Prevalence and correlates of forced sex perpetration and victimization in Botswana and Swaziland

Objectives: We sought to identify correlates of forced sex perpetration among men and victimization among women in Botswana and Swaziland. Methods: We surveyed a 2-stage probability sample of 2074 adults from the 5 districts of Botswana with the highest HIV prevalence rates and all 4 regions of Swaziland. We used multivariable logistic regression to identify correlates of forced sex victimization and perpetration. Results: Lifetime prevalence rates of forced sex victimization of women were 10.3% in Botswana and 11.4% in Swaziland; among men, rates of perpetration were 3.9% in Botswana and 5.0% in Swaziland. Lifetime history of forced sex victimization was the strongest predictor of forced sex perpetration by men in Botswana (adjusted odds ratio [OR]=13.70; 95% confidence interval [CI]=4.55, 41.50) and Swaziland (adjusted OR=5.98; 95% CI=1.08, 33.10). Problem or heavy drinking was the strongest predictor of forced sex victimization among women in Botswana (adjusted OR=2.55; 95% CI=1.19, 5.49) and Swaziland (OR=14.70; 95% CI=4.53, 47.60). Conclusions: Sexual violence in Botswana and Swaziland is a major public health and human rights problem. Ending codified gender discrimination can contribute to fundamentally changing gender norms and may be an important lever for gender-based violence prevention in these countries.