Attitudes towards help-seeking for sexual and gender-based violence in humanitarian settings: the case of Rwamwanja refugee settlement scheme in Uganda
Tóm tắt
Sexual and gender-based violence (SGBV) remains a silent epidemic in many humanitarian settings with many survivors concealing their experiences. Attitudes towards help-seeking for SGBV is an important determinant of SGBV service use. This paper examined the association between attitudes towards seeking care and knowledge and perceptions about SGBV among men and women in a humanitarian setting in Uganda. A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households (261 females and 340 males) in Rwamwanja Refugees Settlement Scheme, South West Uganda. Analysis entails cross-tabulation with chi-square test and estimation of a multivariate logistic regression model. Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV (OR = 2.78, 95% CI: 1.56–4.95); who felt that SBGV was not tolerated in the community (OR = 2.03, 95% CI: 1.03–4.00); those who had not experienced violence (OR = 2.08, 95% CI: 1.06–4.07); and those who were aware of the timing for post-exposure prophylaxis (OR = 3.08, 95% CI: 1.57–6.04). In contrast, results for men sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for PEP (OR = 2.57, 95% CI: 1.30–5.10). Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help (OR = 4.22, 95% CI: 1.47–12.06) than among those with unfavorable help-seeking attitudes. The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviors in humanitarian contexts.
Tài liệu tham khảo
WHO. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and nonpartner sexual violence. Geneva: WHO; 2013.
UNHCR. Sexual and gender-based violence against refugees, Returnees and internally displaced persons: Guidelines for prevention and response. Geneva: United Nations High Commissioner for Refugees; 2003.
Schopper D. Responding to the needs of survivors of sexual violence: do we know what works? Int Rev Red Cross. 2014;96(894):585–600.
Alcorn T. Responding to sexual violence in armed conflict. Lancet. 2014;383(9934):2034–7.
WHO. WHO ethical and safety recommendations for researching, Documenting and monitoring sexual violence in emergencies. Geneva: World Health Organization; 2007.
Reynolds MW, Peipert JF, Collins B. Epidemiologic issues of sexually transmitted diseases in sexual assault victims. Obstet Gynecol Surv. 2000;55(1):51.
Dunkle KL, et al. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.
Dalal K, Dawad S. Economic costs of domestic violence: a community study in South Africa. Health Med. 2011;5(1):1931–40.
Duvvury N, et al. Intimate partner violence: economic costs and implications for growth and development. Women's voice, agency, and participation research series no. 3. Washington, DC: World Bank; 2013.
Hossain M, et al. Men's and women's experiences of violence and traumatic events in rural Côte d'voire before, during and after a period of armed conflict. BMJ Open. 2014;4(2):e003644.
Vu A, et al. The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLoS Curr. 2014; 6 .p. ecurrents.dis.835f10778fd80ae031aac12d3b533ca7.
Wirtz AL, et al. Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia. Confl Heal. 2013;7(1):13.
Palermo T, Peterman A. Undercounting, overcounting and the longevity of flawed estimates: statistics on sexual violence in conflict. Bull World Health Organ. 2011;89(12):924–5.
Hien D, Ruglass L. Interpersonal partner violence and women in the United States: an overview of prevalence rates, psychiatric correlates and consequences and barriers to help seeking. Int J Law Psychiatry. 2009;32(1):48.
Gracia E, Herrero J. Public attitudes toward reporting partner violence against women and reporting behavior. J Marriage Fam. 2006;68(3):759–68.
Palermo T, Bleck J, Peterman A. Tip of the iceberg: reporting and gender-based violence in developing countries. Am J Epidemiol. 2013;179(5):602–12.
Stark L, Ager A. A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma Violence Abuse. 2011;12(3):127–34.
Tappis H, et al. Effectiveness of interventions, programs and strategies for gender-based violence prevention in refugee populations: an integrative review. PLoS Curr. 2016;8. https://doi.org/10.1371/currents.dis.3a465b66f9327676d61eb8120eaa5499.
McCleary-Sills J, et al. Help-seeking pathways and barriers for survivors of gender-based violence in Tanzania: results from a study in Dar es salaam, Mbeya, and Iringa regions. Engender Health/Champion: Dar es Salaam; 2013.
