth interviews was conducted with HIV positive women who had experienced child sexual abuse. The central findings of the study revealed psychological patterns of negative stigmatization, self-blame, mistrust and isolation which may fuel a dependent need for connection with intimate partners, thereby increasing risk for revictimization. Revictimization was pervasively present in adulthood, with HIV infection being a consequence of ongoing sexual and/or physical assault in long-term intimate relationship. Participants reported not using condoms consistently. For these participants, an incapacity to insist on condom use by partners was understood in the context of ongoing sexual and physical violence and threats by their partners, rather than unassertiveness as has been commonly noted. In essence, it was noted in this study that participants who experienced child sexual abuse were disempowered due to both psychological processes and broader social inequities which made them particularly vulnerable to contracting HIV. However, the findings are provisional due to the methodology utilized. Recommendations for future research and HIV prevention and policy are offered.