Naved RT, et al. Physical violence by husbands: magnitude, disclosure and help-seeking behavior of women in Bangladesh. Soc Sci Med. 2006;62(12):2917–29.
Morrison KE, et al. Factors influencing help-seeking from informal networks among African American victims of intimate partner violence. J Interpers Violence. 2006;21(11):1493–511.
Bruschi A, Paula CSD, Bordin IAS. Lifetime prevalence and help seeking behavior in physical marital violence. Rev Saude Publica. 2006;40(2):256–64.
Ansara DL, Hindin MJ. Formal and informal help-seeking associated with women's and men's experiences of intimate partner violence in Canada. Soc Sci Med. 2010;70(7):1011–8.
Rodriguez MA, Quiroga SS, Bauer HM. Breaking the silence: battered women's perspectives on medical care. Arch Fam Med. 1996;5(3):153.
Coker AL, et al. Social support protects against the negative effects of partner violence on mental health. J Women's Health Gender Based Med. 2002;11(5):465–76.
Parvin K, Sultana N, Naved RT. Disclosure and help seeking behavior of women exposed to physical spousal violence in Dhaka slums. BMC Public Health. 2016;16(1):383.
Vyas S, Mbwambo J. Physical partner violence, women’s economic status and help-seeking behaviour in Dar es salaam and Mbeya, Tanzania. Glob Health Action. 2017;10(1):1290426.
Aloud N, Rathur A. Factors affecting attitudes toward seeking and using formal mental health and psychological services among Arab Muslim populations. J Muslim Mental Health. 2009;4(2):79–103.
Bohner G, Dickel N. Attitudes and attitude change. Annu Rev Psychol. 2011;62:391–417.
Undie C, et al. Effectiveness of a community-based SGBV prevention model in emergency settings in Uganda: testing the ‘zero Tolerance Village alliance’ intervention. Nairobi: Population Council; 2016.
Undie C, et al. Screening for sexual and gender-based violence in emergency settings in Uganda: an assessment of feasibility. Nairobi: Population Council; 2016.
WHO. Putting women first: ethical and safety recommendations for research on domestic violence against women. Geneva: World Health Organization; 2001.
UNHCR. Rwamwanja Fact Sheet. Uganda: UNHCR; 2014.
Pulerwitz J, Barker G. Measuring attitudes toward gender norms among young men in Brazil: development and psychometric evaluation of the GEM scale. Men Masculinities. 2008;10(3):322–38.
García-Moreno C, Heise L. WHO multi-country study on Women's health and domestic violence against women: initial results on prevalence. Health Outcomes and Women's Responses. Geneva: World Health Organization; 2005.
UNHCR. Sexual and Gender-Based Violence against Refugees, Returnees and internally displaced persons; Guidelines for prevention and response. Geneva: United Nations High Commissioner for Human Rights; 2003.
Masuda A, Anderson PL, Edmonds J. Help-seeking attitudes, mental health stigma, and self-concealment among African American college students. Journal of Black Studies. 2012;43(7):773–86.
WHO and ILO. Post-exposure prophylaxis to prevent HIV infection: Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. Geneva: World Health Organization/International Labour Organization; 2007.
Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53.
Tsang J-A. Moral rationalization and the integration of situational factors and psychological processes in immoral behavior. Rev Gen Psychol. 2002;6(1):25.
Festinger L, Carlsmith JM. Cognitive consequences of forced compliance. J Abnorm Soc Psychol. 1959;58(2):203.
Mackenzie C, Gekoski W, Knox V. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health. 2006;10(6):574–82.
Wellstead P. Information behaviour of Australian men experiencing stressful life events: the role of social networks and confidants. Inf Res. 2011;16(2):16–2.
Rosenbaum A, Langhinrichsen-Rohling J. Meta-research on violence and victims: the impact of data collection methods on findings and participants. Violence Vict. 2006;21(4):404.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.
Mihorean K. Factors related to reporting spousal violence to police, Family violence in Canada: A statistical profile; 2006. p. 19–28.